Bioreactance-derived haemodynamic parameters in the transitional phase in preterm neonates: a longitudinal study

Wyk, Lizelle Van; Smith, Johan; Lawrenson, John; Lombard, Carl; Boode, Willem P. de

doi:10.1007/s10877-021-00718-9

Cited by 3 publications

(2 citation statements)

References 48 publications

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“…In line with Miletin et al, bioreactance-derived CO was found to change with postnatal age within the transitional period in a cohort of more mature preterm infants. Comparable to recent studies using bioreactance [ 6 , 7 , 15 ], our model also shows that EC-derived CO increased during the transitional period. Normative values for EC-derived CO in the transitional period are limited.…”

Section: Discussionsupporting

confidence: 84%

Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study

Schwarz,

O’Toole,

Healy

et al. 2024

Eur J Pediatr

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The purpose of this study is to evaluate the association of Electrical Cardiometry (EC)-derived cardiac output indexed to weight (CO) and its changes during the first 48 h in relation to adverse short-term outcome in very preterm infants. In this prospective observational study of preterm infants < 32 weeks gestational age (GA), the combined adverse outcome was defined as mortality or abnormal cranial ultrasound (any grade intracranial hemorrhage (ICH) or periventricular leukomalacia) within the first 2 weeks postnatally. Logistic regression models were used to investigate the association between median CO and outcome and mixed-effects models for the time trajectory of CO. In the absence of device-specific thresholds for low or high CO, no thresholds were used in our analysis. Fifty-three infants (median (IQR) GA 29.0 (25.4–30.6) weeks, birthweight 1020 (745–1505) g) were included in the analysis. Median CO was 241 (197–275) mL/kg/min for the adverse outcome and 198 (175–227) mL/kg/min for normal outcome (odds ratio (OR) (95% confidence interval (95% CI)), 1.01 (1.00 to 1.03); p = 0.028). After adjustment for GA, the difference was not significant (adjusted OR (95% CI), 1.01 (0.99 to 1.02); p = 0.373). CO trajectory did not differ by outcome (p = 0.352). A post hoc analysis revealed an association between CO time trajectory and ICH ≥ grade 2. Conclusions: EC-derived CO estimates within 48 h postnatally were not independently associated with brain injury (any grade) or mortality in the first 14 days of life. CO time trajectory was found to be associated with ICH ≥ grade 2. What is Known:• Bioreactance-derived cardiac output indexed to bodyweight (CO) in the transitional period has been associated with adverse short-term outcome in preterm infants. What is New:• Electrical Cardiometry (EC)-derived CO measurements in very preterm infants during the transitional period are not independently associated with adverse outcome (death or ultrasound detected brain damage) within 2 weeks postnatally.• In the first 48 h EC-derived CO increases over time and is higher in extremely preterm infants compared to very preterm and differs from previously reported bioreactance-derived CO values.

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Section: Discussionsupporting

confidence: 84%

Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study

Schwarz,

O’Toole,

Healy

et al. 2024

Eur J Pediatr

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“…Others explored its application in the management of intensive care, perioperative and neonatal patients. However, the results of these different studies are contradictory [10][11][12][13][14][15][16][17]. To date, only one study was conducted in a cohort of 50 patients with PH.…”

Section: Introductionmentioning

confidence: 99%

Bioreactance assessment of cardiac output lacks reliability for the follow-up of patients with pulmonary hypertension

Turquier,

Huot,

Lamkhioued

et al. 2024

PLoS ONE

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Cardiac output (CO) is one of the primary prognostic factors evaluated during the follow-up of patients treated for pulmonary hypertension (PH). It is recommended that it be measured using the thermodilution technique during right heart catheterization. The difficulty to perform iterative invasive measurements on the same individual led us to consider a non-invasive option. The aims of the present study were to assess the agreement between CO values obtained using bioreactance (Starling™ SV) and thermodilution, and to evaluate the ability of the bioreactance monitor to detect patients whose CO decreased by more than 15% during follow-up and, accordingly, its usefulness for patient monitoring. A prospective cohort study evaluating the performance of the Starling™ SV monitor was conducted in patients with clinically stable PH. Sixty patients referred for hemodynamic assessment were included. CO was measured using both the thermodilution technique and bioreactance during two follow-up visits. A total of 60 PH patients were included. All datasets were available at the baseline visit (V0) and 50 of them were usable during the follow-up visit (V1). Median [IQR] CO was 4.20 l/min [3.60–4.70] when assessed by bioreactance, and 5.30 l/min [4.57–6.20] by thermodilution (p<0.001). The Spearman correlation coefficient was 0.51 [0.36–0.64], and the average deviation on Bland-Altman plot was -1.25 l/min (95% CI [-1.48–1.01], p<0.001). The ability of the monitor to detect a variation in CO of more than 15% between two follow-up measurements, when such variation existed using thermodilution, was insufficient for clinical practice (AUC = 0.54, 95% CI [0.33–0.75]).

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A recommendation for the use of electrical biosensing technology in neonatology

van Wyk,

Austin,

Barzilay

et al. 2024

Pediatr Res

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Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice. Impact statement TEBT is not recommended as an accurate determinant of cardiac output (CO) (or stroke volume (SV)). TEBT may be useful for monitoring longitudinal changes from baseline of hemodynamic parameters on an individual patient basis. TEBT-derived thoracic fluid content (TFC) longitudinal changes from baseline may be useful in monitoring progress in respiratory disorders and circulatory conditions affecting intrathoracic fluid volume. Currently there is insufficient evidence to make any recommendations regarding the use of WBEBT for CO monitoring in neonates. Further research is required in all areas prior to the implementation of these monitors into routine clinical practice.

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Bioreactance-derived haemodynamic parameters in the transitional phase in preterm neonates: a longitudinal study

Cited by 3 publications

References 48 publications

Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study

Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study

Bioreactance assessment of cardiac output lacks reliability for the follow-up of patients with pulmonary hypertension

A recommendation for the use of electrical biosensing technology in neonatology

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