title: Early removal versus expectant management of central venous catheters in neonates with bloodstream infection.
abstract: BACKGROUND
  Uncertainty exists regarding the management of central venous catheters (CVCs) in neonates with bloodstream infections. Early CVC removal may reduce the risk of persistent or complicated infection and its associated morbidity and mortality. However, since CVCs provide secure vascular access to deliver nutrition and medications, the possible harms of early removal versus expectant management need to be considered.
  
  
  OBJECTIVE
  To determine the effect of early removal versus expectant management of CVCs on morbidity and mortality in neonates with bloodstream infections..
  
  
  METHODS
  We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials ((CENTRAL), The Cochrane Library, 2011, Issue 1), MEDLINE (1966 to January 2011), EMBASE (1980 to January 2011), CINAHL (1982 to January 2011), conference proceedings, and previous reviews.
  
  
  METHODS
  Randomised and quasi-randomised controlled trials that compared early removal versus expectant management of CVCs in neonates with bloodstream infections.
  
  
  METHODS
  We used the standard methods of the Cochrane Neonatal Review Group.
  
  
  RESULTS
  We did not identify any eligible randomised controlled trials.
  
  
  CONCLUSIONS
  There are no trial data to guide practice regarding early removal versus expectant management of CVCs in neonates with bloodstream infections. While observational data generally indicate that early removal is associated with a lower incidence of persistent or complicated infection, caution should be exercised in applying these findings to practice because of inherent biases in the study design. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical scenario.
authors.affiliation: University of Leeds, Leeds, UK, LS2 9JT.
authors.forename: Chakrapani
authors.initials: C
authors.lastname: Vasudevan
authors.forename: William
authors.initials: W
authors.lastname: McGuire
mesh_terms: D016470:Bacteremia; D055499:Catheter-Related Infections / Q000097:blood* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D013997:Time Factors; D057832:Watchful Waiting