Umbilical Catheter Research Articles

Case report: Diagnosis and resolution of hepatic abscess in a neonate

BACKGROUND: Hepatic abscesses in the neonatal age can be caused by multiple etiologies and their variability in clinical presentation makes their diagnosis difficult. The incidence of infectious liver abscesses is low, however, their mortality is high and their timely diagnosis and early resolution are essential to improve prognosis and life expectancy, since therapeutic management is the cause of prolonged hospitalization due to the administration of long-lasting intravenous antimicrobials. The following is a case report of a neonatal patient with this pathology. CLINICAL REPORT: neonatal patient born by cesarean section, 38 weeks of gestation, male, admitted to the neonatology department due to the need for mechanical ventilation; with umbilical catheters for 72 hours. At 48 hours of life, he presented febrile peaks and elevation of acute phase reactants, later, abdominal distension, feeding intolerance and hepatomegaly, so antibiotic therapy was administered with suspicion of septic ileus. Due to persistent hepatomegaly, an abdominal ultrasound was performed in which cystic images were observed at the hepatic level. EVOLUTION: after the diagnosis of liver abscesses, it was decided to maintain antibiotic therapy with Meropenem and Vancomycin. Due to persistence of the abscesses despite treatment, surgical drainage was required on two occasions, the first at day 30 of life, and the second at 47 days of life. The newborn received, from the onset of symptoms and clinical symptoms, a total of 60 days of Meropenem and 48 days of Vancomycin, with complete resolution of the lesions after 68 days of hospitalization. CONCLUSION: Hepatic abscesses are rare in the neonatal age, of bacterial origin in most cases, related to hematic propagation due to umbilical catheterization. The pathology involves long hospitalizations and long-term antibiotic therapy; however, its prognosis is good with early diagnosis and timely treatment.

DIFFERENCES BETWEEN THE USE OF A CENTRAL VENOUS CATHETER AND A CENTRAL VENOUS CATHETER PERIPHERAL INSERTION: ADVANTAGES, DISADVANTAGES AND RISK FACTORS ASSOCIATED WITH EACH PROCEDURE

Central venous access is a frequent procedure in intensive care units. The peripherally inserted central venous catheter (PICC) is an intravenous device, made of soft and flexible material (polyurethane or carbonane). its disadvantages, and the risks associated with each procedure. Material and Methods: This article is a systematic review, based on the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Central Venous Catheter: Some complications result from its use, such as infection, obstruction, infiltration or extravasation, among others. Some of these events can be handled, but device removal cannot always be avoided. The peripherally inserted central venous catheter (PICC) is an intravenous device, made of soft and flexible material (polyurethane or carbonane), introduced through a superficial or deep vein of the arm, which progresses to the superior vena cava located in the thorax. In this sense, the PICC is the first choice for central venous access after umbilical catheterization, standing out over the conventional central venous catheter. Final Considerations: It is emphasized that serious complications are associated with the use of CVC and PICC, which may result in death. Therefore, correctly performing the technique of handling these devices, avoiding infections and obstructions, as well as knowing how to identify, prevent and treat possible complications, should be considered good clinical practices that contribute to a better useful life of the device and quality of life for its user.

A History of Umbilical Vein Catheterization Does Not Preclude Children from a Successful Meso-Rex Bypass.

