Abstract
Objective: The use of noninvasive monitoring of neonatal hemodynamics is increasing in neonatal care. Methods include noninvasive cardiac output estimated by electrical cardiometry (EC) and peripheral perfusion as perfusion index (PI) using pulse oximetry. Our aim was to evaluate the feasibility to continuously monitor preterm infants with EC and PI during the first 2 postnatal days and the effects of averaging EC data in signal quality (SigQ) analysis. Design: Prospective observational study. Setting: Tertiary neonatal academic hospital. Patients: Preterm infants <32 weeks gestation from birth until 48 h. Main Outcome Measures: Continuous EC and PI measurements. Feasibility was quantified as the time with high SigQ, classified using SigQ index in EC and exception codes in PI. Our predefined threshold for good feasibility was minimum of 24 h with high SigQ for both. Results: Twenty-two preterm infants (median [IQR] gestational age 28 + 6 (26 + 0, 30 + 4) weeks + days, birth weight 960 [773, 1,500] g) were included. We recorded a minimum of 24 h with high SigQ in 14 infants for EC (unaveraged data) and 22 infants for PI measurements. The median (range) % of recording time with high SigQ was 74% (50%, 88%) for EC and 94% (82%, 96%) for PI. Using 1 minute averaging for EC data resulted in an increase of infants with minimum 24 h of high SigQ to 21 infants. Conclusions: EC and PI monitoring are feasible in preterm infants within the first 48 h, but SigQ remains problematic for EC. Signal dropout is masked in averaged EC values.
References
1.
Dempsey
EM
, El-Khuffash
AF
. Objective cardiovascular assessment in the neonatal intensive care unit
. Arch Dis Child Fetal Neonatal Ed
. 2018 Jan
;103
(1
):F72
–7
.2.
McGovern
M
, Miletin
J
. Cardiac output monitoring in preterm infants
. Front Pediatr
. 2018
;6
:84
. .3.
Corsini
I
, Cecchi
A
, Coviello
C
, Dani
C
. Perfusion index and left ventricular output correlation in healthy term infants
. Eur J Pediatr
. 2017
;176
(8
):1013
–8
. .4.
Janaillac
M
, Beausoleil
TP
, Barrington
KJ
, Raboisson
MJ
, Karam
O
, Dehaes
M
, Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life
. Eur J Pediatr
. 2018
;177
(4
):541
–50
. .5.
Takahashi
S
, Kakiuchi
S
, Nanba
Y
, Tsukamoto
K
, Nakamura
T
, Ito
Y
. The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants
. J Perinatol
. 2010
;30
(4
):265
–9
. .6.
Noori
S
, Drabu
B
, Soleymani
S
, Seri
I
. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography
. Arch Dis Child Fetal Neonatal Ed
. 2012
;97
(5
):F340
–3
. .7.
Torigoe
T
, Sato
S
, Nagayama
Y
, Sato
T
, Yamazaki
H
. Influence of patent ductus arteriosus and ventilators on electrical velocimetry for measuring cardiac output in very-low/low birth weight infants
. J Perinatol
. 2015
;35
(7
):485
–9
. .8.
O’Neill
R
, Dempsey
EM
, Garvey
AA
, Schwarz
CE
. Non-invasive cardiac output monitoring in neonates
. Front Pediatr
. 2021 Jan 28
;8
:614585
.9.
Freidl
T
, Baik
N
, Pichler
G
, Schwaberger
B
, Zingerle
B
, Avian
A
, Haemodynamic transition after birth: a new tool for non-invasive cardiac output monitoring
. Neonatology
. 2017
;111
(1
):55
–60
. .10.
Lima
A
, Bakker
J
. Noninvasive monitoring of peripheral perfusion
. Intensive Care Med
. 2005
;31
(10
):1316
–26
. .11.
12.
Urschitz
MS
, Von
EV
, Seyfang
A
, Poets
CF
. Use of pulse oximetry in automated oxygen delivery to ventilated infants
. Anesth Analg
. 2002
;94
(Suppl
):S37
–40
.13.
