Initial vascular access for neonatal resuscitation: a systematic review

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CONTEXT: Establishing vascular access during advanced neonatal resuscitation or cardiac arrest can be difficult but critical for survival and other outcomes. Evidence is needed to support the choice between the available methods of vascular access. OBJECTIVE: To summarize and evaluate evidence on emergency vascular access methods during resuscitation in newborn infants up to 28 days after birth or 44 weeks postmenstrual age. DATA SOURCES: Ovid Medline, Embase, Cochrane and CINAHL were searched from inception to February 24, 2026. STUDY SELECTION: Randomized controlled trials (RCT), non-RCTs, interrupted time series, cohort studies, case series, and individual case reports (if describing complications) DATA EXTRACTION: Of 1381 articles identified, 16 articles (10 descriptive studies, 6 case reports) were included. RESULTS: No studies directly compared vascular access methods for the outcomes of time to heart rate >100 bpm, time to successful placement of devices, successful vascular access at first attempt or number of attempts. Most complications were reported with use of intraosseous (IO) devices. Umbilical vein catheters (UVC) were used primarily after hospital birth while IO devices were used in a wider range of settings. Evidence was insufficient to evaluate the use of peripheral vein catheters during neonatal resuscitation. LIMITATIONS: The lack of RCTs, small sample size and heterogeneity of the studies exclusively from high resource settings limit the generalizability of the results. CONCLUSIONS: Very low certainty evidence indicates that emergency UVC and IO access are feasible during neonatal resuscitation, but limited evidence on effectiveness, timeliness, and safety highlights the need for additional research.

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