A new study has suggested that premature infants having central lines that are maintained over 14 days have less needle pokes that break the skin and more thalamus growth as compared to infants with lines in place for a shorter time.

Researchers have studied two groups of very preterm neonates who were born at < 28 weeks gestation with arterial line and central venous line (AC/CVL) and that were used for a prolonged period of minimum 14 days (n=86) or for a limited period of less than 14 days (n=57). The median number of skin breaks due to the needle pokes was 34 with prolonged AC/CVL usage as compared to a median of 91 skin breaks with limited AC/CVL usage.

The neonates having prolonged AC/CVL had larger thalamic volume detected on MRI scans in a few weeks after birth as compared to those with limited AC/CVL. After regulating the variables of sex, age at birth and age at MRI scan, the neonates with prolonged AC/CVL use had a mean thalamic size of 1,233 cubic millimeters (mm3) as compared to 1,110 mm3 in neonates with limited AC/CVL use.

Senior study author, Dr. Steven Miller, also a professor of pediatrics, University of Toronto and a senior scientist, SickKids Research Institute said that though the study did not investigate the reason for the association but it can be possible that more pain must have influenced the development of synaptic connectivity or the neuronal morphology in the thalamus and might have resulted in slower growth.

Neuropsychological examinations that were done for a total number of 118 children (83%) at a median age of 4.9 years found out that children with a larger thalamus size as infants had achieved higher scores on motor and cognitive assessments as compared to their counter parts with a smaller thalamus size as infants.

The study results do not clear whether reducing the needle pokes or invasive procedures in infancy can promote more brain growth or cause improved outcomes on cognitive or motor assessments later in childhood.

The paper has important suggestions for clinical care as the authors have shown that the reduction of painful procedures, particularly heel sticks can be achieved by using a central line, and the infections were not increased significantly in neonates with these lines.

Source: Prolonged Central Line in Preemies Tied to Fewer Needle Sticks, Better Thalamus Growth - Medscape - Oct 28, 2020. https://bit.ly/3mpvMFc Neurology, online October 21, 2020.