Hua CHEN, Lin PENG, Wei YUAN, Juan GUO, Menghua CHEN, Rongtian LIU, Yingying ZHAO
The Journal of Pediatric Research - 2026;13(2):100-106
Aim: Central venous access in preterm neonates is commonly established with umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs). However, landmark-based methods often result in malpositioning and complications. This study aimed to evaluate whether point-of-care ultrasound (POCUS) guidance improves initial tip placement accuracy and reduces subsequent clinical outcomes. Materials and Methods: This retrospective study included preterm neonates (<37 weeks) who underwent UVC or PICC insertion between March 2023 and April 2024. The neonates were grouped by guidance modality: POCUS vs. non-POCUS (conventional landmark and length-based estimation). The primary outcome was optimal tip placement immediately after insertion [UVC: inferior vena cava (IVC)- right atrium (RA) junction; PICC: superior or IVC near the RA], verified by ultrasound or radiography. Secondary outcomes included complications occurring >=24 hours after insertion, including malposition, infection, thrombosis, and gastrointestinal complications). Continuous and categorical variables were compared using t-tests or Mann-Whitney U tests and chi-square tests, respectively. Two-sided p<0.05 was considered statistically significant. Results: Among 101 neonates (UVC n=55; PICC n=46), the overall optimal tip placement occurred in 64 cases (63.4%). Placement success was significantly higher with POCUS than with non-POCUS guidance: 29/33 (87.9%) vs. 35/68 (51.5%). UVC placement success was 84.2% in the POCUS group versus 47.2% in the non-POCUS group [odds ratio (OR): 5.96; 95% confidence interval (CI): 1.49-23.91]. PICC placement success was 92.9% versus 56.3%, respectively (OR: 10.11; 95% CI: 1.16-88.01). Total complication rates were significantly lower with POCUS for both UVC (OR: 0.24; 95% CI: 0.07-0.88) and PICC (OR: 0.13; 95% CI: 0.02-0.70), driven by low occurrences in gastrointestinal complications and infections. Conclusion: In preterm neonates, POCUS guidance improves initial catheter tip positioning and it is associated with fewer complications. These findings support the integration of POCUS into routine neonatal vascular access workflows and warrant validation in prospective studies.
