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Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor (USCOM)

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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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Data availability

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Acknowledgements

The authors thank Dr. Giulia Dognini, Dr. Valentina Privitera, Dr. Marianna Zicoia, and Dr. Ester De Luca for their help in data collection.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy

    Daniela Doni, Emanuela Zannin, Lucia Iozzi, Valeria Cavalleri, Camilla Rigotti, Mariateresa Sinelli, Tiziana Fedeli & Maria Luisa Ventura

  2. Residency in Pediatrics, Università degli Studi Milano Bicocca, Milan, Italy

    Martha Caterina Faraguna & Alessandro Rinaldi

  3. Residency in Pediatrics, Università degli Studi di Ferrara, Ferrara, Italy

    Claudia Cafolla

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  1. Daniela Doni
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Contributions

DD was the principal investigator, interpreted the data, critically revised the manuscript, and approved the final manuscript as submitted. MF collected the data, drafted the initial manuscript, performed the literature search, and approved the final manuscript as submitted. EZ performed statistical analysis, drafted the figures, reviewed and revised the manuscript, and approved the final manuscript as submitted. AR, CC, and LI contributed to data collection and approved the final manuscript as submitted. VC and MTS contributed to data interpretation, critically revised the manuscript, and approved the final manuscript as submitted. CR contributed to data collection, critically revised the manuscript, and approved the final version as submitted. TF and MLV obtained the resources to conduct the study, contributed to conceiving the study, and approved the final version of the manuscript as submitted.

Corresponding author

Correspondence to Emanuela Zannin.

Ethics declarations

Ethics approval and consent to participate

This study has been conducted in compliance with the principles of the Helsinki Declaration and was approved by the ethical review board of the Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (protocol nr. 4309/23). The study has been registered, NCT05961657. Informed consent was obtained from the parents/legal guardians of the participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Doni, D., Faraguna, M.C., Zannin, E. et al. Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor (USCOM). Eur J Pediatr 183, 2183–2192 (2024). https://doi.org/10.1007/s00431-024-05465-y

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