Mathew
J
, Bada Shekarappa
C
, Padubidri Nanyam Rao
S
. Correlation between perfusion index and CRIB Score in sick neonates admitted to a tertiary center
. J Trop Pediatr
. 2019
;65
(1
):84
–9
. .14.
De Felice
C
, Latini
G
, Vacca
P
, Kopotic
RJ
. The pulse oximeter perfusion index as a predictor for high illness severity in neonates
. Eur J Pediatr
. 2002
;161
(10
):561
–2
. .15.
Kanmaz
HG
, Sarikabadayi
YU
, Canpolat
E
, Altug
N
, Oguz
SS
, Dilmen
U
. Effects of red cell transfusion on cardiac output and perfusion index in preterm infants
. Early Hum Dev
. 2013
;89
(9
):683
–6
. .16.
Hakan
N
, Dilli
D
, Zenciroglu
A
, Aydin
M
, Okumus
N
. Reference values of perfusion indices in hemodynamically stable newborns during the early neonatal period
. Eur J Pediatr
. 2014
;173
(5
):597
–602
. .17.
Alderliesten
T
, Lemmers
PM
, Baerts
W
, Groenendaal
F
, van Bel
F
. Perfusion index in preterm infants during the first 3 days of life: reference values and relation with clinical variables
. Neonatology
. 2015
;107
(4
):258
–65
. .18.
Hawkes
GA
, O'Toole
JM
, Kenosi
M
, Ryan
CA
, Dempsey
EM
. Perfusion index in the preterm infant immediately after birth
. Early Hum Dev
. 2015
;91
(8
):463
–5
. .19.
Kinoshita
M
, Hawkes
CP
, Ryan
CA
, Dempsey
EM
. Perfusion index in the very preterm infant
. Acta Paediatr
. 2013
;102
(9
):e398
–401
. .20.
Van Laere
D
, O'Toole
JM
, Voeten
M
, McKiernan
J
, Boylan
GB
, Dempsey
E
. Decreased variability and low values of perfusion index on day one are associated with adverse outcome in extremely preterm infants
. J Pediatr
. 2016
;178
:119
–24.e1
. .21.
Katheria
AC
, Wozniak
M
, Harari
D
, Arnell
K
, Petruzzelli
D
, Finer
NN
. Measuring cardiac changes using electrical impedance during delayed cord clamping: a feasibility trial
. Matern Health Neonatol Perinatol
. 2015
;1
:15
. .22.
McCarthy
KN
, Pavel
A
, Garvey
AA
, Hawke
A-L
, Levins
C
, Livingstone
V
, Feasibility of non-invasive cardiac output monitoring at birth using electrical bioreactance in term infants
. Arc Dis Child Fetal Neonatal Ed
. 2021 Jul
;106
(4
):431
–4
.23.
Miletin
J
, Semberova
J
, Martin
AM
, Janota
J
, Stranak
Z
. Low cardiac output measured by bioreactance and adverse outcome in preterm infants with birth weight <1,250 g
. Early Hum Dev
. 2020
;149
:105153
. .24.
Cappelleri
A
, Bussmann
N
, Harvey
S
, Levy
PT
, Franklin
O
, El-Khuffash
A
. Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring
. Cardiol Young
. 2020
;30
(2
):249
–55
. .25.
Hsu
KH
, Wu
TW
, Wang
YC
, Lim
WH
, Lee
CC
, Lien
R
. Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry
. J Perinatol
. 2016
;36
(6
):481
–5
. .26.
Song
R
, Rich
W
, Kim
JH
, Finer
NN
, Katheria
AC
. The use of electrical cardiometry for continuous cardiac output monitoring in preterm neonates: a validation study
. Am J Perinatol
. 2014
;31
(12
):1105
–10
. .27.
O’Toole
JM
, Boylan
GB
. Quantitative preterm EEG analysis: the need for caution in using modern data science techniques
. Front Pediatr
. 2019
;7
:174
. .© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
