Peripherally inserted central catheter versus umbilical venous catheter for central venous access in neonates on the first day of life: a systematic review and meta-analysis of central line-associated bloodstream infections and clinical outcomes

Background Umbilical venous catheters (UVCs) and neonatal peripherally inserted central catheters (PICCs) are commonly used for central venous access in neonates. In selected neonates requiring early central venous access, the comparative safety and procedural characteristics of these devices remain unclear. Methods We conducted a systematic review and meta-analysis of interventional studies comparing PICCs and UVCs as early central venous access devices, typically within the first 24 h of life. PubMed, Embase, Web of Science, and Cochrane CENTRAL were searched up to November 2025. Randomised controlled trials (RCTs) and non-randomised studies of interventions were included. Primary outcomes were central line-associated bloodstream infection (CLABSI), mortality, late-onset sepsis and catheter-related complications (thrombosis, occlusion, bleeding and tip migration). Secondary outcomes included insertion-related difficulties and other neonatal outcomes. A random-effects meta-analysis was performed, and certainty of evidence was assessed using GRADE. Results Seven studies (five RCTs, two non-randomised studies) involving 1,522 neonates were included. A meta-analysis of RCTs found no significant differences between PICCs and UVCs for CLABSI (risk ratio/RR 0.75, 95% confidence interval/CI 0.5–1.11) or mortality (RR 1.05, 95% CI 0.58–1.9). A trend towards higher late-onset sepsis (RR 1.36, 95% CI 0.97, 1.91) and longer hospital stay (MD 3.2 days, 95% CI -0.2 days, 6.6 days) was observed with PICCs. PICCs were associated with lower malposition (RR 0.65, 95% CI 0.49–0.86) but higher occlusion rates (RR 2.84, 95% CI 1.23–6.57). Procedure duration was significantly longer for PICC insertion. Catheter dwell time tended to be longer in the PICC groups, representing an important unresolved confounder. Conclusions Current evidence does not demonstrate a reduction in CLABSI, mortality, or late-onset sepsis when neonatal PICCs are used instead of UVCs as early central venous access. Trial registration PROPSERO registration no: CRD42024604746.