Background: 

Arterial catheterization is a routine procedure in extremely preterm neonates. Umbilical arterial catheters (UACs) are typically used for this purpose, but life-threatening complications have been described. Peripheral arterial lines (PALs) might offer a valuable alternative, but their feasibility in extremely preterm newborns is unclear.

Purpose: 

To investigate efficacy and complications of PALs in extremely preterm neonates.

Methods: 

Retrospective analysis of patients born below 26 weeks of gestation in 2011-2014 (cohort 1, UAC as primary arterial access) and 2015-2019 (cohort 2, PAL as primary arterial access). Arterial line placement during their first 14 days of life, duration of arterial access, reasons for discontinuation, and long-term complications were recorded from health records.

Results: 

In total, 161 of 202 newborns had an arterial line during their first 14 days of life. In cohort 2, the life span of a PAL was significantly longer than that in cohort 1. Signs of dysfunction were the primary reason to discontinue a PAL. Signs of peripheral ischemia were present in 36 of 105 cases (34%) when the PAL was removed but persisted in only 2 patients. UAC-associated persistent ischemic damage occurred in 2 of 97 patients.

Implications for Practice and Research: 

PALs are a valuable alternative to UACs even in preterm newborns below 26 weeks of gestational age. A special focus on ischemic complications is warranted. Prospective, multicenter studies to verify safety and efficacy of arterial line management and complications in extremely preterm infants are warranted.

中文翻译：

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极早产新生儿的外周动脉线：脐动脉导管的潜在替代方案

背景： 

动脉导管插入术是极早产新生儿的常规手术。脐动脉导管（UAC）通常用于此目的，但已经描述了危及生命的并发症。外周动脉导管（PAL）可能提供一种有价值的替代方案，但其在极早产新生儿中的可行性尚不清楚。

目的： 

研究 PAL 对极早产新生儿的疗效和并发症。

方法： 

对 2011-2014 年（队列 1，UAC 作为主要动脉通路）和 2015-2019 年（队列 2，PAL 作为主要动脉通路）出生的妊娠 26 周以下患者进行回顾性分析。从健康记录中记录出生后 14 天内的动脉导管放置情况、动脉通路的持续时间、中断的原因以及长期并发症。

结果： 

总共 202 名新生儿中有 161 名在出生后 14 天内接受了动脉导管插管。在队列 2 中，PAL 的寿命明显长于队列 1。功能障碍的迹象是停止 PAL 的主要原因。当 PAL 被切除时，105 例中有 36 例 (34%) 出现外周缺血迹象，但只有 2 例患者持续存在。97 名患者中有 2 名发生了 UAC 相关的持续性缺血性损伤。

对实践和研究的影响： 

即使对于胎龄低于 26 周的早产儿，PAL 也是 UAC 的宝贵替代品。有必要特别关注缺血性并发症。有必要进行前瞻性、多中心研究来验证动脉导管管理的安全性和有效性以及极早产儿的并发症。