Complications of Central Lines in Non-ICU Neonates

Asma Marzouk¹, rahma Thebti¹, Yosra Ben Ahmed², Leila Jallouli¹, Farida Friha¹, Ahlem Kefi¹

¹departement pediatrics Ben Arous Tunisia
²Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia

Introduction:
The use of central venous catheters (CVCs) is a routine but invasive practice in neonatal care, particularly in premature and low birth weight infants. Despite their clinical benefits, CVCs are associated with significant risks, especially in resource-limited settings.

Methods:
We conducted a retrospective descriptive study over a 3-year period (January 2022–January 2025) in the Pediatrics Department of Hospital Ben Arous, a level II center without neonatal intensive care facilities. The aim was to evaluate complications related to CVC use and identify associated risk factors.

Results:
A total of 61 neonates received a CVC. The mean gestational age was 32 weeks + 3 days, and the mean birth weight was 1835 grams. Umbilical catheterization alone was used in 78% of cases. No complications occurred in 34% of patients. The most frequent complication was healthcare-associated infection (39.7%), followed by catheter misplacement (28%) and catheter-related bloodstream infection (21%). Less frequent complications included fluid leakage (4%), accidental removal (2%), arrhythmia (4%), and thrombosis (1%). Among neonates with complications, 85% weighed under 2500 grams and 65% were born 32 weeks + 6 days of gestation. Prolonged catheter duration was significantly associated with nosocomial infection (p = 0.02).

Discussion:
The overall complication rate was 65.6%, exceeding the rates reported in the literature (around 30%). Infectious complications were particularly frequent (21.9% vs. 4% reported), likely reflecting the challenges of infection control in a level II unit without intensive care infrastructure. Identified risk factors such as low birth weight and prematurity were consistent with existing studies.

Conclusion:
In a level II neonatal unit without intensive care, central venous catheters are associated with a high risk of complications, particularly infections. These findings underscore the need for targeted preventive strategies and stricter adherence to infection control protocols to reduce CVC-related morbidity in such settings.

Keywords: central venous catheters , Complications , level II neonatal unit

Asma Marzouk¹, rahma Thebti¹, Yosra Ben Ahmed², Leila Jallouli¹, Farida Friha¹, Ahlem Kefi¹

¹departement pediatrics Ben Arous Tunisia
²Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia

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