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Abstract
Objective To test the hypothesis that a strategy of prolonged arterial line (AL) and central venous line (CVL) use is associated with reduced neonatal invasive procedures and improved growth of the thalamus in extremely preterm neonates (<28 weeks' gestation).
Methods Two international cohorts of very preterm neonates (n = 143) with prolonged (≥14 days) or restricted (<14 days) use of AL/CVL were scanned serially with MRI. General linear models were used to determine the association between skin breaks and thalamic volumes, accounting for clinical confounders and site differences. Children were assessed at preschool age on standardized tests of motor and cognitive function. Outcome scores were assessed in relation to neonatal thalamic growth.
Results Prolonged AL/CVL use in neonates (n = 86) was associated with fewer skin breaks (median 34) during the hospital stay compared to restricted AL/CVL use (n = 57, median 91, 95% confidence interval [CI] 60.35–84.89). Neonates with prolonged AL/CVL use with fewer skin breaks had significantly larger thalamic volumes early in life compared to neonates with restricted line use (B = 121.8, p = 0.001, 95% CI 48.48–195.11). Neonatal thalamic growth predicted preschool-age cognitive (B = 0.001, 95% CI 0.0003–0.001, p = 0.002) and motor scores (B = 0.01, 95% CI 0.001–0.10, p = 0.02). Prolonged AL/CVL use was not associated with greater incidence of sepsis or multiple infections.
Conclusions Prolonged AL/CVL use in preterm neonates may provide an unprecedented opportunity to reduce invasive procedures in preterm neonates. Pain reduction in very preterm neonates is associated with optimal thalamic growth and neurodevelopment.
Glossary
- AL=
- arterial line;
- CI=
- confidence interval;
- CoNS=
- Coagulase-negative staphylococci;
- CVL=
- central venous line;
- FSIQ=
- full-scale IQ;
- GA=
- gestational age;
- IQR=
- interquartile range;
- MABC-2=
- Movement Assessment Battery for Children, second edition;
- NEC=
- necrotizing enterocolitis;
- NICU=
- neonatal intensive care unit;
- PICC=
- peripherally inserted central catheter;
- PMA=
- postmenstrual age;
- UAC=
- umbilical artery catheter;
- UVC=
- umbilical venous catheter;
- WMI=
- white matter injury;
- WPPSI-III=
- Wechsler Preschool and Primary Scale of Intelligence, third edition
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received February 14, 2020.
- Accepted in final form August 17, 2020.
- © 2020 American Academy of Neurology
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