Superiority of long peripheral catheters over short peripheral catheters for completing planned infusion therapy in late preterm and term neonates: a retrospective cohort study with competing-risk analysis.

内容摘要

Long peripheral catheters (LPCs) are increasingly used as alternatives to short peripheral catheters (SPCs) in neonatal intensive care units, but their effectiveness for short-term infusion therapy in late preterm and term neonates remains uncertain. This study compared the risk of failure between LPCs and SPCs while accounting for intentional device changes as competing events. We conducted a single-center retrospective cohort study between November 2019 and October 2020, including neonates with gestational age ≥34 weeks and birth weight ≥1,500 g who received either a LPC or a SPC as the first venous access device. The primary outcome was infusion failure, defined as premature discontinuation of the index device due to occlusion or extravasation requiring reinsertion or unplanned removal before completion of therapy. Intentional change to another catheter for therapeutic reasons was treated as a competing event. Subdistribution hazard ratios were estimated using Fine-Gray competing-risks regression, and incidence rate ratios per 1,000 device-days were calculated using Poisson regression; cause-specific Cox models were used as complementary analyses. Of 197 eligible neonates, 66 received LPCs and 131 received SPCs. Median gestational age (37 weeks in both groups) and birth weight (2,750 g vs 2,760 g) were similar. Median dwell time was 3 days in both groups. Excluding intentional changes, failure occurred in 12/58 LPCs (21%) and 48/108 SPCs (44%). The incidence of failure was 62 versus 146 events per 1,000 device-days in the LPC and SPC groups. In the Fine-Gray model, LPC use was associated with a lower subdistribution hazard of failure than SPC use (subdistribution hazard ratios: 0.46, 95% confidence interval: 0.23-0.89). Cause-specific Cox models showed a similar association (adjusted hazard ratio: 0.42, 95% confidence interval: 0.22-0.83). In late preterm and term neonates requiring short-term peripheral infusion therapy, LPCs were associated with a significantly lower risk of failure and lower failure incidence per device-day than SPCs, even when intentional device changes were considered as competing events. LPCs as a more reliable option for completing short-term planned peripheral infusion therapy in selected neonatal populations, with the caveat that thrombotic complications were not assessed and warrant evaluation in future studies.