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Intravenous in-line filters for preventing morbidity and mortality in neonates

  • Review
  • Intervention

Authors


Abstract

Background

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.

Objectives

To determine the effect of in-line filters on intravenous lines on morbidity and mortality in neonates.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

There is insufficient evidence to recommend the use of intravenous in-line filters to prevent morbidity and mortality in neonates.

Plain language summary

Intravenous in-line filters for preventing morbidity and mortality in neonates

Preterm or sick newborn infants are often fed with nutrients and fluids that are delivered directly into a vein. This intravenous delivery can be associated with infection, toxins released by bacteria, and tiny particles that may be in the fluids, such as rubber and plastic, going into the blood. In adults, placing a filter in the intravenous line has been reported to be effective in reducing such risks and filters are increasingly being recommended for use in newborn infants. The review authors searched the medical literature and identified four eligible studies that recruited a total of 704 newborns. Septicaemia and illness, deaths or problems with the intravenous catheters were no different with or without a filter. This review is unable to recommend their use due to insufficient evidence.

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