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A randomised, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial
  1. Pita Birch1,
  2. Simon Ogden2,
  3. Michael Hewson3
  1. 1Newborn Services, Auckland City Hospital, Auckland, New Zealand
  2. 2Department of Pharmacy, Wellington Hospital, Wellington, New Zealand
  3. 3Wellington Neonatal Unit, Wellington Hospital, Wellington, New Zealand
  1. Correspondence to Dr Pita Birch, Newborn Services, Level 9, Support Building, Auckland District Health Board, Private Bag 92 024, Auckland, New Zealand; pitabirch{at}


Background Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain.

Objective The goal of this study was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line.

Design/Methods This randomised, controlled, double blind, single-centre clinical trial compared heparin at 0.5 IU/ml with no heparin in TPN infused through a neonatal long line, with episodes of CRS as the primary outcome.

Results 210 infants were enrolled (TPN with heparin n=102, TPN without heparin n=108). There was a statistically significant reduction in all episodes of culture-positive CRS in those infants with heparin added to the TPN compared with those without heparin (p=0.04; RR 0.57, 95% CI 0.32 to 0.98; number needed to treat 9, 95% CI 4.6 to 212.4).

Conclusions The addition of heparin at 0.5 IU/ml to TPN infused through a neonatal long line reduces the incidence of culture-positive CRS.

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  • Funding This study was supported by grants from the New Zealand Grants Advisory Subcommittee of the Royal Australasian College of Physicians and the Baxter Clinical Nutrition Grant 2004.

  • Competing interests None.

  • Patient consent Obtained from parents.

  • Ethics approval This study was conducted with the approval of the Wellington Ethics Committee, Ministry of Health, PO Box 5013, approval number: WGT/03/08/079, Wellington.

  • Provenance and peer review Not commissioned; externally peer reviewed.

    This trial was registered on 4 October 2005 (trial start date 5 March 2004) with the Australian New Zealand Clinical Trials Registry (ACTRN12605000579695).