Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants.

AIM: The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit. METHODS: The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs. RESULTS: The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications. CONCLUSION: This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.

Effect of persistent patent ductus arteriosus on mortality and morbidity in very low-birthweight infants.

AIM: Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgical closure of ductus arteriosus is not performed in very low-birthweight (VLBW) infants who have a persistent patent ductus in spite of having undergone treatment with ibuprofen. This study aimed at investigating the possible effect of persistent patent ductus in VLBW infants. METHODS: The study included 177 VLBW infants born at 25-31 weeks of gestation from January 2006 to May 2011. Mortality and major morbidities were compared between infants with a persistent patent ductus (n = 33) and those without it (n = 104). Statistical associations between potential neonatal risk factors and significant morbidities were identified using multivariate regression analyses. RESULTS: Rates of mortality and major morbidities, including the rate of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage grades I-II and III-IV, periventricular leucomalacia, late-onset infections and failure of hearing screening, were insignificantly higher in VLBW infants with a persistent patent ductus than in those without it. CONCLUSION: This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in VLBW infants born at ≥25 weeks' gestational age.