A review of superior vena cava flow measurement in the neonate by functional echocardiography

McGovern, Matthew; Miletin, Jan

doi:10.1111/apa.13584

Cited by 18 publications

(12 citation statements)

References 63 publications

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“…The incidence of low SVC flow is observed to be decreasing over the last 15 years. 4,10,11,24 In the current study, incidence of low SVC flow defined as ≤55 ml/kg/min was 32% and defined as <41 ml/kg/min was 11%, which is consistent with the recently reported studies. 10,25 RVO has been reported to be affected by ductal diameter, foraminal shunting, and worsening respiratory disease reflected by higher FiO 2 and mean airway pressure.…”

Section: Discussionsupporting

confidence: 92%

“…There are several potential reasons for this including timing of cardiac ultrasound measurement, definitions for low SVC flow, incidence of low SVC flow, time of detection of IVH, improved obstetric care and increasing use of less invasive ventilation of preterm infants. 24 Early and late P/IVH have distinct and different risk factors. Early P/IVH was reported to be associated with vaginal delivery and low one minute Apgar score, whereas late P/IVH was associated with antecedent low SVC flow in the first day.…”

Section: Discussionmentioning

confidence: 99%

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Associations of measures of systemic blood flow used in a randomized trial of delayed cord clamping in preterm infants

et al. 2019

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OBJECTIVE: To determine associations of low superior vena cava (SVC) flow (≤55 ml/kg/min) and low right ventricular output (RVO) (≤150 ml/kg/min) in preterm infants. DESIGN/METHODS: An observational study in infants <30 weeks gestation randomized to receive immediate (<10 s) or delayed cord clamping (DCC) (≥60 s). RESULTS: The study enrolled 265 infants with a mean (SD) gestation 28 (2) weeks. Eighty-six (33%) infants had low SVC flow and 81 (31%) infants had low RVO. In multivariate analysis, low SVC flow was associated with gestation; low RVO was associated with DCC, gender and 5-minute Apgar; whereas mean RVO was negatively associated with both FiO 2 and mean airway pressure (MAP) at 9 h and 24 h. Low SVC flow was associated with ductus arteriosus (DA) treatment. Infants with low RVO had higher mortality on univariate analysis, but this was not significant after adjusting for gestation. CONCLUSIONS: SVC flow was associated with gestation, whilst RVO was associated with placental transfusion, gender, condition at birth, and early respiratory adaptation. Compared to infants with normal values, more infants with low SVC flow were treated for DA, but infants with low RVO had no significant difference in mortality or morbidity.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Associations of measures of systemic blood flow used in a randomized trial of delayed cord clamping in preterm infants

et al. 2019

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“…Since its initial description, low-SVC flow in the neonatal population has been shown to correlate with a variety of adverse short- and long-term outcomes ( 8 , 9 , 18 – 23 , 27 , 68 ). Compared with the other echocardiography-based techniques described, SVC flow has the advantage of being unaffected by shunting and is considered by many to be the most robust echocardiography technique for measurement of central blood flow ( 69 ). Similar to other methodologies discussed, however, there are concerns around the repeatability of the technique with studies on inter- and intra-observer variability, showing potential variability of between 1 and 102% and 1 and 34%, respectively ( 66 , 70 , 71 ).…”

Section: Non-invasive Methodologiesmentioning

confidence: 99%

Cardiac Output Monitoring in Preterm Infants

McGovern

Miletin

2018

Front. Pediatr.

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Maintaining optimal circulatory status is a key component of preterm neonatal care. Low-cardiac output (CO) in the preterm neonate leads to inadequate perfusion of vital organs and has been linked to a variety of adverse outcomes with heightened acute morbidity and mortality and adverse neurodevelopmental outcomes. Having technology available to monitor CO allows us to detect low-output states and potentially intervene to mitigate the unwanted effects of reduced organ perfusion. There are many technologies available for the monitoring of CO in the preterm neonatal population and while many act as useful adjuncts to aid clinical decision-making no technique is perfect. In this review, we discuss the relative merits and limitations of various common methodologies available for monitoring CO in the preterm neonatal population. We will discuss the ongoing challenges in monitoring CO in the preterm neonate along with current gaps in our knowledge. We conclude by discussing emerging technologies and areas that warrant further study.

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“…78,79 However, with appropriate training functional echocardiography is becoming standard of care in many neonatal units in Australia, America, and Europe with reliable and reproducible results. 80,81 The option of performing venous Doppler measurements instead of arterial ones could be interesting. The venous system is less influenced by vascular tone or shunts (i.e., PDA).…”

Section: Generalmentioning

confidence: 99%

Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

et al. 2020

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Cools 1 on behalf of the eurUS.brain group INTRODUCTION: Very and extremely preterm infants frequently have brain injury-related long-term neurodevelopmental problems. Altered perfusion, for example, seen in the context of a hemodynamically significant patent ductus arteriosus (PDA), has been linked to injury of the immature brain. However, a direct relation with outcome has not been reviewed systematically. METHODS: A systematic review was conducted to provide an overview of the value of different cerebral arterial blood flow parameters assessed by Doppler ultrasound, in relation to brain injury, to predict long-term neurodevelopmental outcome in preterm infants. RESULTS: In total, 23 studies were included. Because of heterogeneity of studies, a meta-analysis of results was not possible. All included studies on resistance index (RI) showed significantly higher values in subjects with a hemodynamically significant PDA. However, absolute differences in RI values were small. Studies using Doppler parameters to predict brain injury and long-term neurodevelopmental outcome were inconsistent. DISCUSSION: There is no clear evidence to support the routine determination of RI or other Doppler parameters in the cerebral arteries to predict brain injury and long-term neurodevelopmental outcome in the preterm infant. However, there is evidence that elevated RI can point to the presence of a hemodynamically significant PDA.

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A review of superior vena cava flow measurement in the neonate by functional echocardiography

Cited by 18 publications

References 63 publications

Associations of measures of systemic blood flow used in a randomized trial of delayed cord clamping in preterm infants

Associations of measures of systemic blood flow used in a randomized trial of delayed cord clamping in preterm infants

Cardiac Output Monitoring in Preterm Infants

Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

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