Continuous non-invasive measurement of cardiac output in neonatal intensive care using regional impedance cardiography: a prospective observational study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives To compare agreement between echocardiography and regional impedance cardiography (RIC)-derived cardiac output (CO), and to construct indicative normative ranges of CO for gestational age groups.
Design, setting and participants Prospective cohort observational study performed in a tertiary centre in London, UK, including neonates born between 25 and 42 weeks’ gestational age.
Exposures Neonates on the postnatal ward had 2 hours of RIC monitoring; neonates in intensive care had RIC monitoring for the first 72 hours, then weekly for 2 hours, with concomitant echocardiography measures.
Main outcomes and measures RIC was used to measure CO continuously. Statistical analyses were performed using R (V.4.2.2; R Core Team 2022). RIC-derived CO and echocardiography-derived CO were compared using Pearson’s correlations and Bland-Altman analyses. Differences in RIC-derived CO between infants born extremely, very and late preterm were assessed using analyses of variance and mixed-effects modelling.
Results 127 neonates (22 extremely, 46 very, 29 late preterm and 30 term) were included. RIC and echocardiography-measured weight-adjusted CO were correlated (r=0.62, p<0.001) with a Bland-Altman bias of −31 mL/min/kg (limits of agreement −322 to 261 mL/min/kg). The RIC-derived CO fell over 12 hours, then increased until 72 hours after birth. The 72-hour weight-adjusted mean CO was higher in extremely preterm (424±158 mL/min/kg) compared with very (325±131 mL/min/kg, p<0.001) and late preterm (237±81 mL/min/kg, p<0.001) neonates; this difference disappeared by 2–3 weeks of age.
Conclusions RIC is valid for continuous, non-invasive CO measurement in neonates. Indicative normative CO ranges could help clinicians to make more informed haemodynamic management decisions, which should be explored in future studies.
Design, setting and participants Prospective cohort observational study performed in a tertiary centre in London, UK, including neonates born between 25 and 42 weeks’ gestational age.
Exposures Neonates on the postnatal ward had 2 hours of RIC monitoring; neonates in intensive care had RIC monitoring for the first 72 hours, then weekly for 2 hours, with concomitant echocardiography measures.
Main outcomes and measures RIC was used to measure CO continuously. Statistical analyses were performed using R (V.4.2.2; R Core Team 2022). RIC-derived CO and echocardiography-derived CO were compared using Pearson’s correlations and Bland-Altman analyses. Differences in RIC-derived CO between infants born extremely, very and late preterm were assessed using analyses of variance and mixed-effects modelling.
Results 127 neonates (22 extremely, 46 very, 29 late preterm and 30 term) were included. RIC and echocardiography-measured weight-adjusted CO were correlated (r=0.62, p<0.001) with a Bland-Altman bias of −31 mL/min/kg (limits of agreement −322 to 261 mL/min/kg). The RIC-derived CO fell over 12 hours, then increased until 72 hours after birth. The 72-hour weight-adjusted mean CO was higher in extremely preterm (424±158 mL/min/kg) compared with very (325±131 mL/min/kg, p<0.001) and late preterm (237±81 mL/min/kg, p<0.001) neonates; this difference disappeared by 2–3 weeks of age.
Conclusions RIC is valid for continuous, non-invasive CO measurement in neonates. Indicative normative CO ranges could help clinicians to make more informed haemodynamic management decisions, which should be explored in future studies.
Date Issued
2024-07-01
Date Acceptance
2023-12-02
Citation
Archives of Disease in Childhood: Fetal and Neonatal Edition, 2024, 109 (4), pp.450-455
ISSN
1359-2998
Publisher
BMJ Publishing Group
Start Page
450
End Page
455
Journal / Book Title
Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume
109
Issue
4
Copyright Statement
Copyright © 2023 The Author(s). This article has been accepted for publication in Archives of Disease in Childhood - Fetal and Neonatal Edition 2023 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/archdischild-2023-325941
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/38123965
PII: archdischild-2023-325941
Subjects
ARTERIAL
BIRTH
BLOOD-PRESSURE
Cardiology
HYPOTENSION
INFANTS
Intensive Care Units
LEFT-VENTRICULAR OUTPUT
Life Sciences & Biomedicine
Neonatal
Neonatology
Pediatrics
Science & Technology
WEIGHT
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2023-12-14