Umbilical Catheter Placement Research Articles

Real-time ultrasound to assess the umbilical catheter position in neonates: a randomized, controlled trial.

To compare real-time ultrasound (RT-US) use as an adjunct tool to verify umbilical catheter placement versus standard care without ultrasound. Neonates requiring umbilical venous catheter (UVC) and umbilical artery catheter (UAC) placement were randomized into the standard formula (No-US) and the RT-US groups. X-rays were used to confirm the catheter position. Fifty and forty-nine neonates were in the RT-US and No-US groups, respectively. RT- US showed a significantly higher rate of initial X-ray-confirmed proper catheter position than No-US (p < 0.001). The rates of proper positions of UVCs and UACs were significantly higher in the RT-US group than in the No-US group (both p < 0.001). Neonates in the RT-US group required fewer catheter adjustments and subsequent X-rays than those in the No-US group. RT-US enhances the accuracy of UVC and UAC placement, reduces catheter adjustments, and the number of X-rays required. TCTR20190622001.

Development and usability of a virtual reality umbilical venous catheter placement simulator.

Exposure to procedures varies in the neonatal intensive care unit (NICU). A method to teach procedures should be available without patient availability, expert oversight, or simulation laboratories. To fill this need, we developed a virtual reality (VR) simulation for umbilical vein catheter (UVC) placement and sought to establish its face and content validity and usability. Engineers, software developers, graphic designers, and neonatologists developed a VR UVC placement simulator following a participatory design approach. The software was deployed on the Meta Quest 2 head-mounted display (HMD). Neonatal nurse practitioners (NNPs) from a level 4 NICU used the simulator and completed an 11-item questionnaire to establish face and content validity. Participants also completed the validated simulation task load index and system usability scale to assess the usability of the simulator. Group 1 tested the VR simulation, which was optimized based on feedback, prior to Group 2's participation. A total of 14 NNPs with 2-37years of experience participated in testing. Participants scored the content and face validity of the simulator highly, with most giving scores ≥ 4/5. Usability was established with relatively high average system usability scores for both groups (Group 1: 67.14 ± 7.8, Group 2: 71 ± 14.1) and low SIM-TLX scores indicating manageable load while using the simulator. After optimization, Group 2 found the UVC simulator to be realistic and effective. Both groups felt the simulator was easy to use and did not cause physical or cognitive strain. All participants felt the UVC simulator provided a safe environment to make mistakes, and the majority would recommend this experience to trainees.

The practice of umbilical vessels catheterization in neonatal intensive care units: a survey

Background: Umbilical venous catheterization and umbilical arterial catheterization provides easy access for administering fluids, exchange transfusion, medications, parenteral nutrition, blood pressure monitoring and blood sampling in neonates. Objective was to know the common practices related to the placement and maintenance of umbilical catheters, along with the associated complications in the level 3 and 4 neonatal intensive care units in the USA. Methods: A questionnaire-based survey study was conducted among NICU practitioners across United States. Only one survey was sent to each NICU. Results: Among the survey respondents, 50.8% represented level 3 NICUs, while 49.2% represented level 4 NICUs. The maximum duration for both UVC and UAC use was commonly reported as up to 7 days. Birth weight was the predominant method (86.8%) used for calculating catheter length. X-rays were universally employed for position confirmation. Heparin was widely utilized through UVC (96.7%), with a concentration of 0.5 IU/ml (73.7%). In cases of malpositioned UVC, practitioners employed techniques such as inserting another catheter, utilizing twisting movements during insertion, adjusting the UVC to a low position, and replacing the malpositioned UVC with a peripheral intravenous line. Common complications associated with UVC included line occlusion, thrombosis, and infections, while poor extremity perfusion and thrombosis were reported with UAC. Most units allowed feeding even when patients had a UAC in place. Conclusions: Despite the presence of institutional policies in most NICUs, practitioners encountered several complications during the use of umbilical catheters.

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study.

