Ultrasound-Guided Non-Tunneled Centrally Inserted Central Catheters versus Peripherally Inserted Central Catheters in Neonates Under 1000 grams: A Comparative Cohort Study

INTRODUCTION: Peripherally inserted central catheters (n-PICCs) are standard in neonatal intensive care but carry high complication rates. Ultrasound-guided non-tunneled centrally inserted central catheters (nT-CICCs) offer a potential alternative. This study compared outcomes of nT-CICCs versus n-PICCs in extremely low birth weight (ELBW) neonates. METHODS: Single-center, comparative cohort study (April 2022-October 2025) enrolling neonates <1000g requiring central venous access. A retrospective cohort receiving n-PICCs was compared with a prospective cohort receiving nT-CICCs. The primary outcome was Central Line-Associated Bloodstream Infection (CLABSI) density rate on successfully placed catheters. Secondary outcomes included procedural success, mechanical complications, and risk factors for CLABSI. RESULTS: We analyzed 103 catheter insertions (50 nT-CICCs, 53 n-PICCs). Procedural success was 100% for nT-CICCs and 94% for n-PICCs (3 immediate failures excluded from follow-up). Among 100 indwelling catheters, nT-CICCs showed significantly lower CLABSI rates (1.83 vs 11.09 per 1000 catheter-days; P = .038). Overall complications affected 4% of the nT-CICC group versus 64% of the n-PICC group (P < .001). nT-CICCs enabled therapy completion in 66% of cases compared with 12% for n-PICCs. Catheter type was the sole independent predictor of CLABSI (adjusted HR 7.1, 95% CI 1.01-49.74; P = .048). CONCLUSIONS: Ultrasound-guided nT-CICCs are associated with significantly lower rates of infectious and mechanical complications compared with n-PICCs in ELBW neonates. This approach provides a safer and more durable option for central venous access in this vulnerable population.