Non-invasive cardiac output measurement in low and very low birth weight infants: a method comparison.
BACKGROUND
Cardiac output (CO) measurement in low (LBW) and very low (VLBW) birth weight infants is difficult. Hitherto, sporadical transthoracic echocardiography (TTE) is the only non-invasive measurement method. Electrical velocimetry (EV) has been evaluated as an alternative in normal weight newborns.


OBJECTIVE
The study was designed to evaluate if EV could be interchangeable with TTE even in LBW and VLBW infants.


METHODS
In 28 (17 LBW, 11 VLBW) pre-mature newborns, n = 228 simultaneous TTE (trans-aortic Doppler), and EV measurements (134 LBW, 94 VLBW) of stroke volume (SV) and heart rate (HR) were performed, thereof calculating body weight indexed SV (=SV*) and CO (=CO*) for all patients and the subgroups. Method comparison was performed by Bland-Altman plot, method precision expressed by calculation of the coefficient of variation (CV).


RESULTS
Mean CO* in all patients was 256.4 ± 44.8 (TTE) and 265.3 ± 48.8 (EV) ml/kg/min. Bias and precision were clinically acceptable, limits of agreement within the 30% criterion for method interchangeability (17). According to their different anatomic dimensions and pathophysiology, there were significant differences of SV(*), HR, and CO* for LBW and VLBW infants as well for inotropic treatment and ventilation mode.


CONCLUSIONS
Extending recent publications on EV/TTE comparison in newborns, this study suggests that EV is also applicable in LWB/VLBW infants as a safe and easy to handle method for continuous CO monitoring in the NICU and PCICU.
Centre Chirurgical Marie Lannelongue, INSERM 999, Université Paris XI Sud , Orsay , France.
Oswin
O
Grollmuss
Institut de Puériculture et de Périnatalogie, Université Paris V Descartes , Clamart , France.
Patricia
P
Gonzalez
cardiac output; electrical velocimetry; low birth weight infants; neonatal intensive care unit; pediatric cardiac intensive care unit; stroke volume; transthoracic echocardiograph; very low birth weight infants