In neonatal intensive care units around the world, short peripheral catheters (SPCs) constitute a cornerstone of vascular access for newborns requiring intravenous therapy. These devices, valued for their relative ease of insertion and minimally invasive nature, enable the delivery of life-saving fluids, medications, and nutrition. However, as indispensable as SPCs are, their use is not without peril. A recent comprehensive scoping review sheds light on an underappreciated yet profoundly concerning complication inherent in neonatal SPC use: peripheral infusion-related infiltration and extravasation. The study uncovers nuances in detection practices, highlights gaps in clinical protocols, and advocates for timely intervention strategies that could dramatically enhance patient outcomes in this vulnerable population.
Peripheral infusion-related infiltration and extravasation refer to the inadvertent leakage of intravenous fluids from the vein into surrounding tissues. While infiltration involves the leakage of non-vesicant fluids, extravasation denotes the escape of vesicant substances capable of causing tissue damage. In neonates, this complication assumes critical significance due to their fragile skin, underdeveloped vasculature, and limited subcutaneous fat, factors which compound their susceptibility to tissue injury and long-term morbidity. Notably, the small caliber of neonatal veins and their propensity for vein collapse further increase the risk of catheter-related complications, making the early detection of infiltration and extravasation paramount.
The scoping review, conducted by van Rens et al. and published in Pediatric Research in 2025, meticulously canvassed extant literature surrounding detection methodologies for these catheter-related complications in neonates. The effort to distill effective detection techniques stems from the recognition that infiltration and extravasation are frequently underreported or misdiagnosed, often resulting in delayed management. The review emphasizes the critical need for systematic assessment tools and trained clinical vigilance as foundational elements in reducing adverse outcomes associated with SPCs.
The physiological profile of neonatal skin and vasculature underlies the increased risk associated with SPC complications. Neonatal dermal layers are substantially thinner compared to adults, characterized by a delicate epidermal barrier and immature collagen matrix. This structural immaturity facilitates faster propagation of extravasated agents into the interstitial space, accelerating tissue ischemia and necrotic damage in severe cases. Moreover, neonatal veins possess smaller diameters and reduced vessel wall elasticity, challenging catheter stabilization and increasing the likelihood of mechanical disruption causing infiltration.
The review highlights the clinical signs traditionally relied upon for infiltration and extravasation detection, such as localized swelling, erythema, tenderness, and coolness of the surrounding tissues. However, these signs are often subtle or nonspecific in neonates, thwarting straightforward clinical assessment. Consequently, the authors urge the integration of objective monitoring systems alongside clinical examination. Technologies such as near-infrared (NIR) thermography and ultrasound imaging possess latent potential for noninvasively visualizing catheter placement and fluid extravasation, yet their deployment in routine neonatal care remains sporadic.
A major revelation from the scoping review pertains to the lack of standardized assessment scales for infiltration and extravasation severity in neonates. Unlike adult and pediatric populations where validated scales exist, neonatal care practices are hindered by heterogeneous assessment protocols and insufficient training on early warning signs. This heterogeneity contributes to the inconsistent reporting of such adverse events and impedes the development of universally accepted management guidelines. The authors advocate for the construction and validation of dedicated neonatal assessment instruments to streamline detection efforts.
Compounding the diagnostic challenge is the variability in the composition of infused solutions. Several vesicant drugs commonly administered via SPCs, including certain chemotherapeutic agents and parenteral nutrition components, possess varying degrees of cytotoxicity and osmolarity. These properties influence the extent and severity of tissue damage following extravasation. The review underscores the necessity for tailored monitoring protocols corresponding to the specific pharmacologic agents infused, emphasizing that vigilant observation must increase commensurate with vesicant potency.
Early and accurate identification of infiltration and extravasation is pivotal, as delayed intervention substantially elevates the risk of tissue necrosis, scarring, and in extreme cases, limb ischemia requiring surgical intervention. The review discusses current management strategies, highlighting the cornerstone principles of prompt catheter removal, limb elevation, and careful application of compresses. Adjunct therapies such as hyaluronidase injections to disperse extravasated solutions and the potential use of antidotes for specific agents are addressed, although evidence in neonates remains limited and often extrapolated from adult studies.
