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Doni D, Faraguna MC, Zannin E, Rinaldi A, Cafolla C, Iozzi L, Cavalleri V, Rigotti C, Sinelli M, Fedeli T, Ventura ML. Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor (USCOM). Eur J Pediatr 2024; 183:2183-2192. [PMID: 38376594 DOI: 10.1007/s00431-024-05465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
We aimed to establish reference ranges for USCOM parameters in preterm infants, determine factors that affect cardiac output, and evaluate the measurement repeatability. This retro-prospective study was performed at Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. We included infants below 32 weeks of gestational age (GA) and/or 1500 g of birth weight (BW). We excluded infants with congenital heart diseases or hemodynamic instability. Measurements were performed at 3 ± 1, 7 ± 2, and 14 ± 2 postnatal days. We analyzed 204 measurements from 92 patients (median GA = 30.57 weeks, BW = 1360 g). The mean (SD) cardiac output (CO) was 278 (55) ml/min/kg, cardiac index (CI) was 3.1 (0.5) L/min/m2, and systemic vascular resistance (SVRI) was 1292 (294) d*s*cm-5/m2. CO presented a negative correlation with postmenstrual age (PMA), while SVRI presented a positive correlation with PMA. The repeatability coefficient was 31 ml/kg/min (12%). Conclusion: This is the first study describing reference values for USCOM parameters in hemodynamically stable preterm infants and factors affecting their variability. Further studies to investigate the usefulness of USCOM for the longitudinal assessment of patients at risk for cardiovascular instability or monitoring the response to therapies are warranted. What is Known: • The ultrasonic cardiac output monitoring (USCOM) has been widely used on adult and pediatric patients and reference ranges for cardiac output (CO) by USCOM have been established in term infants. What is New: • We established reference values for USCOM parameters in very preterm and very-low-birth-weight infants; the reference ranges for CO by USCOM in the study population were 198-405 ml/kg/min. • CO normalized by body weight presented a significant negative correlation with postmenstrual age (PMA); systemic vascular resistance index presented a significant positive correlation with PMA.
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Affiliation(s)
- Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | | | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Alessandro Rinaldi
- Residency in Pediatrics, Università degli Studi Milano Bicocca, Milan, Italy
| | - Claudia Cafolla
- Residency in Pediatrics, Università degli Studi di Ferrara, Ferrara, Italy
| | - Lucia Iozzi
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Valeria Cavalleri
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Mariateresa Sinelli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
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Karabulut M, Uslu HS. Effect of sleeping position on cardiac output, pulmonary pressure, and superior vena cava flow in healthy term infants. Pediatr Neonatol 2024; 65:229-236. [PMID: 37973502 DOI: 10.1016/j.pedneo.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although the mechanism of action in newborns is unknown, sleep positioning is associated with many pathophysiological events. This study aimed to compare the effects of supine and prone sleeping positions on cardiac output (CO), systolic pulmonary arterial pressure (SPAP), and superior vena cava (SVC) flow in healthy newborns. METHODS In the first 24-72 h of life, 40 healthy term newborns born in the same hospital were included in this prospective, cross-sectional, observational study. CO, SVC flow, and SPAP values of newborns in the supine and prone sleeping positions were calculated using echocardiographic examination. The measurements were statistically compared. RESULTS In the supine sleeping position, CO, SVC flow, and SPAP were 235.00 (193.07-283.30) ml/kg/min, 92.80 (77.82-121.87) ml/kg/min, and 27.85 (24.70-30.48) mmHg. In the prone sleeping position, CO, SVC flow, and SPAP were measured as 195.35 (166.00-229.40) ml/kg/min, 67.25 (51.82-96.66) ml/kg/min, 31.60 (28.45-37.20) mmHg, respectively. Depending on sleeping position, these variables were significantly different between the groups. CONCLUSION SVC flow and CO decreased in the prone sleeping position compared to the supine sleeping position in healthy newborns, whereas SPAP increased. The different hemodynamic effects of sleeping position on the cardiac, pulmonary, and nervous systems should be considered as flow and pressure changes are important in newborns.
