Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry

Hsu, Kuang‐Hung; Tw, Wu; Yc, Wang; Lim, WH; Lee, Cheng-Chung; Lien, Reyin

doi:10.1038/jp.2016.2

Cited by 50 publications

(31 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is non-invasive, easy to apply, offers continuous assessment and has recently been validated against invasive methods of CO measurements in hemodynamically stable newborns. However, more data are needed for validation in neonates with hemodynamic compromise before its widespread clinical applicability ( 48 , 49 ).In addition, sicker infants on significant ventilator support (i.e., high frequency oscillation) may have poor correlation compared with echocardiography derived COs ( 50 ).…”

Section: Assessment Of Cardiac Output (Co) and Tissue Perfusionmentioning

confidence: 99%

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

2018

View full text Add to dashboard Cite

Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification. Special emphasis has been placed on bedside focused echocardiography/focused cardiac ultrasound, which can be used as an additional tool for early, neonatologist driven, ongoing evaluation and management. An approach to goal oriented management of shock has been described and how bed side functional echocardiography can help in making a logical choice of intervention (fluid therapy, inotropic therapy or vasopressor therapy) in infants with shock.

show abstract

Section: Assessment Of Cardiac Output (Co) and Tissue Perfusionmentioning

confidence: 99%

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

2018

View full text Add to dashboard Cite

show abstract

“…It has been studied in different clinical scenarios including surgical ligation for patent ductus arteriosus (PDA) [12], hemodynamic transition after birth [13], caffeine administration [14], and umbilical cord milking in preterm infants [15]. Previously, we conducted an observational study to establish the reference ranges for nonintubated and hemodynamically stable neonates without a PDA [16]. …”

Section: Introductionmentioning

confidence: 99%

Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

Hsu¹,

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Electrical cardiometry (EC) is an impedance-based monitoring that provides noninvasive cardiac output (CO) assessment. Through comparison to transthoracic echocardiography (Echo), the accuracy of EC has been verified. However, left-to-right patent ductus arteriosus (PDA) shunting is a concern because PDA shunts aortic flow to the pulmonary artery and may interfere with EC in measuring CO. Objective: To determine the agreement between EC and Echo in preterm infants with a hemodynamically significant PDA (hsPDA). Methods: We reviewed our hemodynamic database in which simultaneous CO measurements by Echo and EC (Aesculon®) were recorded. Preterm infants with left-to-right shunting hsPDA were enrolled. Results: A total of 105 paired measurements in 36 preterm infants were compared. Infants' median (range) age and weight at measurement were 27⁺² weeks (24⁺⁰-33⁺¹) and 1,015 g (518-1,880), with mean (95% CI) ductal diameter 2.11 mm (1.99-2.22) or 2.15 mm/kg (2.00-2.30). Mean CO_EC and CO_Echo were 252 ± 32 and 258 ± 45 mL/kg/min, respectively, which demonstrated a moderate correlation and without a significant between-measurement difference. Bland-Altman analysis showed a bias, limits of agreement, and error percentage of -5.3 mL/kg/min, -78.3 to 67.7 mL/kg/min, and 28.6%, respectively. There was a trend of increased bias and error percentage of infants with high CO ≥280 mL/kg/min and supported with high-frequency ventilator. Conclusions: EC and Echo have a wide but clinically acceptable agreement in measuring CO in preterm infants with hsPDA. However, for infants with high CO or ventilated by high-frequency ventilation, interpretation of CO_EC should be approached with caution.

show abstract

“…No reference values are available in this kind of population since EC has been evaluated previously in hemodynamically stable term and preterm infants (including low birth weight and very low birth weight). [6][7][8][9] Comparing our two cases, we can speculate that CO around 300 mL/kg/min can be suitable to have hemodynamic balance in patients with HLHS. In case 1, in fact, CO was persistently higher than 300 mL/kg/min, while case 2 showed a low CO (around 190 mL/kg/min) even postballoon atrial septostomy which was not resolved.…”

Section: Case Reportmentioning

confidence: 66%

Noninvasive Cardiac Output Monitoring in Newborn with Hypoplastic Left Heart Syndrome

et al. 2020

View full text Add to dashboard Cite

Objective This study aimed to describe the first two cases of electrical cardiometry applied to newborn with hypoplastic left heart syndrome for hemodynamical assessment in the first days of life before surgical correction and see if this can help decision making process in these patients. Study Design We describe two case series of two full-term newborn with hypoplastic left heart syndrome in the Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, between December 2019 and January 2020. Results Case 1 was persistently hemodynamically stable with prostaglandin E1 infusion at 0.01 mcg/kg/min, showing good capillary refill time, good diuresis, no difference between pre- and postductal values of oxygen saturation or blood pressure. Electrical cardiometry monitoring constantly showed cardiac output values higher than 300 mL/kg/min. Case 2 showed poor clinical condition needing prostaglandin E1 infusion up to 0.05 mcg/kg/min, intubation and septostomy associated with low cardiac output around 190 mL/kg/min. Once cardiac output has begun to rise and reached values constantly over 300 mL/kg/min, clinical condition improved with amelioration in oxygen saturation, diuresis, blood pressure, and blood gas analysis values. She was then extubated and finally clinically stable until surgery with minimal infusion of prostaglandin E1 at 0.01 mcg/kg/min. Conclusion This case highlights how hemodynamic information provided by electrical cardiometry can be used to supplement the combined data from all monitors and the clinical situation to guide therapy in these newborns waiting surgery. Key Points

show abstract

Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry

Abstract: Hemodynamic reference by EC is notably distinct among neonates of diverse maturity. CO is most closely correlated to BSA.

Cited by 50 publications

References 27 publications

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

Noninvasive Cardiac Output Monitoring in Newborn with Hypoplastic Left Heart Syndrome

Contact Info

Product

Resources

About