74: Umbilical Lines are an Independent Risk Factor for Adverse Outcomes in Very Preterm Babies

Abstract

Background: Placement of umbilical arterial and/or venous (UA or UV) lines is a common practice in the care of preterm babies in Canada. It is not, however, clear whether they improve neonatal outcomes Objectives: To explore the effect of umbilical lines on mortality and morbidities in very preterm babies Design/Methods: Data were abstracted from the Canadian Neonatal Network database for babies born at {\textless}29 weeks gestational age (GA) from January 2010 to December 2012 (excluding babies who were moribund on admission or with major congenital anomalies). Four groups were identified: Gp0 with no umbilical lines; Gp1 with umbilical venous (UV) lines only; Gp2 with umbilical artery (UA) lines only; and Gp3 with both UA and UV lines. Data fields included demographics, peripartum factors, major inpatient morbidities (nosocomial infection (NI), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), brain injury (BI) and retinopathy of prematurity (ROP)), and mortality. Univariable and multivariable regression analyses were performed to compare the four groups. Results: Of 4623 babies 820 (17.7{%}) were in Gp0, 1032 (22.3{%}) in Gp1, 120 (2.6{%}) in Gp2, and 2651 (57.3{%}) in Gp3. With increasing number of lines babies were smaller, had lower Apgar scores, were more likely to have high SNAPII scores, and were more likely to be born by Cesarean Section. Univariate analysis showed that babies with no umbilical lines (Gp0) had the lowest mortality and lowest rates of NI, NEC, BPD, BI, and ROP. Increasing from one to two lines also increased rates. After adjustment for risk factors (see table and footnote) babies with no lines had significantly lower rates of a composite outcome of death or major inpatient morbidity - there was no difference in mortality between groups. Similar results were obtained when the model was adjusted for SNAPII instead of Apgar score. Conclusions: Most very preterm babies in Canada get UA and/or UV lines (usually both). Umbilical lines are more likely to be inserted into smaller, sicker babies. However, after adjustment for risk factors and acuity, babies with no umbilical lines are more likely to survive without major morbidity. Adding a second umbilical line appears to increase risk further. Clinical strategies should take into account the inherent risks of UA and/ or UV lines. Alternative practices, such as early placement of peripherally inserted central catheters, require further evaluation. (Table presented) .