الفهرس 
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Abstract
Venous access is essential in the management of preterm infants especially for providing parenteral nutrition and medications and thus, secure venous access is crucial in their management. Very preterm neonates who receive nutrition via a central catheter have been reported to have significantly higher weight gain, shorter hospital stay, and lower rates of infection compared with infants with multiple peripheral points of venous access.
Umbilical venous catheters (UVCs) are frequently the first choice for vascular access in very low birth weight infants because they provide easy and fast access. However, use of UVCs is associated with an increased rate of late onset sepsis (LOS) after a median period of 5 days, and an alternative access point is usually needed after UVC removal. In addition, UVCs are associated with short and longer term complications including misplacement, extravasation, and thrombosis.
The most commonly used alternative mode of venous access is peripherally inserted central catheters (PICCs). These catheters provide prolonged central venous access, are considered cost effective, and have a longer indwelling time before the risk of LOS increases.
The risk of LOS associated with PICCs has been reported to increase after an indwelling time of 35 days, compared with 7 days with UVCs. The majority of neonatal units use UVCs for primary access followed by placement of PICCs after 5 to 7 days in infants who need ongoing central access. However, on the basis of LOS data and complications associated with UVC, some neonatal units have opted to use PICCs for primary access and do not use UVCs if possible. It is unclear which strategy is better in the management of very preterm infants.
Care procedures for the neonate in intensive care units require the use of advanced technology; the central venous catheter (CVC) is one of the most common among the invasive procedures used in these patients. Depending on the material and caliber, it can be inserted at the bedside, such as the peripherally inserted central catheter (PICC), and remain for a prolonged period to allow the administration of solutions and medications, sample collection for examinations, blood product transfusion, and monitoring of hemodynamics. Among the complications related to its use, infections show the highest frequency and the most potential for morbidity and mortality.
Newborns, especially preterm, are at increased risk of infection and are considered immunocompromised due to their immune system immaturity. their immune response is characterized by a decrease in neutrophil–endothelial adhesion, low levels of complement factors, and immaturity regarding the different subpopulations of lymphocytes and mononuclear phagocytic system cells.
The use of invasive devices implies the impairment of the natural physical barrier consisting of the skin, which allows bloodstream invasion by opportunistic microorganisms. When bacteremia progresses into severe sepsis, it can lead to hemodynamic changes and even death.
The risk factors for early sepsis, defined as those that occur within the first 48 h of life, are related to the underlying disease and to the quality of the care provided. Regarding late sepsis, which occurs after the first 48 h of life, it is related to the indirect contact with the contaminated hospital environment, with low birth weight, the use of invasive devices such as CVC and mechanical ventilation (MV), delayed start of enteral nutrition, prolonged use of parenteral nutrition, and complications of prematurity, such as patent ductus arteriosus and necrotizing enterocolitis, which may require surgical intervention.
The aim of the present study was to evaluate the risk factors for central venous line complications versus umbilical venous catheter in preterm neonates admitted to El Warak Central Hospital in neonatal intensive care unit and its outcome.
This Prospective observational study had been carried out in NICUs at EL Warak central hospital between December2018 and December 2019, The study was carried out on 100 newborns ( preterm) that were admitted to NICU by different cause and have central inserted vascular catheter (Umbilical venous catheter and central veous cathter).
The main results of the study revealed that:
No significant difference found between the two groups regarding GA, sex and delivery.
The predominant diagnosis was RDS among both groups followed by CHD then sepsis among UVC group, while in CVC group sepsis comes in the second place followed by HIE and CHD.
The CVC group has significant higher values regarding heart rate, respiratory rate, and temperature compared to UVC group.
No significant diffrence found between the two groups regarding CNS manifestation. However, CNS manifestations were more frequent in CVC group compared to UVC group; poor reflexes were the predominant in both groups. Regarding genitalia, only one patient in CVC group suffered from inguinal hernia.
That CRP and PTT were significantly higher in CVC group compared to UVC. However, TLC, platelets count and HCT values were lower while INR was higher in CVC group compared to UVC group without statistical significance difference.
Moderate was the most frequent condition among the two groups, meanwhile, bad condition was more frequent in CVC group. However, there is no significant difference between the groups regarding general condition.
Based on our results we recommend for larger prospective studies across multiple centers are needed to clarify the relationship between these possible risk factors and PICC complications.