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Affiliation(s)
- Muhammed Karabulut
- Department of Paediatric Cardiology, Clinical of Paediatric Health and Diseases, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
| | - Hasan Sinan Uslu
- Department of Neonatal İntensive Care, Clinical of Paediatric Health and Diseases, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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Bravo MC, Jiménez R, Parrado-Hernández E, Fernández JJ, Pellicer A. Predicting the effectiveness of drugs used for treating cardiovascular conditions in newborn infants. Pediatr Res 2024; 95:1124-1131. [PMID: 38092963 DOI: 10.1038/s41390-023-02964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/08/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Cardiovascular support (CVS) treatment failure (TF) is associated with a poor prognosis in preterm infants. METHODS Medical charts of infants with a birth weight <1500 g who received either dopamine (Dp) or dobutamine (Db), were reviewed. Treatment response (TR) occurred if blood pressure increased >3rd centile for gestational age or superior vena cava flow was maintained >55 ml/kg/min, with decreased lactate or less negative base excess, without additional CVS. A predictive model of Dp and Db on TR was designed and the impact of TR on survival was analyzed. RESULTS Sixty-six infants (median gestational age 27.3 weeks, median birth weight 864 g) received Dp (n = 44) or Db (n = 22). TR occurred in 59% of the cases treated with Dp and 31% with Db, p = 0.04. Machine learning identified a model that correctly labeled Db response in 90% of the cases and Dp response in 61.4%. Sixteen infants died (9% of the TR group, 39% of the TF group; p = 0.004). Brain or gut morbidity-free survival was observed in 52% vs 30% in the TR and TF groups, respectively (p = 0.08). CONCLUSIONS New predictive models can anticipate Db but not Dp effectiveness in preterm infants. These algorithms may help the clinicians in the decision-making process. IMPACT Failure of cardiovascular support treatment increases the risk of mortality in very low birth weight infants. A predictive model built with machine learning techniques can help anticipate treatment response to dobutamine with high accuracy. Predictive models based on artificial intelligence may guide the clinicians in the decision-making process.
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Affiliation(s)
- María Carmen Bravo
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain.
| | - Raquel Jiménez
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
- Department of Signal Theory and Communications, Carlos III University, Madrid, Spain
| | | | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
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Grooby E, Sitaula C, Chang Kwok T, Sharkey D, Marzbanrad F, Malhotra A. Artificial intelligence-driven wearable technologies for neonatal cardiorespiratory monitoring: Part 1 wearable technology. Pediatr Res 2023; 93:413-425. [PMID: 36593282 DOI: 10.1038/s41390-022-02416-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 01/03/2023]
Abstract
With the development of Artificial Intelligence techniques, smart health monitoring is becoming more popular. In this study, we investigate the trend of wearable sensors being adopted and developed in neonatal cardiorespiratory monitoring. We performed a search of papers published from the year 2000 onwards. We then reviewed the advances in sensor technologies and wearable modalities for this application. Common wearable modalities included clothing (39%); chest/abdominal belts (25%); and adhesive patches (15%). Popular singular physiological information from sensors included electrocardiogram (15%), breathing (24%), oxygen saturation and photoplethysmography (13%). Many studies (46%) incorporated a combination of these signals. There has been extensive research in neonatal cardiorespiratory monitoring using both single and multi-parameter systems. Poor data quality is a common issue and further research into combining multi-sensor information to alleviate this should be investigated. IMPACT STATEMENT: State-of-the-art review of sensor technology for wearable neonatal cardiorespiratory monitoring. Review of the designs for wearable neonatal cardiorespiratory monitoring. The use of multi-sensor information to improve physiological data quality has been limited in past research. Several sensor technologies have been implemented and tested on adults that have yet to be explored in the newborn population.