Crucially, the scoping review illuminates the role of multidisciplinary teams in mitigating SPC-related extravasation injuries. Nursing staff, who frequently serve as the first line of inspection, require targeted education and validated toolkits to enhance detection sensitivity. Meanwhile, neonatologists, pharmacists, and wound care specialists are integral to crafting individualized care plans when extravasation occurs. Strengthening communication pathways among these professionals emerges as a critical recommendation to ensure timely, coordinated responses.
One of the most promising avenues to reduce infiltration and extravasation events lies in the optimization of insertion techniques and catheter materials. The authors reference recent advancements in catheter technology, such as the development of bioengineered catheters with improved biocompatibility and flexible tips designed to minimize endothelial trauma. Additionally, ultrasound-guided insertion protocols enhance vein visualization and catheter placement accuracy, reducing mechanical complications. Adoption of these innovations in neonatal practice could significantly ameliorate infusion safety profiles.
The review also calls attention to underexplored areas warranting future research. There is an urgent need for large-scale, prospective studies that systematically evaluate detection tools and intervention outcomes in neonatal populations. Such studies would facilitate the generation of high-quality evidence, informing evidence-based guidelines and international standards. Moreover, the integration of technological modalities including continuous infusion pressure monitoring and advanced imaging techniques holds promise but requires rigorous validation before routine clinical implementation.
Importantly, the psychological impact on neonates and their families following extravasation injuries warrants acknowledgment. Pain, prolonged hospitalization, and cosmetic sequelae can contribute to distress and impair long-term quality of life. The review advocates for holistic care models that incorporate family education, pain management protocols, and psychosocial support, fostering resilience in this delicate patient population.
In light of the outlined challenges and emerging insights, the scoping review by van Rens and colleagues represents a pivotal contribution to neonatal care literature. By systematically highlighting current knowledge gaps and advocating for comprehensive detection and management frameworks, the study sets the stage for improved clinical practices that prioritize safety without compromising the essential benefits of SPC use. Enhanced vigilance, coupled with technological innovation and multidisciplinary collaboration, may redefine standards of care and reduce preventable harm associated with neonatal peripheral infusions.
As neonatal healthcare professionals digest these findings, the imperative to implement early recognition protocols becomes resoundingly clear. Embedding standardized assessment tools, promoting staff education, and embracing technological adjuncts represent actionable steps to transform neonatal infusion therapy safety. Ultimately, this review serves as a clarion call to the pediatric community to elevate practices surrounding SPC use, ensuring that the lifelines intrinsic to neonatal survival do not inadvertently become sources of harm.
Intravenous access remains a double-edged sword in the neonatal arena—indispensable yet fraught with risk. The advances charted in this review illuminate a path toward harnessing the clinical benefits of SPCs while minimizing associated morbidities through vigilant detection and meticulous management. By fostering an environment of continued research, clinical innovation, and multidisciplinary engagement, the neonatal care field can move decisively toward safeguarding the smallest and most vulnerable patients entrusted to its care.
Subject of Research: Detection of peripheral infusion-related infiltration and extravasation complications in neonates using short peripheral catheters.
Article Title: Detection of peripheral infusion-related infiltration and extravasation in neonates: a scoping review.
Article References:
van Rens, M.F.P.T., Huis, A., Hugill, K. et al. Detection of peripheral infusion-related infiltration and extravasation in neonates: a scoping review. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04367-5
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41390-025-04367-5
Tags: catheter-related complications in infantsclinical protocols for neonatal careearly detection of infusion issuesenhancing patient outcomes in neonatal careinfiltration and extravasation in infantsintravenous therapy in newbornsminimizing tissue damage in neonatesneonatal intensive care unit protocolsneonatal peripheral infusion complicationsshort peripheral catheters in neonatologytimely intervention strategies in NICUvascular access challenges in neonates