Umbilical vein catheterization (UVC) can cause portal venous thrombosis, leading to the development of extrahepatic portal venous obstruction (EHPVO) and portal hypertension (PHT). The feasibility of the Meso-Rex bypass (MRB) for the treatment of EHPVO in patients with a history of UVC has been questioned. We compared the feasibility of performing an MRB in patients with or without a history of previous UVC. A retrospective review of patients with EHPVO and known UVC status explored for a possible MRB at our institution was performed (1997-2022). Patients were categorized in two groups: with (UVC(+)) or without (UVC(-)) a history of UVC for comparison. A p-value less than 0.05 was considered significant. One hundred and eighty-seven patients were included (n = 57 in UVC(+); n = 130 in UVC(-)). Patients in the UVC group were significantly younger at surgery and the incidence of prematurity was higher. Other risk factors for the development of EHPVO were similar between the groups, but only history of UVC could predict the ability to receive MRB (odds ratio [OR]: 7.4 [3.5-15.4]; p < 0.001). The success rate of MRB was significantly higher in patients with no history of UVC (28/57 [49.1%] in UVC(+) vs. 114/130 [87.7%] in UVC(-); p < 0.001). However, MRB patency at discharge (25/28 [89.3%] in UVC(+) vs. 106/114 [94.7%] in UVC(-); p = 0.3) was equally high in both groups. Our results indicate that a history of UVC is not a contraindication to MRB. Half of the patients were able to successfully receive an MRB. Patients with symptomatic PHT from EHPVO should not be excluded from consideration for MRB based on UVC history.

Neonatal Catheter and Tube Placement and Radiographic Assessment Statistics in Relation to Important Anatomic Landmarks.

Neonatal catheters and tubes are commonly used for monitoring and support for intensive care and must be correctly positioned to avoid complications. Position assessment is routinely done by radiography. The objective of this study is to characterize neonatal catheter and tube placement in terms of the proportion of those devices that are malpositioned. Using an institutional dataset of 723 chest/abdominal radiographs of neonatal intensive care unit (ICU) patients (all within 60 days of birth), we assessed the proportion of catheters that are malpositioned. Many radiographs contained multiple catheter types. Umbilical venous catheters (UVCs; 448 radiographs), umbilical arterial catheters (UACs; 259 radiographs), endotracheal tubes (ETTs; 451 radiographs), and nasogastric tubes (NGTs; 603 radiographs) were included in our analysis. UVCs were malpositioned in 90% of radiographs, while UACs were malpositioned in 36%, ETTs in 30%, and NGTs in just 5%. The most common locations in which UVCs were malpositioned were in the right atrium (31%) and umbilical vein (21%), and for UACs the most common malpositioned tip location was the aortic arch (8%). For the remaining tubes, 5% of ETTs were found to be in the right main bronchus and 4% of NGTs were found in the esophagus. A substantial proportion of catheters and tubes are malpositioned, suggesting that optimizing methods of catheter placement and assessment ought to be areas of focus for future work. · Neonatal catheters are frequently malpositioned.. · Most umbilical venous catheters need readjustment.. · X-ray and ultrasound are important for assessment.. · Catheter tips should be assessed in all X-rays..

Pasos para la mejora en la canalización umbilical en neonatología

IntroductionIn neonatal units, umbilical vessel catheterization is the preferred method to gain vascular access in the initial management of the newborn because it is quick and easy. The failure rate ranges from 25% to 50%, as the catheter can be found in the portal system in up to 40% of cases, leading to complications. This failure rate warrants the investigation of different methods to reduce the frequency of catheter malposition. We describe different techniques to improve the success rate in umbilical vein catheterization, such as the double catheter technique, positioning the newborn in right lateral decubitus for insertion, liver compression, and ultrasound-guided catheter insertion. The primary objective of the study was to assess the impact of new techniques on the success rate of central umbilical venous catheterization. Material and methodsPre- and post-intervention quasi-experimental study in a level B NICU conducted in January to June 2022 (pre-intervention) and July to December 2022 (post-intervention). ResultsPrior to the introduction of these new catheterization techniques, the failure rate of blind umbilical catheter insertion was 52%. Since the introduction of these measures, the overall failure rate has decreased to 27%. ConclusionsAfter the introduction of the new catheterization and recanalization methods, our success rate in umbilical vein catheterization has increased, and we believe it is necessary to implement them in units with similar failure rates to ours.

Safety and feasibility of platelet transfusion through long catheters in the neonatal intensive care unit: an in vitro study

ObjectiveTo assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen umbilical venous catheters (UVCs) and 24 G...

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.