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Affiliation(s)
- Ethan Grooby
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
| | - Chiranjibi Sitaula
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
| | - T'ng Chang Kwok
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.
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Hassan MA, Bryant MB, Hummler HD. Comparison of Cardiac Output Measurement by Electrical Velocimetry with Echocardiography in Extremely Low Birth Weight Neonates. Neonatology 2022; 119:18-25. [PMID: 34724661 DOI: 10.1159/000519713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Electrical velocimetry (EV) offers a noninvasive tool for continuous cardiac output (CO) measurements which might facilitate hemodynamic monitoring and targeted therapy in low birth neonates, in whom other methods of CO measurement are not practicably feasible. METHODS This prospective observational study compared simultaneous cardiac output measurements by electrical velocimetry (COEV) with transthoracic echocardiography (COTTE) in extremely low birth weight (ELBW) neonates in the neonatal intensive care unit (NICU). Echocardiography was performed by 1 single examiner. Data were analyzed by Bland-Altman analysis and independent-samples analysis of variance. A mean percentage error (MPE) of <30% and limits of agreement (LOA) up to ±30% were considered clinically acceptable. RESULTS Thirty-eight ELBW neonates were studied and yielded 85 pairs of COEV and COTTE measurements. Bland-Altman analysis showed an overall bias (the mean difference) and LOA of -126 and -305 to +52 mL min-1, respectively, and an MPE of 66%. Patients with patent ductus arteriosus had a higher bias with LOA and MPE of -166.8, -370.7 to +37 mL min-1, and 69%, respectively. The overall true precision was 58%. CONCLUSION This study showed high bias and lack of agreement between EV and TTE for measurement of CO in ELBW infants in NICU, limiting applicability of EV to monitor absolute values.
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Affiliation(s)
- Mohammad Ahmad Hassan
- Department of Pediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.,Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Manuel B Bryant
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany.,Neonatal Department, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Helmut D Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany.,Department of Neonatology, University of Tuebingen, Tuebingen, Germany
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Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis. Crit Care Med 2021; 50:126-137. [PMID: 34325447 DOI: 10.1097/ccm.0000000000005144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze the validity of electrical bioimpedance-based noninvasive cardiac output monitoring in pediatrics compared with standard methods such as thermodilution and echocardiography. DATA SOURCES Systematic searches were conducted in MEDLINE and EMBASE (2000-2019). STUDY SELECTION Method-comparison studies of transthoracic electrical velocimetry or whole body electrical bioimpedance versus standard cardiac output monitoring methods in children (0-18 yr old) were included. DATA EXTRACTION Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Mean differences of cardiac output, stroke volume, or cardiac index measurements were pooled using a random-effects model (R Core Team, R Foundation for Statistical Computing, Vienna, Austria, 2019). Bland-Altman statistics assessing agreement between devices and author conclusions about inferiority/noninferiority were extracted. DATA SYNTHESIS Twenty-nine of 649 identified studies were included in the qualitative analysis, and 25 studies in the meta-analyses. No significant difference was found between means of cardiac output, stroke volume, and cardiac index measurements, except in exclusively neonatal/infant studies reporting stroke volume (mean difference, 1.00 mL; 95% CI, 0.23-1.77). Median percentage error in child/adolescent studies approached acceptability (percentage error less than or equal to 30%) for cardiac output in L/min (31%; range, 13-158%) and stroke volume in mL (26%; range, 14-27%), but not in neonatal/infant studies (45%; range, 29-53% and 45%; range, 28-70%, respectively). Twenty of 29 studies concluded that transthoracic electrical velocimetry/whole body electrical bioimpedance was noninferior. Transthoracic electrical velocimetry was considered inferior in six of nine studies with heterogeneous congenital heart disease populations. CONCLUSIONS The meta-analyses demonstrated no significant difference between means of compared devices (except in neonatal stroke volume studies). The wide range of percentage error reported may be due to heterogeneity of study designs, devices, and populations included. Transthoracic electrical velocimetry/whole body electrical bioimpedance may be acceptable for use in child/adolescent populations, but validity in neonates and congenital heart disease patients remains uncertain. Larger studies in specific clinical contexts with standardized methodologies are required.
