Comparing Malposition and Complications Associated with Ultrasound-Guided versus Radiography-Guided Central Catheter Tip-Position in Neonates: A Systematic Review and Meta-Analysis.

Introduction: There is a growing interest in ultrasound-guided central catheter (CC) tip-position, driven by its potential to improve accuracy and reduce complications. We aimed to systematically review and meta-analyze studies that reported complications associated with ultrasound-guided versus radiography-guided CC tip-position in neonates.

Methods: We searched Medline, Cochrane, Embase, CINAHL, and clinicaltrials.gov for randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing the complications of ultrasound- versus X-ray-guided CC tip-position in neonates up to June 2024. RCTs and NRSs were analyzed separately. The outcomes included malposition, number of X-rays, procedure time, catheter manipulation, cardiac tamponade, extravasation, occlusion, and sepsis rates. Subgroup meta-analysis based on catheter type was performed. Statistical analyses were conducted using Review Manager 5.4.1 and R 4.1.0, and the GRADE methodology was applied to assess evidence certainty.

Results: Eight studies (4 RCTs and 4 NRSs, N = 1,322 neonates) were included. Ultrasound-guided catheter tip-position significantly reduced malposition rates (3 RCTs, N = 181, RR: 0.51, 95% CI: 0.37 to 0.70; 4 NRSs, N = 1,110, RR: 0.25, 95% CI: 0.11 to 0.57) and decreased the need for X-rays (2 RCTs, N = 112, MD: -1.22, 95% CI: -2.32 to -0.11; 2 NRSs, N = 401, MD: -0.31, 95% CI: -0.47 to -0.15). No significant differences were found in procedure time, catheter manipulation, or sepsis rates. All evidence was of low certainty per grade.

Conclusions: The use of ultrasound-guided CC tip-position in neonates is associated with a reduction in malposition rates and radiation exposure (low certainty evidence). Further research is needed to confirm the benefits of ultrasound-guided CC tip-position in neonates.