Risk factors for neonatal catheter-related bloodstream infections: a systematic review and meta-analysis

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Background Catheter-related bloodstream infection (CRBSI) is a prevalent nosocomial infection in neonatal units. The incidence of CRBSI can prolong hospitalization, cause irreparable harm, and negatively affect newborn survival and quality of life. Previous research has identified risk factors for CRBSI, but the findings have been inconsistent, and all predisposing factors have not been systematically described. This study aimed to investigate the risk factors for developing CRBSI in neonates and to provide a scientific basis for decision-making in the prevention of neonatal CRBSI. Methods A systematic search of PubMed, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), and the Wanfang Database was performed from the time of each database’s inception to 1 October 2025. The search strategy combined subject terms and free-text keywords. The Newcastle–Ottawa scale (NOS) was used to assess the quality of the literature, and meta-analysis was carried out using RevMan 5.3. Heterogeneity was evaluated using the I 2 statistic method, and publication bias was analyzed with funnel plot tests. Results A total of 18 articles involving 11,963 participants were included in this study. In the meta-analysis, the risk factors for the development of CRBSI in neonates, ranked from strongest to weakest association, were as follows: Multi-lumen central venous catheters (CVCs) ≥ 2, 5-min Apgar score≤7, number of manipulations≥2, catheter indwelling time>14d, gestational age≤32w, parenteral nutrition (PN), maternal disease, birth weight<1,500 g, male sex, and catheterization of the upper and lower limbs. These risk factors were found to be significantly associated with the development of CRBSI. Conclusion This meta-analysis identifies key modifiable risk factors for CRBSI in neonates, informing a proposed evidence-based prevention bundle. This bundle targets factors such as catheter dwell time, aseptic technique, and nutrition management to reduce CRBSI incidence and improve resource efficiency, especially in high-risk neonates.