Point-of-care ultrasound (POCUS) can guide umbilical vein catheter placement in real time and monitor catheter tip position, allowing avoidance of severe complications due to catheter malposition. This study aims to explore the effectiveness of POCUS in guiding venous catheter insertion and monitoring complications. Sixty-eight neonates with ultrasound-guided venous catheter insertion at the Neonatal Department of Dongguan Children's Hospital between December 2020 and February 2022 were included. POCUS was applied to monitor catheter tip location daily until catheter removal. A displacement range exceeding the intersection of the inferior vena cava and right atrium by ±0.5 cm was considered misalignment. Sixty-four neonates had a displaced catheter tip (94.1%, 64/68), with a median displacement distance of 0.4 cm (minimum -0.2 cm, maximum 1.2 cm). Ten neonates had a misalignment (14.7%, 10/68) caused by displacement. Displacement usually occurs within 2-4 days after placement, with displacement rates of 94.1% (64/68), 90.6% (58/64), and 98.3% (59/60) on days 2, 3, and 4, respectively, and could still occur on day 9 post-placement. In addition, misalignment mainly occurs on the second day after placement. During the monitoring process, 58 neonates had catheter tip displacement ≥2 times, resulting in 252 displacement and 22 misalignment incidents. Among them, the catheter tip migrated outward from the inferior vena cava seven times, all of which were removed in time. Ultrasound was used for positioning 486 times, and x-ray was indirectly avoided 486 times. The catheter tip is prone to displacement and misalignment after umbilical vein catheterization, which most commonly occurs on days 2-4. POCUS is recommended for daily monitoring of the tip location during umbilical vein catheterization until catheter removal.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g?

Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Magnetic Catheter Placement in Neonates: A Handheld Solution to Radiation Exposure and Operational Delays (Adv. Sensor Res. 1/2023)

Magnetic Tracking In article number 2200029, Jurgen Kosel and co-workers present a novel 5Dmagnetic tracking system for subcutaneous medical devices, providing the capability for precise device localization in an extremely compact and portable pocket-size format. The system is entirely benign, avoids X-rays, and can be used to immediately confirm the proper placement of umbilical catheters and endotracheal tubes in neonates.

Central Subclavian Catheterization in Newborns: Single-Center Experience

AbstractOur main aim of this article was to show that central venous catheter (CVC) can be an easy-to-use, less-complicated catheter application such as peripherally inserted central catheter and umbilical catheter placement in the neonatal intensive care unit. We here described our experience with subclavian vein catheterization. Neonates who had venous access through subclavian central catheterization were assessed retrospectively. Data such as gestational age, age at the time of catheter insertion, birth weight, and gender were collected. In addition, problems related to catheterization during hospitalization were documented. This study comprised 40 newborns, 22 male and 18 female, with a mean gestational week of 29.57 ± 3.80 weeks and a mean gestational weight of 2067.50 ± 545.97 g. Due to occlusion, catheters were switched in five cases twice and in three cases once, totaling 53 catheterizations on 40 newborns. None of our patients had pneumothorax or hemothorax. On the postoperative 8th and 21st days, the catheter was withdrawn due to catheter infection in two (5%) patients, and catheter cultures revealed coagulase negative Staphylococcus aureus in both cases. Even in preterm infants, subclavian central venous catheterization is a safe and straightforward technique of gaining venous access in expert hands in the neonatal intensive care unit.

The incidence of pericardial effusion requiring intervention in infants with a history of umbilical catheter placement: the US national database.

To assess the association of umbilical catheters (UC) placement with pericardial effusion (PCE) in newborn infants. We analyzed the National Inpatient Sample dataset. We compared prevalence of PCE in infants with UC versus those without in three subpopulations: infants with birth weight (BW) > 2500 g or GA > 34 weeks, preterm infants with BW < 1500 g, and term infants with congenital heart disease (CHD) using regression analysis methods while controlling for clinical and demographic variables. First analysis included a weighted sample of 22,751,313 infants with no hydrops fetalis. Of them, 1869 neonates (0.01%) had PCE. Pericardial effusion was found in 0.17% of infants with only UAC, 0.21% of infants with only UVC and 0.29% of infants with both catheters with an adjusted odds ratios (aOR) (1.5, CI:1.2-1.9), (2.3, CI:1.7-2.9), and (2.9, CI:2.4-3.6), p < 0.001, respectively. Similar findings were found in infants <1500 g and in those with CHD. Umbilical Catheter placement is associated with increased risk for pericardial effusion.

