Intracavitary electrocardiography for 1‑Fr epicutaneous‑cava catheter tip location in neonates: 6‑Year retrospective study

BACKGROUND: Evidence for intracavitary electrocardiography (IC-ECG) to locate 1-Fr epicutaneous-cava catheter (ECC) tips in neonates remains limited. METHODS: We retrospectively analyzed 196 neonates (2019-2025) undergoing 1-Fr ECC insertion with IC-ECG guidance using either a conventional monitor-defibrillator (DEF) or a dedicated neonatal interface (Pilot™). Bedside echocardiography performed at the end of the procedure (within 2 h) served as the reference standard. Endpoints were applicability, feasibility, accuracy, malposition, and early complications (⩽24 h). RESULTS: IC-ECG correctly identified catheter-tip position in 94.9% of cases under an intention-to-diagnose framework (186/196) and showed complete concordance with echocardiography in all evaluable catheters. Applicability was 100% (196/196; 95% CI 98.1-100.0). Feasibility (interpretable tracing) was 94.9% (186/196; 95% CI 90.8-97.5). Diagnostic accuracy was 94.9% under intention-to-diagnose (186/196; 95% CI 90.8-97.5) and 100% among interpretable tracings (186/186; 95% CI 98.0-100.0). In 10 cases, the tracing was neither readable nor interpretable, likely due to electrical interference. In three cases, the tracing was readable but the P-wave never reached a maximal amplitude throughout catheter navigation; ultrasound verification confirmed malposition. No clinically significant arrhythmias or occlusions occurred within 24 h. CONCLUSIONS: IC-ECG provides excellent diagnostic performance for 1-Fr ECC tip location in neonates. A flat P-wave should prompt ultrasound confirmation. Multicenter studies are warranted.