Central venous catheters are commonly used in the management of newborn infants who are preterm or have other potentially life‐threatening illness. The use of central venous catheters is recognised as a risk factor for nosocomial infection (Adams‐Chapman 2002; Apostolopoulou 2004; Chien 2002; Nagata 2002; Stoll 2002). Giving parenteral nutrition is an indication for the use of central venous catheters, and is also a risk factor for nosocomial infection in newborns (Adams‐Chapman 2002) and older patients (Hodge 2002). Nosocomial infection may be associated with significant morbidity and mortality (Nagata 2002; Stoll 2002). Nosocomial infection may lead to increased duration of respiratory illness, including chronic lung disease (Liljedahl 2004; Van Marter 2002), and increased need for respiratory support (Ogawa 1999; Stoll 2002); increased length of hospital stay (Isaacs 2003; Stoll 2002); and impaired neurodevelopmental outcome (Stoll 2004).

By virtue of their underlying illness, patients requiring central venous catheters may have impaired defence mechanisms ‐ both local and systemic. Prematurity is recognised as a risk factor for late onset sepsis (Dear 1999), and it is often these infants in whom central venous catheters are used. Preterm neonates are at high risk of infection because of impaired immunity and central venous catheters may further increase this risk because they are foreign bodies. Central venous catheters are also commonly used in infants with major abdominal pathology or other surgical illness. Infants receiving TPN for surgical conditions have been shown to have impaired immune responses (Cruccetti 2003).

The Centers for Disease Control (in the USA) provides recommendations for the prevention of catheter‐related infections when using central venous catheters. The CDC does not recommend the use of antimicrobial prophylaxis (O'Grady 2002). However, in some neonatal units, it is standard practice to use antimicrobial prophylaxis in infants with central venous catheters in an attempt to reduce catheter colonisation and thereby reduce the risk of acquired infection. The choice of antibiotics depends on the most frequently encountered organisms, which may vary with local circumstances. Based on their own experience and retrospective analysis, Shaul et al (Shaul 1998) recommend antibiotic prophylaxis at the time of insertion of tunnelled or implantable subcutaneous central venous catheters. In a randomised controlled trial, Henrickson et al (Henrickson 2000) demonstrated a reduction in infection following administration of antibiotic/heparin solutions to paediatric oncology patients with tunnelled central venous catheters. They concluded that the prophylaxis was well tolerated and stated that it would not lead to an increase in emergence or spread of vancomycin‐resistant enterococcus, as they did not find any in their study.

Prophylactic antibiotics may be effective in preventing catheter‐related blood stream infection in newborns, but may have the undesirable effect of promoting the emergence of resistant strains of micro‐organisms (Freij 1999) or of altering the pattern of isolates causing infection (Viudes 2002). A policy of prophylactic antibiotic use must take this possibility into account, and has been used as a basis for arguing against implementation of prophylactic antibiotics (Haas 2003; Isaacs 2000; Isaacs 2003; McGuire 2004). The emergence of resistant strains of organisms will develop over time and may vary between different antibiotics.

Recent Cochrane systematic reviews on the use of prophylactic antibiotics for neonates with umbilical artery (Inglis 2004) and venous (Inglis 2005) catheters showed that there is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when using such catheters in newborn infants.