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Karlsson J, Svedmyr A, Wiegele M, Lönnqvist PA, Wallin M, Hallbäck M. Cardiac Output Assessments in Anesthetized Children: Dynamic Capnography Versus Esophageal Doppler. Anesth Analg 2021; 134:644-652. [PMID: 34304235 DOI: 10.1213/ane.0000000000005679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this study was to compare esophageal Doppler cardiac output (COEDM) against the reference method effective pulmonary blood flow cardiac output (COEPBF), for agreement of absolute values and ability to detect change in cardiac output (CO) in pediatric surgical patients. Furthermore, the relationship between these 2 methods and noninvasive blood pressure (NIBP) parameters was evaluated. METHODS Fifteen children American Society of Anesthesiology (ASA) I and II (median age, 8 months; median weight, 9 kg) scheduled for surgery were investigated in this prospective observational cohort study. Baseline COEPBF/COEDM/NIBP measurements were made at positive end-expiratory pressure (PEEP) 3 cm H2O. PEEP was increased to 10 cm H2O and COEPBF/COEDM/NIBP was recorded after 1 and 3 minutes. PEEP was then lowered to 3 cm H2O, and all measurements were repeated after 3 minutes. Finally, 20-µg kg-1 intravenous atropine was given with the intent to increase CO, and all measurements were recorded again after 5 minutes. Paired recordings of COEDM and COEPBF were examined for agreement and trending ability, and all parameters were analyzed for their responses to the hemodynamic challenges. RESULTS Bias between COEDM and COEPBF (COEDM - COEPBF) was -17 mL kg-1 min-1 (limits of agreement, -67 to +33 mL kg-1 min-1) with a mean percentage error of 32% (95% confidence interval [CI], 25-37) and a concordance rate of 71% (95% CI, 63-80). The hemodynamic interventions caused by PEEP manipulations resulted in significant decrease in COEPBF absolute numbers (155 mL kg-1 min-1 [95% CI, 151-159] to 127 mL kg-1 min-1 [95% CI, 113-141]) and a corresponding relative decrease of 18% (95% CI, 14-22) 3 minutes after application of PEEP 10. No corresponding decreases were detected by COEDM. Mean arterial pressure showed a relative decrease with 5 (95% CI, 2-8) and 6% (95% CI, 2-10) 1 and 3 minutes after the application of PEEP 10, respectively. Systolic arterial pressure showed a relative decrease of 5% (95% CI, 2-10) 3 minutes after application of PEEP 10. None of the recorded parameters responded to atropine administration except for heart rate that showed a 4% relative increase (95% CI, 1-7, P = .02) 5 minutes after atropine. CONCLUSIONS COEDM was unable to detect the reduction of CO cause by increased PEEP, whereas COEPBF and to a minimal extent NIBP detected these changes in CO. The ability of COEPBF to react to minor reductions in CO, before noticeable changes in NIBP are seen, suggests that COEPBF may be a potentially useful tool for hemodynamic monitoring in mechanically ventilated children.
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Affiliation(s)
- Jacob Karlsson
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Anders Svedmyr
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Marion Wiegele
- Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Per-Arne Lönnqvist
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden
| | - Mats Wallin
- From the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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Abstract
In our aim to improve patient outcome we are transitioning from a "one-size-fits-all" protocolized approach toward an individualized hemodynamic management, that is tailored to the cardiovascular (patho-)physiology and the specific clinical characteristics of each individual patient. In this narrative review an overview is provided about an individualized approach toward various neonatal hemodynamic conditions.
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Affiliation(s)
- Willem P de Boode
- Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
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