Development and validation of a nomogram for predicting unplanned PICC removal in preterm infants with gestational age <32 weeks.

OBJECTIVE

To develop and validate a risk prediction model for unplanned removal (UR) of peripherally inserted central catheters (PICC) in preterm infants with gestational age (GA) < 32 Weeks.

METHODS

This retrospective study analyzed preterm infants with PICC admitted to a neonatal intensive care unit (NICU) (January 2018 to December 2024). Clinical and catheter-related variables were assessed. Multivariable logistic regression identified predictors of PICC-UR, with model performance evaluated by C-index, calibration, and decision curve analysis (internal validation via 1000 bootstraps).

RESULTS

We identified five independent predictors for PICC-UR: insertion site (categorical), white blood cell count (WBC), platelet count (PLT), and fibrinogen (Fib) (all modeled as continuous linear terms), along with hypercholanemia (HCA). These predictors were integrated into a nomogram designed to estimate the individual risk of PICC-UR in preterm infants. The predictive model demonstrated a high accuracy with a C-index of 0.827 [95% confidence interval (CI): 0.740-0.915]. Internal validation confirmed excellent calibration and significant clinical utility based on decision curve analysis.

CONCLUSIONS

This validated nomogram, incorporating insertion site, WBC, PLT, Fib and HCA, aids early identification of high-risk infants. It offers actionable insights for optimizing PICC fixation and biochemical monitoring, potentially reducing PICC-UR in NICU.