Early Onset Portal Hypertension Due to Silent Extensive Portal Vein Thrombosis Following Umbilical Vein Catheterization

Background: Umbilical vein catheterization is a routine procedure in neonatal intensive care units. This invasive procedure, though easy and useful, can result in disastrous complications. Clinical Description: A 28 day old baby boy presented with umbilical sepsis along with multiple skin abscesses. He had a history of double volume exchange transfusion for Glucose 6 Phosphate deficiency induced hyperbilirubinemia, during the postnatal period. Ultrasound whole abdomen done to look for intra-abdominal abscesses revealed extensive portal vein thrombosis including the main portal vein and its branches with cavernoma formation. Upper gastrointestinal endoscopy revealed Grade II esophageal varices suggestive of the development of portal hypertension. Management and Outcome: Baby was started on subcutaneous enoxaparin which continued for 3 months. Follow up ultrasound showed complete obliteration of portal vein, replaced by cavernomas with development of grade II esophageal varices seen on upper gastrointestinal endoscopy. Conclusion: This case highlights how umbilical vein catheterization in the neonatal period can lead to catastrophic complications such as obliteration of the entire main portal vein and its branches, formation of portal cavernoma, portal hypertension, and esophageal varices, all of which can develop silently, at a very early age.

Association of umbilical venous catheters vs peripherally inserted central catheters with death or severe intraventricular hemorrhage among preterm infants < 30 weeks: A randomized clinical trial.

Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs) are routinely inserted in preterm infants for total parenteral nutrition and medications. We aimed to examine whether the rates of severe intraventricular hemorrhage (IVH) or death vary among preterm infants receiving UVCs compared to PICCs. This randomized controlled trial included preterm infants < 30 weeks gestation assigned after birth to either UVC placement group or PICC group. A total of 233 preterm infants (117 infants in UVC group, 116 infants in PICC group) were randomized and collected data was available for intention-to-treat analysis. There were no differences in baseline population characteristics. Severe IVH occurred in 16 infants (13.6%) in the UVC group and 11(9.5%) in the PICC group (risk difference [RD], 4.1% [5% CI, -4 to 12.3]; P = 0.42). The incidence of death before 28 days of life did not differ significantly between groups (10 [8.5% ] in UVC vs 6 [5.1%] in PICC; RD, 3.4% [95% CI, -3.0 to 9.84]; P = 0.44). Seventeen percent (20/117) of the UVC group died or developed severe IVH compared with 12% (14/116) of the PICC group (risk difference, 5% [95% CI, -4.01 -14.06]; P = 0.36). The incidence of necrotizing enterocolitis (NEC) was significantly higher in the UVC group infants than in the PICC group infants (7.7% vs. 1.7%); p = 0.03. The incidence of severe IVH or death did not differ significantly among preterm m infants < 30 weeks gestation subjected to UVC or PICC placement. Early inotropic support was a significant risk factor for the development of severe IVH. UVC maybe an additional risk factor for the development of NEC, but further research is required to validate this finding.

Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters

The aim of this study was to evaluate the risk of catheter-associated bloodstream infection (CABSI) among different catheter types using a large prospective database in the neonatal intensive care unit (NICU) of a tertiary care centre in Switzerland. We included all neonates admitted to the NICU with at least one central intravascular catheter inserted between January 2017 and December 2020. We used marginal Cox model to determine the risk of CABSI among different catheter types. A total of 574 neonates and 1103 intravascular catheters were included in the study: 581 venous umbilical catheters, 198 arterial umbilical catheters and 324 peripherally inserted central catheters (PICCs). We identified 17, four and four CABSIs in neonates with venous umbilical catheters, arterial umbilical catheters and PICCs, respectively. The risk of CABSI increased after two days of umbilical catheter maintenance. Using univariable Cox models, and adjusting for sex and gestational age, we observed a similar CABSI risk between venous and arterial umbilical catheters (HR 0.57; 95% CI 0.16e2.08). Birth weight was associated with CABSI, with higher weight being protective (HR 0.37, 95% CI 0.16e0.81). Strategies aimed at reducing umbilical catheter dwell time, particularly in low and very low birth weight neonates, may be effective in decreasing the incidence of CABSI in this population.