Radiological imaging on umbilical venous catheter’s placement in preterm infants in the neonatal intensive care unit

Umbilical vessel catheterization is a technique used for neonatal reanimation, in neonatal intensive care units.Imaging techniques provide a strong support for the performance of this practice. In this case, radiography is themost widely used instrumental investigation for the evaluation of umbilical venous catheter placement. By protocol,the image is acquired with an antero-posterior projection of the thoraco-abdominal district, with perpendicularradius to the median sagittal plane. The following descriptive study has been carried out on 20 newborn patientsof the Neonatal Intensive Care Unit of the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, bornbetween December 4th 2020 and March 31th 2021. This study describes the effectiveness of the “thoraco-abdominal”radiological technique for the assessment of neonatal umbilical catheter placement. The basic premise for patients’recruitment was the request for evaluation of umbilical venous catheter placement in preterm infants.

Radiological imaging on umbilical venous catheter’s placement in preterm infants in the neonatal intensive care unit

Umbilical vessel catheterization is a technique used for neonatal reanimation, in neonatal intensive care units. Imaging techniques provide a strong support for the performance of this practice. In this case, radiography is the most widely used instrumental investigation for the evaluation of umbilical venous catheter placement. By protocol, the image is acquired with an antero-posterior projection of the thoraco-abdominal district, with perpendicular radius to the median sagittal plane. The following descriptive study has been carried out on 20 newborn patients of the Neonatal Intensive Care Unit of the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, born between December 4th 2020 and March 31th 2021. This study describes the effectiveness of the “thoraco-abdominal” radiological technique for the assessment of neonatal umbilical catheter placement. The basic premise for patients’ recruitment was the request for evaluation of umbilical venous catheter placement in preterm infants.

Portal gas in neonates; is it always surgical? A case report.

BACKGROUNDHepatic portal venous gas in infants is frequently due to late presentation of necrotizing enterocolitis which is considered a relative indicator for surgical intervention.CASE SUMMARYA preterm baby underwent an umbilical catheter placement and discovered in abdominal radiograph to have air in the portal venous system due to malpositioning of the umbilical catheter.CONCLUSIONHepatic portal venous gas in infants without signs of necrotizing enterocolitis could result from malposition of umbilical venous catheter, and in that case, should be managed medically, with no need for surgical intervention.

What Are the Risk Factors for Methicillin-resistant Staphylococcus Aureus Infection Among Patients in a Neonatal Intensive Care Unit?

<h3>Background</h3> Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) often occur in neonatal intensive care units (NICUs). However, few studies investigating relevant risk factors and potential interventions have been conducted. The purpose of the current study was to identify risk factors for MRSA infection in NICU patients. <h3>Methods</h3> The current investigation was a prospective cohort study of newborns admitted to the NICU at a Japanese teaching hospital between 1 July 2002 and 31 December 2008. The following patient-related factors were investigated: birth-weight, gestational age, sex, Apgar score, number of fetuses, length until cord detachment, and eye mucous. The medical factors investigated included type of delivery, inborn/outborn, antimicrobial therapy, use of medical devices, Kangaroo mother care, patient-to-nurse ratio, and MRSA colonization pressure. Cox proportional hazards regression was used to analyze risks of MRSA infection, and hazards ratios (HRs) and confidence intervals (CIs) were calculated. The statistical significance level was set at α = 0.05. <h3>Results</h3> A total of 1608 cases were analyzed, and MRSA was isolated from 282 (17.5%) patients. Significant parameters identified in Cox proportional hazards analysis included caesarean section (HR 1.46, 95% CI 1.10–1.95), eye mucous (HR 1.53, 95% CI 1.15–2.05), administration of the mother's first milk via catheter (HR 1.57, 95% CI 1.03–2.41), umbilical catheter placement (HR 2.05, 95% CI 1.02–4.10), patient-to-nurse ratio (HR 0.12, 95% CI 0.05–0.26), and MRSA colonization pressure (HR 16.79, 95% CI 8.41–33.50). <h3>Conclusions</h3> This study identified the risk factors for MSRA infection and determined that identifying high-risk patients, shortening periods of catheterization, maximizing patient-to-nurse ratios, and reducing MRSA colonization pressure can help reduce MRSA transmission among NICU patients.

The danger awaiting premature babies: Portal vein thrombosis.

