The First "Line" for a Premature Baby: Why the Belly-Button Catheter Still Wins on Day One

A plain-language look at a randomized study (Oğuz and colleagues, Children, 2025) comparing two ways of giving a tiny newborn fluids and medicine

Premature babies are often too small and too fragile to be fed by mouth or to have ordinary IV drips in their arms and legs, so within the first hours of life the medical team places a thin, soft tube called a central line into a large vein to deliver nutrition, sugar, and medicines safely. A new randomized study compared the two lines used most often — one threaded through the newborn's belly-button vein and one threaded up from a vein in the arm or leg — to see which is the better choice to place first. The answer was clear: the belly-button line was quicker to place, needed fewer needle attempts, and ran into fewer mechanical problems, while carrying no extra risk of infection over the roughly one week it stayed in.

Why This Question Matters

For a baby weighing less than about three-and-a-half pounds, every needle stick is stressful and every hour without stable access to a vein delays the nutrition and medicine the baby needs to grow. A dependable central line makes an enormous difference; research over many years has shown that babies with a good central line gain weight faster, go home sooner, and have fewer infections than babies who need to be stuck over and over for ordinary IVs [1]. So the question is not whether to place a central line, but which line to place first — and that is exactly what families and clinicians have long wondered about.

The two options each have a long history. The umbilical venous catheter, or UVC, uses the vein inside the umbilical cord stump, which is still open in the first hours after birth. This makes it fast and painless to place because the cord itself has no feeling. The peripherally inserted central catheter, or PICC, is a very fine tube threaded from a small vein in the arm or leg up toward the heart. Both have saved countless lives, but both can also cause problems — infection, blood clots, or the tube slipping out of place [2].

How Families and Clinicians Used to Face This

For decades the umbilical line was almost always placed first simply because it is so quick. The catch has always been how long to leave it in. Studies found that if an umbilical line stays in too long — beyond about five to seven days — the chance of a bloodstream infection starts to climb, so most units learned to remove it within a week and, if the baby still needed access, switch to a longer-lasting line [3]. Doctors built careful checklists and routines around this timing [4], and expert groups agreed on the roughly one-week limit, while honestly admitting that no high-quality trial had ever nailed down the exact best approach [5].

That uncertainty led some teams to a different idea: what if you skipped the umbilical line altogether and placed the longer-lasting arm-or-leg line (the PICC) right from day one? In theory, one durable line could mean one procedure instead of two. Earlier studies that simply observed babies rather than randomly assigning them had suggested the two lines were fairly similar for infection [6], but almost no one had directly tested the "PICC-first" idea in a fair, coin-toss-style comparison [7]. This study was designed to do just that.

What the Researchers Did

The team, working in a single large newborn intensive care unit, enrolled 136 premature babies who each weighed no more than about 1500 grams (roughly 3.3 pounds) and were less than a day old [8]. Using a method as fair as a coin toss, each baby was randomly assigned to receive either a UVC or a PICC as their very first line. Experienced staff placed every line and confirmed its position with an X-ray and ultrasound. The two groups of babies were very similar in size and maturity at the start, which is important because it means any difference in results came from the type of line, not from one group being sicker or smaller than the other. The researchers then tracked how long each line lasted, how hard it was to place, and what problems came up.

What They Found

The umbilical line came out ahead on nearly every practical measure. It took about half as long to place — roughly one minute versus two — and needed fewer attempts. It also spared babies from many extra pokes and procedures down the line. Most strikingly, the arm-or-leg line failed early far more often: within the first two days, 24 of the PICCs stopped working and had to be removed, compared with only 5 of the umbilical lines. When a line fails on day one or two, the baby is back to being stuck repeatedly for ordinary IVs at the worst possible moment.

Counting all the mechanical problems together — clots, fluid leaking into the tissue, or bleeding — 40 out of every 100 PICCs had to be removed for such a problem, compared with only 14 out of every 100 umbilical lines. Fluid leaking into the surrounding tissue, in particular, was much more common with the PICC. This is not surprising when you picture the two tubes: the arm-or-leg line used in this study was extraordinarily thin — finer than a human hair in places — which makes it slow to thread and easy to kink, block, or dislodge in a baby who is constantly moving. The belly-button line is wider and sits in a larger vein, so it stays put more reliably and can even be used to draw blood samples, sparing the baby extra needle sticks.

Importantly, the two lines were essentially tied when it came to infection: about a quarter of babies in each group had a line removed for a possible infection, and the measured infection rates were similar and in line with what other hospitals report [9]. In other words, choosing the belly-button line first did not expose babies to more infection — it simply avoided many of the mechanical headaches. Both lines stayed in for about the same length of time, roughly a week, so the differences came from the type of line rather than how long it was used. After their umbilical line was removed, about 1 in 4 babies went on to get a PICC for continued, longer-term access — showing that the two lines can work as a team rather than as rivals, with each one used for the job it does best.

