Non-invasive cardiac output monitoring in neonates: From technologic promise to clinical practice

Due to the clinical importance of early detection of hemodynamic compromise and the limitations of transthoracic echocardiography (TTE) as an intermittent, operator-dependent assessment, the introduction of non-invasive cardiac output monitoring (NICOM) in the neonatal population has generated considerable interest. Electrical biosensing technology (EBT), one type of NICOM modality, offers non-invasive, continuous, bedside assessment of multiple hemodynamic parameters, yet its clinical utility is limited by variable accuracy and precision, lack of interchangeability with TTE and limited trending studies. Despite this, EBT is progressively being used in research and even clinical domains. Advancing continuous EBT-enabled cardiac output monitoring from technologic promise to clinical accountability requires specific neonatal-based refinements of the technology and a strategic shift in research emphasis, moving from method-comparison studies to rigorously designed, outcome-based trials, in order to determine whether EBT-informed management can meaningfully improve neonatal morbidity and mortality.