The impact of central venous catheter use on long-term growth and neurobehavioral outcome in preterm children born < 29 weeks of gestation.

Abstract

Background: Preterm infants often receive central venous catheters (CVCs) for parenteral nutrition during initial enteral feeding advancement. Whether the use of CVCs promotes growth and neurodevelopmental outcomes is currently unknown.

Methods: Using German Neonatal Network data, this retrospective population-based cohort study evaluated long-term outcomes in very low birth weight infants (VLBWI) born < 29 weeks of gestation. Multivariate regression analyses and propensity score matching were applied to assess associations between CVC use, somatic growth, and cognitive outcomes (Wechsler Preschool and Primary Scale III intelligence quotient (IQ), Strengths and Difficulties Questionnaire (SDQ)) at 5-7 years of age.

Results: In the follow-up cohort of 2072 infants, 74% had a history of neonatal CVC use. VLBWI with CVCs had a significantly lower mean gestational age (25.97 vs. 26.97 weeks, p < 0.001) and lower somatic parameters at birth (mean weight: 829 vs. 986 g, length: 33.7 vs. 35.7 cm, head circumference: 23.8 vs. 25.1 cm, all: p < 0.001) than those without CVCs. Before risk adjustment, mean weight, head circumference, and body mass index at preschool age were significantly lower in children with prior CVC use. These children additionally exhibited lower IQ and higher SDQ scores. Adjusting for potential confounders, linear regression analyses and propensity score matching indicated that CVC use itself was not associated with differences in weight, length, head circumference, or cognitive outcomes at preschool age. Notably, In infants with CVCs, full enteral feeding was achieved approximately 8 days later than in those without CVCs (21.5 vs. 13.2 d, p < 0.001). Prolonged attainment of full enteral feeding was associated with reduced preschool IQs (β: -0.069, CI: -0.116 to -0.022, p < 0.001).

Conclusion: In this study, CVC use was not associated with improved somatic growth or psychomotor outcomes at preschool age. Furthermore, our data suggest that earlier attainment of full enteral feeding is associated with more favorable long-term psychomotor outcomes. Within the limits of an association study, these findings support prioritizing strategies that facilitate early enteral feeding advancement in VLBWI, while avoiding routine CVC insertion whenever clinically appropriate.