Aim:Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion.Material and Methods:Premature infants (≤32 gestational weeks) who were hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files.Results:Ninety-six patients whose complete data could be reached were enrolled in the study. The mean gestational age of the patients was found as 29±2 weeks and the mean birth weight was 1353±369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of the cases of portal vein thrombose were complete occlusion and eight were partial occlusion. All patients with complete occlusion and six patients with partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31±13.8 days. Thrombosis disappeared in 7–120 days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation.Conclusion:Portal vein thrombosis which has a significant place among the causes of portal hypertension in childhood, is mostly asymptomatic in the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications.

Point-of-care ultrasound use in umbilical line placement: a review

Point-of-care ultrasound (POCUS) has become a novel tool for assessing umbilical catheter tip location in the neonate. This review analyzes the current evidence on the efficacy and utility of POCUS for identifying umbilical catheter positioning. Medline, EMBASE, and Cochrane searches were performed until October 2018. Eight studies were identified comparing POCUS to x-ray in assessing umbilical catheter tip location in the last 10 years. POCUS was shown to be feasible and appears to be a superior imagining modality to x-rays in assessing umbilical line tip location. POCUS is more accurate in determining umbilical catheter positioning, allows for more rapid line umbilical catheter placement, and reduces the time to treatment as well as radiation exposure to the neonate when compared with x-ray. The available studies support further education in training neonatal providers to become proficient in POCUS for assessing umbilical lines.

Learning Curves for Training in Ultrasonography-Based Examination of Umbilical Catheter Placement: A Piglet Study

Background: The training required for accurate assessment of umbilical catheter placement by ultrasonography (US) is unknown. Objective: To describe the learning curve and provide an estimate of the accuracy of physicians’ US examinations (US skills) and self-confidence when examining umbilical catheter tip placement. Methods: Twenty-one physicians with minimal experience in US completed a 1.5-hour eLearning module. Ten piglets with catheters inserted in the umbilical vessels were used as training objects. Following eLearning each physician performed up to twelve 10-min US examinations of the piglets. Expert examinations were reference standards. Sensitivity and specificity of physicians’ skills in detecting catheter tip placement by US was used to describe the learning curve. Self-confidence was reported by Likert scale after each examination. Results: Physicians’ detection of a correctly placed and misplaced umbilical artery catheter tip increased by an odds ratio of 1.6 (95% CI: 1.1, 2.3) and 3.6 (95% CI: 1.7, 7.8) per examination performed. A sensitivity of 0.97 (95% CI: 0.80, 0.99) and specificity of 0.95 (95% CI: 0.84, 0.99) was reached after 6 examinations. For the venous catheter, US skills in detecting a misplaced catheter tip increased with an odds ratio of 2.4 (95% CI: 1.2, 4.8) per US examination. Overall, performance and self-confidence plateaus were reached after 6 examinations. Conclusion: We found steep learning curves for targeted US examination of umbilical catheter placement. eLearning followed by 6 examinations was found to be adequate training to perform with a sufficiently high accuracy and self-confidence to allow for point-of-care use.

Extrapulmonary sequestration with a left internal thoracic arterial feeding vessel in an infant treated with video-assisted thoracoscopic resection: a case report

BackgroundCongenital lung malformations exist along a spectrum of pathogenesis and disease severity. Extrapulmonary sequestration (EPS), in which nonfunctional lung tissue develops without connection to the tracheobronchial tree, is one rare manifestation of this disease. Atypical vascular anatomy with a systemic feeding vessel characterizes these lesions.Case presentationA 3 day old, 37 week gestation infant underwent chest X-ray for confirmation of umbilical catheter placement and was found to have an elevated left hemidiaphragm consistent with eventration versus congenital diaphragmatic hernia. He remained asymptomatic and was evaluated as an outpatient at the age of 9 months, where CT angiogram demonstrated extrapulmonary versus intrapulmonary sequestration with a systemic feeding vessel from the left internal mammary artery.ConclusionsIt is exceedingly rare for the feeding artery to arise from the internal mammary; two such cases have been reported to date, both in adult patients. Here we present a third case of EPS with arterial supply from the internal mammary successfully treated with video-assisted thoracoscopic resection in a 9 month old infant.

Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice.

Background: Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants. Methods: A pre–post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period. Results: During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%). Conclusion: Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.

A Simulation-based Quality Improvement Approach to Improve Pediatric Resident Competency with Required Procedures.

