Comparing Short-Term Effects of Umbilical Artery Catheter (UAC) Tip Position in Neonates: A Randomized Control Trial

Introduction: The latest Cochrane review supported high-position umbilical artery catheters (UAC) as it led to fewer complications and reduced the need for replacement or re-insertion of the catheters.  However, the studies included were dated more than three decades ago. Objectives: To determine the safety (short-term complications) of UAC in the newborn at two different positions. Methods: A randomized control trial was performed from March 2012 to August 2013, among the newborns requiring UAC insertion in Neonatal Intensive Care, at Hospital Universiti Sains Malaysia. Patients were randomly assigned to either high or low UAC positions using block randomization. Outcomes: The primary outcomes were the incidence of aortic thrombosis, intraventricular haemorrhage (IVH), necrotising enterocolitis, hypertension, haematuria and feeding intolerance.  The secondary outcome was to compare the incidence of short-term outcomes of UAC position to gestational age and birth weight.  Results: One hundred and seventy-eight patients were included (89 per study arm). The mean gestational age was 34 weeks with a mean birth weight of 2.31 kg. There were no significant differences between the two groups in terms of baseline data. The overall incidence of complications was 20 (23%) in the low position and 18 (20%) in the high position group UAC (p=0.76). The observed complications between the low and high position UAC group: IVH 6.7% vs. 9%, p=0.58; feeding intolerance 6.7% vs. 4%, p=0.51; hypertension 4% vs. 6%, p=0.51; peripheral ischemic 2% vs. 0%, p=0.25. Conclusion: This study showed that the rate of complications in the low UAC position was comparable with the high UAC position.