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Inter-center variation in non-elective removal of central catheters amongst level 4 NICUs

Journal of Perinatology (2025)Cite this article

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Abstract

Objective

To quantify inter-center variation (ICV) in non-elective removal (NER) of central venous catheters (CVCs) in level 4 Neonatal Intensive Care Units (NICUs).

Study design

Using the Children’s Hospitals Neonatal Database (CHND), we identified CVCs in infants admitted 2017–2023. The primary outcome was CVC NER, and the primary exposure was CHND center. We quantified unadjusted and adjusted ICV in NER.

Result

We analyzed 71,865 patients and 135,671 CVCs. Median gestational age was 36 weeks and birth weight 2450 g. Over 50% infants (28,077) received >1 CVC. Centers placed 196–7120 catheters with a median dwell time of 7 (IQR 4–14) days. The overall NER rate was 11.7%, with significant ICV (unadjusted ICV: 3–19%, p < 0.001; adjusted center-level odds of NER: 0.26–2.03, p < 0.001).

Conclusion

There is significant ICV in NER between level IV NICUs. Reducing modifiable NER may increase safety for patients with CVCs. Center-specific NER metrics may serve as clinical benchmarks.

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Fig. 1: aOR of NER by CHND center demonstrating 7.1-fold adjusted variation in NER between centers.
Fig. 2: Indication for NER stratified by center.

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Data availability

CHNC is a consortium of multiple hospitals, each with a formal legal agreement between the hospital and the CHNC organization. Because the data registry collects multiple elements of protected health information (PHI), the legal agreements strictly prohibit sharing of data among member hospitals or outside the organization

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Acknowledgements

Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber and Billie Short and ex-officio David Durand, Francine Dykes, Jeanette Asselin, are executive members of the Children’s Hospitals Neonatal Consortium, Inc., who developed and manage the CHND (thechnc.org). For more information, please contact: exec@thechnc.org. We appreciate Mr. John Mallett and Ms. Evelyn Werbaneth’s contribution to study design and data analysis. We are indebted to the following CHNC participating institutions that serve the infants and their families; these institutions (and their site sponsors) also have invested in and continue to participate in the Children’s Hospitals Neonatal Database (CHND): 1. Atlanta, Children’s Healthcare of Atlanta – Egleston (Anthony Piazza) 2. Atlanta, Children’s Healthcare of Atlanta - Scottish Rite (Gregory Sysyn) 3. Austin, Dell Children’s (Ashley Lucke, Molly Pont) 4. Birmingham, Children’s of Alabama (Allison Black, Carl Coghill) 5. Boston Children’s Hospital (Anne Hansen) 6. Charlotte, Levine Children’s Hospital (Eugenia Pallotto) 7. Chicago, Ann & Robert H. Lurie Children’s Hospital (Karna Murthy, Gustave Falciglia) 8. Cincinnati Children’s Hospital (Beth Haberman) 9. Cleveland Clinic (Tetyana Nesterenko) 10. Columbus, Nationwide Children’s Hospital (Thomas Bartman) 11. Dallas, Children’s Medical Center (Sushmita Yallapragada, Lina Chalak) 12. Denver, Children’s Hospital Colorado (Danielle Smith, Stephanie Bourque) 13. Detroit, Children’s Hospital Michigan (Girija Natarjan) 14. Ft. Worth, Cook Children’s Healthcare System (Annie Chi, Yvette Johnson) 15. Hartford, Connecticut Children’s (Annmarie Gotiolo) 16. Houston, Texas Children’s Hospital (Lakshmi Katarkan, Kristina Reber) 17. Indianapolis, Riley Children’s Health (Rebecca Rose) 18. Iowa City, University of Iowa Stead Family Children’s Hospital (Julie Lindower) 19. Kansas City, The Children’s Mercy Hospital (Julie Weiner) 20. Little Rock, Arkansas Children’s (Laura Carroll) 21. Los Angeles Children’s Hospital (Rachel Chapman) 22. Madison, American Family Children’s Hospital (Nina Menda) 23. Memphis, Le Bonheur Children’s Hospital (Mark Weems) 24. Minneapolis, Children’s Minnesota (Ann Downey) 25. Milwaukee, Wisconsin Children’s Hospital (Joanne Lagatta) 26. Oakland, UCSF Benioff Children’s Hospital (Priscilla Joe) 27. Oklahoma Children’s Hospital (Trent Tipple, Patricia Williams) 28. Omaha Children’s Hospital (Nicole Birge) 29. Orange County, Children’s Hospital of Orange County (Michel Mikhael) 30. Orlando, AdventHealth for Children (Narendra Dereddy, Rajan Wadhawan) 31. Orlando, Nemours Children’s Hospital (Aaron Weiss) 32. Philadelphia, Children’s Hospital of Philadelphia (Michael Padula) 33. Philadelphia, St. Christopher’s Hospital for Children (Vilarmis Quinones) 34. Phoenix Children’s Hospital (Pam Griffiths) 35. Pittsburgh Children’s Hospital (Toby Yanowitz) 36. Rochester, MN, Mayo Clinic Children’s (Ellen Bendel-Stenzel) 37. Salt Lake City, Primary Children’s Hospital (Con Yee Ling) 38. San Diego, Rady Children’s Hospital (Mark Speziale) 39. Seattle Children’s Hospital (Robert DiGeronimo, Elizabeth Jacobsen) 40. St. Louis Children’s Hospital (Beverly Brozanski, Rakesh Rao) 41. St Paul, Children’s Minnesota (Ann Downey) 42. St. Petersburg, All Children’s Hospital (Linda Van Marter) 43. Toronto, The Hospital for Sick Children (Kyong-Soon Lee) 44. Washington, Children’s National Hospital (Billie Lou Short) 45. Wilmington, Nemours/Alfred I. duPont Hospital for Children (Kevin Sullivan) 46. Winston-Salem, Brenner Children’s Hospital (Cherrie Welch)

