Neonatology
Original Paper
Non-Invasive Cardiac Output Monitoring in Preterm Infants Undergoing Patent Ductus Arteriosus Ligation: A Comparison with EchocardiographyWeisz D.E.a · Jain A.b-d · Ting J.f · McNamara P.J.d, e · EL-Khuffash A.g, haDepartment of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, bDepartment of Paediatrics, Mount Sinai Hospital, cDepartment of Physiology, University of Toronto, Departments of dPhysiology and Experimental Medicine and eNeonatology, Hospital for Sick Children, Toronto, Ont., and fDepartment of Neonatology, University of British Columbia, Vancouver, B.C., Canada; gDepartment of Paediatrics, The Rotunda Hospital, and hDepartment of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Article / Publication Details
Received: April 29, 2014
Accepted: June 17, 2014
Published online: October 01, 2014
Issue release date: November 2014
Number of Print Pages: 7
Number of Figures: 3
Number of Tables: 2
ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)
For additional information: https://www.karger.com/NEO
Abstract
Background: Non-invasive cardiac output monitoring (NICOM; NICOM™) may be useful in the management of extremely premature preterm infants. Objectives: To evaluate a new bioreactance-based method of continuous NICOM in preterm infants following patent ductus arteriosus (PDA) ligation. Methods: Infants underwent three paired NICOM and echocardiography assessments of stroke volume (SV) and left ventricular output (LVO) in the postoperative period: at 1, 6-8, and 16-18 h postoperatively. NICOM- and echocardiography-measured SV and LVO during those periods were compared using Bland-Altman analysis and the intraclass correlation coefficient (ICC). Results: Twenty-five infants with a median (interquartile range) gestational age and birth weight of 25.0 weeks (24.5-25.9) and 700 g (615-775), respectively, were included. The overall systematic bias (limits of agreement) across all time points between the NICOM and echocardiography SV readings was 39% (8-69) with NICOM consistently underestimating echocardiography values. There was moderate consistency between NICOM and echocardiography SV values (ICC 0.78, p < 0.001). Compared with the 1-hour scans, the 6- to 8- and 16- to 18-hour scans had increased biases of 7.9% (95% CI 2.5-13.2) and 9.7% (95% CI 3.6-15.8), respectively. Conclusion: Continuous LVO measurement using NICOM was feasible and demonstrated a consistent systematic bias compared with echocardiography in unstable extremely preterm infants without a PDA ligation. NICOM may be used as a trending tool for continuous monitoring in this population, but wide limits of agreement and increasing bias over time suggest it is not interchangeable with echocardiography.
© 2014 S. Karger AG, Basel
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External Resources
- Weisz DE, Jain A, McNamara PJ, EL-Khuffash A: Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 2012;102:61-67.
- Noori S, Friedlich P, Seri I, Wong P: Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants. J Pediatr 2007;150:597-602.
- El-Khuffash AF, Jain A, Dragulescu A, McNamara PJ, Mertens L: Acute changes in myocardial systolic function in preterm infants undergoing patent ductus arteriosus ligation: a tissue Doppler and myocardial deformation study. J Am Soc Echocardiogr 2012;25:1058-1067.
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Article / Publication Details
Received: April 29, 2014
Accepted: June 17, 2014
Published online: October 01, 2014
Issue release date: November 2014
Number of Print Pages: 7
Number of Figures: 3
Number of Tables: 2
ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)
For additional information: https://www.karger.com/NEO
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