Can the non-tunneled central venous catheters be an alternative for neonatal tunneled catheters? A prospective cohort study from a low-resource setting

Introduction: The aim of this study was to compare the insertion difficulty and outcomes of non-tunneled cuffed central venous catheters (CVCs), recently introduced in neonates in our limited-resource setting, to tunneled CVCs. Methods: This prospective cohort study was conducted in the pediatric anesthesia department at the Hedi Chaker University Hospital of Sfax, in Tunisia, during the period lasting from January 2024 to October 2025. We included all neonates (<1 month) who had a central line inserted in the operating room of pediatric surgery under sevoflurane sedation. Then, we compared the insertion success rate, difficulties during insertion, and the outcomes of tunneled CVCs versus non-tunneled CVCs. Univariate logistic regression analyses were used to determine the risk ratio (RR) with the 95% approximate confidence intervals related to non-tunneled CVCs. The significance level was set at p < 0.05. Results: Eighty-three newborns were included: 38 in the tunneled CVC group and 45 in the non-tunneled CVC group. Demographic data including age, weight, and gender were comparable in both groups. The central line insertion failed in four children from the non-tunneled CVC group (8.8%) versus no patients from the tunneled CVC group, with p = 0.035 and RR = 1.125 [1.04–1.556]. The incidence of central line-related morbidity was 50% in the tunneled CVC group versus 20% in the non-tunneled CVC group with p < 0.001 and RR = 0.745 [0.314-0.901]. The duration of the central lines was comparable in both groups. Conclusion: The insertion of a non-tunneled CVC is more challenging than tunneled catheters in neonates. Nevertheless, their reduced incidence of complications and their comparable lifetime can justify their use as an alternative for the tunneled CVCs among this population.