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Published on: June 12, 2020
Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational
C E Schwarz1,2,3, J M O'Toole4,5, D B Healy4
1Department of Paediatrics & Child Health, University College Cork, Cork, Ireland. christoph.schwarz@med.uni-heidelberg.de.
Insights
Electrical Cardiometry (EC)-derived cardiac output (CO) in very preterm infants was not linked to overall adverse outcomes like death or brain injury within two weeks. However, CO changes over time showed an association with severe brain bleeds (ICH grade ≥2).
Area of Science:
- Neonatal physiology and critical care
- Cardiovascular monitoring in infants
- Neuroprotection strategies
Background:
- Previous studies linked bioreactance-derived cardiac output (CO) to adverse outcomes in preterm infants.
- Understanding early hemodynamic changes is crucial for managing very preterm infants.
- Electrical Cardiometry (EC) offers a non-invasive method for CO assessment.
Purpose of the Study:
- To evaluate the association between EC-derived CO and its changes within 48 hours postnatally with adverse short-term outcomes in very preterm infants (<32 weeks gestational age).
- To define adverse outcomes as mortality or abnormal cranial ultrasound (intracranial hemorrhage or periventricular leukomalacia) within the first two weeks of life.
- To analyze the time trajectory of EC-derived CO in relation to these outcomes.
Main Methods:
- Prospective observational study including 53 very preterm infants.
- Electrical Cardiometry (EC) was used to measure cardiac output indexed to weight (CO) in the first 48 hours.
- Logistic regression and mixed-effects models analyzed the association between median CO, CO trajectory, and adverse outcomes.
Main Results:
- EC-derived CO was not independently associated with the combined adverse outcome (mortality or any grade brain injury) after adjusting for gestational age.
- The time trajectory of CO did not significantly differ between infants with normal and adverse outcomes.
- A post hoc analysis indicated an association between the CO time trajectory and severe intracranial hemorrhage (ICH ≥ grade 2).
Conclusions:
- EC-derived CO measurements within 48 hours are not independently predictive of overall brain injury or mortality in the first 14 days for very preterm infants.
- The temporal changes in EC-derived CO may be associated with specific severe brain injuries like significant intracranial hemorrhage.
- EC-derived CO values in the transitional period may differ from bioreactance-derived values and show increases over time in extremely preterm infants.
Abstract:
The purpose of this study is to evaluate the association of Electrical Cardiometry (EC)-derived cardiac output indexed to weight (CO) and its changes during the first 48 h in relation to adverse short-term outcome in very preterm infants. In this prospective observational study of preterm infants < 32 weeks gestational age (GA), the combined adverse outcome was defined as mortality or abnormal cranial ultrasound (any grade intracranial hemorrhage (ICH) or periventricular leukomalacia) within the first 2 weeks postnatally. Logistic regression models were used to investigate the association between median CO and outcome and mixed-effects models for the time trajectory of CO. In the absence of device-specific thresholds for low or high CO, no thresholds were used in our analysis. Fifty-three infants (median (IQR) GA 29.0 (25.4-30.6) weeks, birthweight 1020 (745-1505) g) were included in the analysis. Median CO was 241 (197-275) mL/kg/min for the adverse outcome and 198 (175-227) mL/kg/min for normal outcome (odds ratio (OR) (95% confidence interval (95% CI)), 1.01 (1.00 to 1.03); p = 0.028). After adjustment for GA, the difference was not significant (adjusted OR (95% CI), 1.01 (0.99 to 1.02); p = 0.373). CO trajectory did not differ by outcome (p = 0.352). A post hoc analysis revealed an association between CO time trajectory and ICH ≥ grade 2. Conclusions: EC-derived CO estimates within 48 h postnatally were not independently associated with brain injury (any grade) or mortality in the first 14 days of life. CO time trajectory was found to be associated with ICH ≥ grade 2. What is Known: • Bioreactance-derived cardiac output indexed to bodyweight (CO) in the transitional period has been associated with adverse short-term outcome in preterm infants. What is New: • Electrical Cardiometry (EC)-derived CO measurements in very preterm infants during the transitional period are not independently associated with adverse outcome (death or ultrasound detected brain damage) within 2 weeks postnatally. • In the first 48 h EC-derived CO increases over time and is higher in extremely preterm infants compared to very preterm and differs from previously reported bioreactance-derived CO values.
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