734 - To Place or Not to Place? Umbilical Venous Lines in Infants with Congenital Diaphragmatic Hernia

Poster Number: 734
Publication Number: 734.245

Amanda Holmes, Texas Children's Hospital, Brookshire, TX, United States; Amy Mehollin-Ray, Emory University, Atlanta, GA, United States; James E. Crowe, Baylor College Medicine, Houston`, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Caraciolo J. Fernandes, Baylor College of Medicine, Houston, TX, United States

Background: Infants with congenital diaphragmatic hernia (CDH) are among the most critically-ill neonates admitted to a neonatal intensive care unit (NICU) and are at risk for mortality and significant morbidity. Stabilization of these infants after birth typically requires ventilator support and intravenous parenteral nutrition until the diaphragmatic defect is repaired. The usual, rapidly obtained central venous access for critically ill neonates at birth is an umbilical venous catheter (UVC). However, in CDH infants, the anatomic differences from a typical newborn due to the intrathoracic herniation of abdominal contents, which may include the liver, complicates this simple procedure. Currently, there is a gap in the research on the determinants of unsuccessful placement of UVC in infants with CDH.

Objective: To identify the determinants of unsuccessful placement of UVC in infants with CDH.

Design/Methods: A single center retrospective review of the medical records of infants with CDH admitted after birth to a tertiary-care level 4 NICU between January 2014 and December 2020. Data abstracted included maternal and birth data, fetal CDH imaging parameters (including observed-to-expected total fetal lung volume (O/E TFLV) and percent liver herniation (%LH)) and outcome of successful placement of UVC assessed independently by two radiologists. Logistic regression analysis was used to investigate variables’ associations with incorrect UVC placement.

Results: A total of 117 inborn CDH patients with complete data were available for analyses. Maternal and birth data are summarized in Table 1. Only 16 (13.7%) of UVCs were appropriately placed. In adjusted analysis, every one percent increase in liver herniation was associated with a nearly four-fold increase in odds of the UVC being malpositioned (p=0.018) while higher Apgar scores, other/ventral CDH side and older age at time of UVC placement were all associated (p< 0.05) with decreased odds of malpositioned UVC (Table 2). In multivariable analysis, greater liver herniation was associated with increased odds of malpositioned UVC (adjusted odds ratio (aOR) = 4.2, p=0.020) (Table 3).

Conclusion(s): Prenatal imaging can help prognosticate likelihood of successful placement of a UVC in infants with CDH. Our findings can help clinicians develop algorithms to guide the decision of whether and when to attempt placement of a UVC in an infant with CDH.