Introduction: Pediatric residents report a lack of confidence and competence with procedural skills at graduation. Training programs could benefit from improved approaches to target these needs. Using the Institute for Healthcare Improvement (IHI) Model for Improvement and three Plan-Do-Study-Act (PDSA) cycles, we examined the impact of a procedure simulation boot camp on self-reported procedural confidence and competence as well as the longitudinal impacts of these sequential interventions on Accreditation Council for Graduate Medical Education (ACGME) Graduating Resident Survey (GRS) results.Methods: Three rapid cycle interventions were performed in successive academic years. The interventions included 1) increased awareness of available procedural experiences, 2) institution of procedural educational conferences, and 3) implementation of a senior resident procedure boot camp. Senior resident self-reported procedural confidence was measured before and after the boot camp. Procedural competence was measured using the ACGME GRS. Results: Thirty-two of 34 senior residents (94%) completed the 2016 ACGME GRS, similar to the response rates of 2014 (92%) and 2015 (94%), and 30 of 34 third-year residents participated in the procedure boot camp (88%). Resident confidence and competence with procedural skills improved after the institution of the quality improvement intervention. ACGME GRS-reported competency increased in bag and mask ventilation (77% to 94%), neonatal endotracheal intubation (39% to 69%), peripheral IV placement (10% to 50%), and umbilical catheter placement (35% to 53%).Conclusion: A quality improvement intervention with three rapid PDSA cycles was successful in improving senior pediatric resident confidence and competence with ACGME required procedural skills.

Case 1: Secondary Structural Cause of Tachypnea Following Congenital Diaphragmatic Hernia Repair in a Term Neonate

A 39-3/7 weeks’ gestation male infant is born to a 29-year-old gravida 1 para 0 woman via urgent cesarean delivery due to failed induction. Prenatal laboratory tests yielded unremarkable results. Rupture of membranes is for 7 days. Apgar scores are 3, 6, and 8 at 1, 5, and 10 minutes, respectively. In the delivery room, the baby requires positive pressure ventilation for respiratory distress. Initial chest radiography reveals a possible diaphragmatic hernia (Fig 1). The patient is intubated for respiratory distress and placed on a conventional ventilator. After placement of umbilical catheters, the infant is transferred to the NICU for further care. Repeat chest radiography reveals bowel-containing diaphragmatic hernia, stomach visible below the diaphragm, and a crescent opacity in the left upper lung field suggestive of a herniated spleen. Initial echocardiography on postnatal day 2 reveals abnormal ventricular septal motion but no significant tricuspid regurgitation consistent with pulmonary hypertension. The patient is taken to the operating room for repair, reduction, and primary closure of the hernia (Fig 2). Following surgery, the patient is weaned to continuous positive airway pressure on postnatal day 4 and subsequently weaned to room air on postnatal day 6. Figure 1. Chest radiograph revealing a possible diaphragmatic hernia, with the stomach visible below the diaphragm. Figure 2. Chest radiograph status post repair of the left diaphragmatic hernia. Seven days after birth, the patient develops tachypnea during feeding without retractions or desaturations, prompting another chest radiograph. ### Diagnosis The chest radiograph revealed retrocardiac opacity suspicious for a pulmonary sequestration. Chest ultrasonography followed by magnetic resonance imaging/magnetic resonance angiography confirmed the diagnosis of pulmonary sequestration (Figs 3 and 4). The size of the pulmonary sequestration was 4.5 cm anteroposterior × 2.8 cm transverse × 3.6 cm craniocaudal. Figure 3. Magnetic resonance imaging showing …

Incorrect umbilical vein catheterization is associated with severe periventricular hemorrhages and mortality in extremely premature newborns.

To investigate the relationship between umbilical vein catheter (UVC) placement and death in extremely premature newborns (<29 weeks gestation). Utilizing a retrospective, case-control study design, results for newborns that received UVC placements and died were compared with those who received UVC placements and survived (n = 719) by univariate and multiple logistic regression analyses. Death rate was 30% in infants with low lines versus 16% in those without (p = 0.012). High UVC tip placement significantly and independently increased severe periventricular hemorrhages (p = 0.014). Severe periventricular hemorrhage increased death rates by 3-fold independent of gestational age (p < 0.001). Proper line placement significantly reduced severe periventricular hemorrhage by 2.5-fold independent of gestational age (p = 0.019). In extremely premature newborns, incorrect UVC placement is significantly associated with death through its relation to severe periventricular hemorrhage.