Early versus delayed removal of central venous catheters in neonates on parenteral nutrition - A systematic review and meta-analysis

Abstract

Parenteral nutrition (PN) improves the outcomes in sick and preterm neonates. The duration of PN administration poses a dilemma to clinicians as longer central venous catheter (CVC) use increases the risk of adverse outcomes, while early PN discontinuation may decelerate growth. We conducted a systematic review and meta-analysis comparing PN discontinuation and CVC removal at lower (100 ml/kg/day) versus higher (140 ml/kg/day) enteral feed volumes in neonates. We searched PubMed, Embase, Web of Science and Cochrane Library databases on 6th February 2025 for randomised controlled trials (RCTs). We followed Cochrane handbook recommendations, PRISMA reporting guidelines and GRADE recommendations. Of 522 articles identified on the database search, 13 were eligible for full-text screening. The meta-analysis included two multi-centric RCTs on very low birthweight neonates from high-income countries. The central-line associated bloodstream infection rates, mortality, major morbidities, and anthropometry at discharge did not differ between the two groups. The early CVC removal group had a higher incidence of late-onset sepsis (culture positive OR negative) [2 studies, 347 participants, RR: 1.37, 95 % CI: 1, 1.87, I² = 0, Moderate certainty] and required a longer duration to regain birthweight (2 studies, 315 participants, per protocol analysis, MD: 1.05 days, 95 % CI: 0.13, 1.98 days, I² = 13 %, Moderate certainty).

We conclude that discontinuing PN and removing CVC at lower enteral feed volumes increases the risk of late-onset sepsis. Although the time to regain birthweight was longer, no differences in anthropometry were noted at discharge. Further evidence is required from low- and middle-income countries.