Central venous pressure line insertion for the primary health care physician

Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.

Neonatal portal vein thrombosis: risk factors, diagnosis, treatment recommendations and review of the literature

BackgroundNeonatal portal vein thrombosis (PVT) is currently more commonly encountered as a result of advances in diagnostic tools and increase in invasive interventions.MethodsIn this study, 11 premature and 12 term infants diagnosed with PVT were retrospectively evaluated for clinical and laboratory characteristics, umbilical catheterization procedure, PVT location, risk factors, treatments, and long-term outcomes.ResultsMedian age of the patients at diagnosis was 10 days (range 3–90 days), and 69.6% of patients were girls. Of the 23 patients, 87% had left PVT and, 91.3% had at least one thrombosis risk factor, which was sepsis in 73.9% of patients, and presence of umbilical venous catheter in 87%. Totally, 59.1% of PVTs were completely resolved in a median follow-up of 7 months (1 month to 12 months), and 78.3% of these patients had no anticoagulant therapy (ACT). Partial thrombus resolution was achieved in 9 patients (40.9%). Five patients (%21) received ACT. Overall, 34.8% of patients had long-term complications. neonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms.ConclusionNeonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms.

Novel strategies to reduce central-line–associated blood stream infection (CLABSI) events in the neonatal intensive care unit

Background: We describe the components of an improved and easy-to-implement strategy to reduce CLABSI events in the NICU implemented during July–September 2021 in a tertiary-care healthcare center. These strategies were added to an existing institutional protocol created following CDC guidelines. Methods: During the previous timeframe of the implementation of new strategies, CDC insertion-related prevention measures [ie, hand hygiene, use of personal protective equipment (PPE), catheter size selection, standard chlorhexidine gluconate (CHG) antisepsis, maintenance related Curos disinfecting caps, and scrubbing the hub] were part of an existing protocol at our institution. We introduced the following key elements along with the previous ones: decrease length of umbilical vein catheter (UVC) utilization from 14 days to 5–7 days, change of dressing materials from BIOPATCH to 3M Tegaderm CHG chlorhexidine gluconate IV securement transparent dressing, enhanced compliance of an existing artificial nail policy, and restricted blood draw from central lines. Results: After optimization of the previous protocol through these additional strategies, we achieved a significant reduction in the NICU CLABSI rates from 12 CLABSI events between July 2020 and June 2021 to only 3 CLABSI events between July 2021 and June 2022. Conclusions: Revision of CLABSI bundle prevention protocols should be performed frequently to allow improvement opportunities to be added to diminish infection rates. The addition of simple and easy-to-implement key elements interventions to the existing CLABSI bundle had an important impact on the CLABSI rate at our institution.Disclosures: None

Securement of Umbilical Venous Catheter Using Cyanoacrylate Glue: A Randomized Controlled Trial

To evaluate the role of cyanoacrylate glue in reducing dislodgement of umbilical venous catheters (UVCs). This was a single-center, randomized, controlled, nonblinded trial. All infants requiring an UVC according to our local policy were included in the study. Infants with a UVC with a centrally located tip as verified by real-time ultrasound examination were eligible for the study. Primary outcome was the safety and efficacy of securement by cyanoacrylate glue plus cord-anchored suture (SG group) vs securement by suture alone (S group), as measured by reduction in dislodgment of the external tract of the catheter. Secondary outcomes were tip migration, catheter-related bloodstream infection, and catheter-related thrombosis. In the first 48hours after UVC insertion, dislodgement was significantly higher in the S group than in the SG group (23.1% vs 1.5%; P<.001). The overall dislodgement rate was 24.6% in the S group vs 7.7% in the SG group (P=.016). No differences were found in catheter-related bloodstream infection and catheter-related thrombosis. The incidence of tip migration was similar in both groups (S group 12.2% vs SG group 11.7%). In our single-center study, cyanoacrylate glue was safe and effective for securement of UVCs, and particularly effective in decreasing early catheter dislodgments. UMIN-CTR Clinical Trial; Registration number: R000045844.