Author information

Authors and Affiliations

  1. Children’s Hospital Colorado and University of Colorado School of Medicine, Department of Pediatrics, Division of Neonatology, Aurora, CO, USA

    Lauren A. Beard & Theresa R. Grover

  2. Children’s Hospitals Neonatal Consortium, Dover, DE, USA

    Isabella Zaniletti, Theresa R. Grover, Michael A. Padula & Karna Murthy

  3. Children’s Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael A. Padula

  4. Ann and Robert H. Lurie Children’s Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karna Murthy

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  1. Lauren A. Beard
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  2. Isabella Zaniletti
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Contributions

Dr. Beard conceptualized and designed the study; led data collection, analysis and interpretation; drafted the initial manuscript; reviewed and revised the manuscript; and approved the final manuscript as submitted. Isabella Zaniletti provided data analysis design and execution; led data collection, analysis, and interpretation; reviewed and revised the manuscript; and approved the final manuscript as submitted. Dr. Grover provided feedback on study design and execution; participated in data analysis and interpretation; reviewed and revised the manuscript; and approved the final manuscript as submitted. Dr. Padula provided feedback on study design and execution participated in data analysis and interpretation; reviewed and revised the manuscript; and approved the final manuscript as submitted. Dr. Murthy conceptualized and designed the study; led data collection, analysis, and interpretation; reviewed and revised the manuscript; and approved the final manuscript as submitted.

Corresponding author

Correspondence to Lauren A. Beard.

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The authors declare no competing interests.

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All methods were performed in accordance with the relevant guidelines and regulations. The CHNC consortium data is deidentified with the IRB exemption noted below. Use of this retrospective dataset does not constitute human subjects research requiring informed consent. The Stanley Manne Research Institute provided regulatory exemption of oversight on this project (IRB#: 2011-14673).

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Beard, L.A., Zaniletti, I., Grover, T.R. et al. Inter-center variation in non-elective removal of central catheters amongst level 4 NICUs. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02478-9

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