Venous access is an essential part of caring for the sick neonate; however, problems such as contamination of fluids with bacteria, endotoxins and particulates have been associated with intravenous infusion therapy. Intravenous in-line filters claim to be an effective strategy for the removal of bacteria, endotoxins and particulates associated with intravenous therapy in adults and are increasingly being recommended for use in neonates.
To determine the effect of in-line filters on intravenous lines on morbidity and mortality in neonates.
We used the standard search strategy of the Cochrane Neonatal Group. We searched the electronic databases MEDLINE (from 1966 to April 2, 2011), EMBASE (from 1980 to April 2, 2011), CINAHL (from 1982 to April 2, 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2011). There was no language restriction. Further searching included cross references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching.
Randomised or quasi-randomised controlled trials that compared the use of intravenous in-line filters with placebo or nothing in neonates were included in the review.
Data collection and analysis
The procedures of the Cochrane Neonatal Review Group (CNRG) were followed throughout.
Titles and abstracts identified from the search were checked by the review authors. The full text of all studies of possible relevance were obtained. The review authors independently assessed the trials for their methodological quality and subsequent inclusion in the review. Authors were contacted for further information as needed.
Statistical analysis followed the procedures of the Cochrane Neonatal Review Group. Dichotomous data is expressed as relative risk and 95% confidence intervals, and risk difference and 95% confidence intervals.
There were four eligible studies that recruited a total of 704 neonates. This review found no significant effect of in-line filters in any of the reported outcomes of overall mortality, proven and suspect septicaemia, local phlebitis and thrombus, necrotizing enterocolitis, duration of cannula patency, length of stay in hospital, number of catheters inserted and financial costs.
There is insufficient evidence to recommend the use of intravenous in-line filters to prevent morbidity and mortality in neonates.