Extra-hepatic portal vein obstruction leading to portal cavernoma cholangiopathy without liver dysfunction

In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. EHPVO leads to the cavernous transformation of the portal vein in the absence of recanalization. Portal cholangiopathy (also referred to as portal biliopathy) is common in patients with long-standing chronic PVT. It is due to compression of the large bile ducts by the venous collaterals (portal cavernoma) that form in patients with chronic PVT. Typically, symptoms of portal cholangiopathy include jaundice, biliary colic and pruritus.

Multicenter Evaluation of Pre-operative Feeding in Infants with Ductal Dependent Circulation.

Enteral feeds are often withheld from neonates with ductal dependent cardiac lesions who are receiving prostaglandins. This is despite positive benefits of enteral feeding. We describe a multicenter cohort of these neonates who were fed pre-operatively. We also give a granular description of vital sign measurements and other risk factors prior to feeding. A retrospective chart review was performed at seven centers. Inclusion criteria were full-term neonates under one month of age with ductal dependent lesions receiving prostaglandins. These neonates were fed for at least 24h during the pre-operative period. Premature neonates were excluded. Using the inclusion criteria, 127 neonates were identified. While being fed, 20.5% of the neonates were intubated, 10.2% were on inotropes, and 55.9% had an umbilical arterial catheter in place. Median oxygen saturations in the six hours prior to feeding were 92.5% in patients with cyanotic lesions, median diastolic blood pressure was 38mmHg and median somatic NIRS were 66.5%. The median peak daily feeding volume reached was 29ml/kg/day (IQ range 15.5-96.8ml/kg/day). One patient developed suspected necrotizing enterocolitis (NEC) in this cohort. Only one adverse event occurred, which was an aspiration thought to be related to feeding, but did not result in intubation or cessation of feeds. NEC was rare among neonates with ductal dependent lesions while receiving enteral nutrition pre-operatively. Umbilical arterial catheters were in place in the majority of these patients. Hemodynamic measures demonstrated a high median oxygen saturation prior to initiation of feeds.

Idiopathic Upper Limb Ischemia in a Term Infant

Acute Limb Ischemia (ALI) is a rare disease in neonates with overwhelming sequences that could eventually end up with limb loss. ALI may be due to intrauterine causes as thromboembolic events or in utero compression. Postnatal ALI is usually iatrogenic after umbilical artery catheter. We present a case of acute upper limb ischemia with no apparent underlying cause that was managed conservatively.

Effect of Implementing Educational Program about Care for Neonates Undergoing Umbilical Venous Catheter Installation on Nurses Performance

Effect of Implementing Educational Program about Care for Neonates Undergoing Umbilical Venous Catheter Installation on Nurses Performance

Finding the most suitable puncture site for intraosseous access in term and preterm neonates: an ultrasound-based anatomical pilot study

