title: Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life.
abstract: We aimed to assess the relationship between the clinical and biochemical parameters of perfusion and superior vena cava (SVC) flow in a prospective observational cohort study of very low birth weight (VLBW) infants. Newborns with congenital heart disease were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Capillary refill time (forehead, sternum and toe), mean blood pressure, urine output and serum lactate concentration were also measured simultaneously. Thirty-eight VLBW infants were examined. Eight patients (21%) had SVC flow less than 40 ml/kg/min. There was a poor correlation between the capillary refill time (in all sites), mean blood pressure, urine output and SVC flow. The correlation coefficient for the serum lactate concentration was r = -0.28, p = 0.15. The median serum lactate concentration was 3.5 (range 2.8-8.5) vs. 2.7 (range 1.2-6.9) mmol/l (p = 0.01) in low flow versus normal flow states. A serum lactate concentration of >2.8 was 100% sensitive and 60% specific for detecting a low flow state. Combining a capillary refill time of >4 s with a serum lactate concentration of >4 mmol/l had a specificity of 97% for detecting a low SVC flow state. Serum lactate concentrations are higher in low SVC flow states. A capillary refill time of >4 s combined with serum lactate concentrations >4 mmol/l increased the specificity and positive and negative predictive values of detecting a low SVC flow state.
authors.affiliation: Department of Paediatrics and Newborn Medicine, Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin 8, Ireland. miletinj@yahoo.com
authors.forename: J
authors.initials: J
authors.lastname: Miletin
authors.forename: K
authors.initials: K
authors.lastname: Pichova
authors.forename: E M
authors.initials: EM
authors.lastname: Dempsey
mesh_terms: D001783:Blood Flow Velocity; D001794:Blood Pressure; D002196:Capillaries / Q000503:physiopathology*; D005260:Female; D005546:Forehead / Q000098:blood supply; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000379:methods; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013249:Sternum / Q000098:blood supply; D014034:Toes / Q000098:blood supply; D014463:Ultrasonography; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D019344:Lactic Acid