Central Venous Catheter (CVC)-associated Primary Bloodstream Infection (PBSI) is an important cause of adverse events in newborns. In Brazil, it has an incidence of 26.3% (95% CI 18.4–35.0%), impacting clinical severity, length of hospital stay, and hospital costs.

To investigate potential risk factors for CVC-associated PBSI in neonates admitted to Neonatal Intensive Care Units (NICUs).

This is a retrospective cohort study conducted in a university hospital between March 2023 and May 2025. Neonates with CVCs were included, and the following clinical and care-related variables were analyzed: peripheral venipunctures, number of CVC manipulations, duration of use, mechanical ventilation (MV), parenteral nutrition, gestational age (GA), and birth weight. Binomial logistic regression was used (RStudio).

A total of 72 neonates were included (totaling 966 CVC-days), of whom 16 (22.9%) developed PBSI. A significant association with PBSI was observed for the number of peripheral venipunctures (p = 0.0311; OR = 1.07; 95% CI: 1.00–1.15), neonates with more than 5 punctures (OR: 6.31; 95% CI: 0.76–51.92), and use of MV (p = 0.0166; OR = 1.24; 95% CI: 1.04–1.48), particularly neonates with MV >10 days (OR: 6.4; 95% CI: 1.9–21.98). GA showed a trend toward a protective effect (p = 0.087; OR = 0.80; 95% CI: 0.66–1.03), with a significant reduction for GA >28 weeks (OR: 0.17; 95% CI: 0.05–0.60). A trend toward association was also observed for the number of CVC manipulations (p = 0.099; OR = 1.01; 95% CI: 1.00–1.03), with increased risk for more than 8 manipulations (OR: 6.5; 95% CI: 1.4–30.5). The other variables showed no significant association.

Statistical analysis identified that the number of peripheral venipunctures (>5) increased the likelihood of PBSI by 6.31%, and the use of MV (>10 days) increased the risk of PBSI by 6.4%. Additionally, a trend toward association was observed for the number of CVC manipulations (>8), increasing the chance of PBSI by 6.5%, with an estimated 1% increase in risk per manipulation. Gestational age showed a trend as a protective factor, with approximately a 20% reduction in the likelihood of PBSI for each additional week of gestation beyond 28 weeks. The data demonstrate the importance of potentially modifiable care-related factors as significantly associated with increased risk of PBSI development, such as punctures and catheter reinsertions.