The purpose of this prospective ultrasound-based pilot study was to identify the most suitable tibial puncture site for intraosseous (IO) access in term and preterm neonates, describe tibial dimensions at this site, and provide anatomical landmarks for rapid localization. We measured the tibial dimensions and distances to anatomical landmarks at puncture sites A (proximal: 10 mm distal to the tibial tuberosity; distal: 10 mm proximal to the malleolus medialis) and B (chosen by palpation of the pediatrician), in 40 newborns in four weight groups (< 1000 g; 1000–2000 g, 2000–3000 g, and 3000–4000 g). Sites were rejected if they fell short of the assumed safety distance to the tibial growth plate of 10 mm. If both A and B were rejected, puncture site C was determined sonographically at the maximum tibial diameter while maintaining the safety distance. Puncture site A violated the safety distance in 53% and 85% (proximally and distally, respectively) and puncture site B in 38% and 33%. In newborns weighing 3000–4000 g, at median (IQR), the most suitable puncture site at the proximal tibia was 13.0 mm (12.0–15.8) distal to the tuberosity and 6.0 mm (4.0–8.0) medial to the anterior rim of the tibia. The median (IQR) diameters at this site were 8.3 mm (7.9–9.1) (transverse) and 9.2 mm (8.9–9.8) (anterior–posterior). The diameters increased significantly with increasing weight. Conclusion: This study adds concise, practical information on the implementation of IO access in neonatal patients: the tibial dimensions in newborns in four different weight groups and initial data on anatomical landmarks to easily locate the IO puncture site. The results may help implement IO access in newborns more safely.What is Known:• Intraosseous access is a feasible option for emergency administration of vital drugs and fluids in newborns undergoing resuscitation when an umbilical venous catheter is impossible to place.• Severe complications of IO access due to malpositioned IO needles have been reported in neonates.What is New:• This study reports the most suitable tibial puncture sites for IO access and the tibial dimensions, in newborns of four weight groups.• The results can help to implement safe IO access in newborns.

EBNEO commentary: Early amino acids in extremely preterm infants and neurodisability at 2 years.

Preterm infants require nutritional support immediately after birth to prevent catabolism and support normal growth, often in the setting of increased energy requirements due to postnatal environmental conditions and critical illness. Observational studies in preterm infants have shown that there is a positive association between protein intake in the first month of life, short-term growth outcomes at NICU discharge1 and long-term neurodevelopmental outcomes.2, 3 However, a meta-analysis of randomised controlled trials found that preterm infants with higher intake of parenteral amino acids demonstrated improved postnatal growth but did not show improvement in neurodevelopmental outcomes compared with infants who received lower intake of amino acids.4 Despite evidence for the benefit of early protein delivery on growth in the preterm infant, there are still many questions about the optimal dosing regimen of parenteral amino acids, including starting dose, maximal intake dose, timing and speed of increase in delivery. For example, there have been small, randomised controlled trials that have raised concerns for adverse effects from high-dose (>3 g/kg/day) parenteral amino acids advanced rapidly in the first week of life, including smaller head circumference at NICU discharge5, 6 and reduced growth through the first 2 years of life.7 In this multicenter, double-blind, randomised control trial, extremely low-birth-weight infants who received higher parenteral amino acid intake in the first 5 days of life (3.4 ± 0.6 vs 2.6 ± 0.6 g/kg/day) did not have improved survival without neurodevelopmental impairment at 2 years of corrected gestational age. In fact, higher amino acid intake was associated with higher rates of moderate-to-severe neurodisability than neonates who received lower amino acid intake. Although increased protein intake was associated with improved growth in the first month of life, there were no differences in growth at 2 years old. This study was adequately powered and is the largest study to date to test for differences in neurodevelopmental outcome as a result of amino acid dose in the first week of life. The investigators provided a difference of 0.8 g/kg per day of protein between groups, thus isolating its effect over other components of parenteral nutrition. Limitations included that additional amino acids were only administered for 5 days; it is unclear whether prolonged supplementation would change outcomes. Outcomes at 2 years old weakly predict outcomes in school-aged children. Plasma amino acid concentrations were not reported, but are critical to determine whether current paediatric amino acid solutions are adequate for preterm infants. In summary, increasing parenteral amino acid intake via the umbilical arterial catheter for 5 days after birth does not improve neurodevelopmental outcomes or growth at 2 years in preterm infants; higher protein intake may be associated with worse neurodevelopmental outcomes. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommends that preterm infants should not receive more than 3.5 g/kg/day of parenteral amino acids unless administered in a clinical trial.8 This study supports that recommendation; clinicians should be cautious of excessive parenteral protein administration to preterm infants especially in the first 5 days of life. URL LINK: https://ebneo.org/ebneo-commentary-early-amino-acids-and-nd-outcomes/ None. None.