Publication: Low vs high position umbilical artery catheter of clinical outcomes among neonates: A systematic review and meta-analyses
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Date
2022
Authors
Shokor, Damia Md
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Abstract
OBJECTIVE: To determine whether the position of the tip of an umbilical arterial catheter (UAC) influences the frequency of clinical vascular compromise, aortic thrombosis, intraventricular hemorrhage, necrotising enterocolitis, hypertension, hematuria and mortality rate in neonates requiring UACs. DESIGN: Systematic review with meta-analyses of randomized controlled trials (RCTs) and quasi-RCT. DATA SOURCES: Cochrane central register of controlled trials (CENTRAL), PubMed and ProQuest from inception to 1st July 2022. Reference lists of identified trials and systematic review were assessed. TRIAL SELECTION: Published and unpublished randomised clinical trials that evaluated the comparison of clinical outcomes in neonates with placement of UACs at low or high position, published in English language; irrespective of blinding procedure, publication status, publication year, or sample size. Seven trials included in this systematic review and meta-analysis including one trial which only published as thesis publication. DATA EXTRACTION: One author independently screened titles and abstracts of trials identified, and relevant trials were evaluated in full text for eligibility. One reviewer then independently extracted data on methods, interventions, outcomes, and risk of bias from included trials. These data were cross-checked by two different authors. Random effects models were used to estimate odd ratios and mean differences with 95% confidence intervals. RESULTS: Seven trials totalling 1809 neonates were included. There were increased in the events of clinical vascular compromise (OR 2.77, 95% CI 1.85 to 4.15) and aortic thrombosis (OR 4.67, 95% CI 1.3 to 16.7) in low UACs position compared to high UACs position. No increased risk of incidence of the other clinical outcomes including mortality rate. However, the quality assessment of the trials is of low and moderate quality according to GRADE quality assessment. CONCLUSION: Low UACs position resulted in slightly higher risk incidence of clinical vascular compromise and aortic thrombosis but not associated with increased incidence of other UAC-related clinical outcomes including mortality rate. Low UACs position is still generally safe and acceptable practice based on latest RCT. However, more safety data would be needed for full assessment before deciding on the appropriate placement of UACs
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