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Safety of enteral nutrition practices in neonates with umbilical arterial catheters in situ: current evidence to guide clinical practice

Journal of Perinatology (2025)Cite this article

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Abstract

Umbilical arterial catheters (UAC) in neonates are used for blood pressure monitoring, blood sampling, administration of fluids, nutrition, and medications. As UAC applications evolve, enteral nutrition practices vary in neonates in the presence of a UAC. The theoretical concern for mesenteric ischemia when a UAC is in place led to early nil per os approaches, delaying the initiation of enteral nutrition. More contemporary practices have favored introducing enteral feeding in neonates with UACs. However, there remains a paucity of data to guide clinical practice approaches regarding enteral feeding in neonates with a UAC in place. In this perspective article, we examine the physiological effects of UACs and review existing literature on feeding practices in neonates with a UAC. We offer an approach to managing enteral feeding in neonates with a UAC, addressing the central question: Is routine feeding in neonates with a UAC in place justified in current clinical practice?

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Fig. 1: Determinants of enteral nutrition practices in neonates with an umbilical arterial catheter (UAC) in place include.
Fig. 2: Current evidence pertaining to enteral nutrition when umbilical arterial catheter (UAC) is in place.

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Acknowledgements

Childrens Hospital Neonatal Consortium (CHNC) Cardiac and Extreme Preterm Infants Focus Groups.

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Authors and Affiliations

  1. Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Giulia Lima, Sarah U. Morton & Philip T. Levy

  2. Section of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Amy B. Hair

  3. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Misty Good & Erika Yazawa

  4. Division of Neonatology, University of Tennessee Health Science Center and Le Bonheur Children’s Hospital, Memphis, TN, USA

    Mark Weems

  5. Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Caroline E. Crocker

  6. Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Patricia Denning

  7. Division of Neonatology, The Ohio State University/Nationwide Children’s Hospital, Columbus, OH, USA

    Leeann Pavlek

  8. Department of Pediatrics, Wake Forest School of Medicine and Levine Children’s Hospital, Charlotte, NC, USA

    Eugenia Pallotto

  9. Division of Neonatology, Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA

    Leah Staines

  10. Divisions of Neonatology and Pain and Palliative Care, Fetal Care Program, Connecticut Children’s Medical Center, Hartford, CT, USA

    DonnaMaria Cortezzo

  11. Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA

    DonnaMaria Cortezzo

  12. Department of Pediatrics, UC Davis, Sacramento, CA, USA

    Satyan Lakshminrusimha

  13. Division of Newborn Medicine, UPMC Magee-Women’s Hospital/Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    John Ibrahim

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Contributions

PL and JI conceptualized and designed the study. GL drafted the initial manuscript, and critically reviewed and revised the manuscript. SUM, AH, MG, LP, MW, PL, PD, CC, EY, LP, EP, EG, DC, JI, SL assisted with study design and provided expert input. SL provided figures. All authors critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted.

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Correspondence to Philip T. Levy.

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Lima, G., Morton, S.U., Hair, A.B. et al. Safety of enteral nutrition practices in neonates with umbilical arterial catheters in situ: current evidence to guide clinical practice. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02509-5

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