Clinical Use and Complications of Percutaneous Central Venous Catheterization in Very Low Birth Weight Infants / 소아과

ABSTRACT

PURPOSE: The administration of total parenteral nutrition (TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization (PCVC) in very low birth weight infants. METHODS: A total of 56 very low birth weight infants below 1, 500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group (n=32) included the babies who had undergone PCVC and a control group (n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. RESULTS: There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2, 000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1, 000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1, 000 to 1, 500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2, 000 g. CONCLUSION: Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.