What This Means for Your Baby

The reassuring bottom line is that the familiar approach many units already use is well supported: place the quick, gentle umbilical line first, then switch to a PICC later only if the baby still needs access. There is no proven benefit to starting with the harder-to-place PICC, and a real downside — it is far more likely to fail in the first couple of days [3][10]. If your baby's umbilical line is later replaced by a PICC, that is a planned, normal step to keep access safe over time, not a sign that anything went wrong. And when a PICC is used, the team's careful work to position the tip correctly and watch the line closely is what keeps it safe [11][12].

A few honest limits are worth knowing. This was a single hospital's study with a modest number of babies, and it did not follow children long enough to measure rare, long-term effects such as a clot in the liver's main vein, which can occasionally follow an umbilical line and, very rarely, cause problems years later. The very thin PICC used here may also differ from the ones some hospitals use today, and a unit with a lot of experience placing PICCs might see a smaller difference between the two lines than this study found. None of this changes the everyday message, but it is why researchers are careful to say that larger studies are still needed to confirm the findings before they become a firm rule for every hospital.

What Researchers Are Working on Next

The next step is bigger studies across many hospitals, using today's catheter models and more thorough scanning for blood clots, and following children long enough to check for any lasting effects [13]. Researchers also want to agree on a single, shared way of defining line infections so different hospitals can be compared fairly. For now, though, families can take comfort in a simple, steady message: the belly-button line placed soon after birth is a fast, well-tested, and low-stress way to begin caring for a premature baby, and the team's plan to remove it at the right time and switch lines when needed is exactly the kind of careful, evidence-based care their baby deserves.

References

  1. Yang ZM, Wang SN, Ma YL, et al. Application of umbilical venous catheter combined with peripherally inserted central catheter in very low birth weight infants. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15(5):353–355. PMID:23676938 ↩
  2. Hess S, Poryo M, Böttger R, et al. Complications associated with umbilical vein catheters and peripherally inserted central catheters in premature infants with a birth weight < 1250 g. Wien Med Wochenschr. 2023;173(7-8):161–167. doi:10.1007/s10354-022-00979-2 ↩
  3. Shalabi M, Adel M, Yoon E, et al; Canadian Neonatal Network. Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates. Pediatrics. 2015;136(6):1073–1079. doi:10.1542/peds.2015-2710 ↩
  4. Butler-O'Hara M, D'Angio CT, Hoey H, Stevens TP. An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. J Pediatr. 2012;160(6):972–977.e2. doi:10.1016/j.jpeds.2011.12.004 ↩
  5. Keir A, Giesinger R, Dunn M. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5–7 days) central venous access? J Paediatr Child Health. 2014;50(8):649–652. doi:10.1111/jpc.12690 ↩
  6. Konstantinidi A, Sokou R, Panagiotounakou P, et al. Umbilical venous catheters and peripherally inserted central catheters: are they equally safe in VLBW infants? A non-randomized single-center study. Medicina (Kaunas). 2019;55(8):442. doi:10.3390/medicina55080442 ↩
  7. Dongara AR, Patel DV, Nimbalkar SM, Potana N, Nimbalkar AS. Umbilical venous catheter versus peripherally inserted central catheter in neonates: a randomized controlled trial. J Trop Pediatr. 2017;63(5):374–379. doi:10.1093/tropej/fmw099 ↩
  8. Oğuz ŞS, Demirel T, Bozkurt M, et al. Umbilical and peripheral venous catheter-related outcomes in premature neonates. Children (Basel). 2025;12(11):1472. doi:10.3390/children12111472 ↩
  9. Gupta S, Patwardhan G, Parikh T, Kadam S, Vaidya U, Pandit A. Which long line do we use in very low birth weight neonates; umbilical venous catheter or peripherally inserted central catheter? J Neonatal Perinatal Med. 2021;14(2):229–235. doi:10.3233/NPM-190379 ↩
  10. Arnts IJ, Bullens LM, Groenewoud JM, Liem KD. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs. 2014;43(2):205–215. doi:10.1111/1552-6909.12278 ↩
  11. Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol. 2013;33(4):307–312. doi:10.1038/jp.2012.112 ↩
  12. Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics. 2010;125(4):648–653. doi:10.1542/peds.2009-2559 ↩
  13. Van Ommen CH, Bergman KA, Boerma M, et al. NEOnatal Central-venous Line Observational study on Thrombosis (NEOCLOT): evaluation of a national guideline on management of neonatal catheter-related venous thrombosis. J Thromb Haemost. 2023;21(4):963–974. doi:10.1016/j.jtha.2022.11.044 ↩