Kieliszczyk Joanna, Baranowski Wojciech, Kosiak Wojciech
Department of Pediatrics, Dr. Alfred Sokołowski Specialist Hospital in Wałbrzych, Poland.
Ultrasound Laboratory, Dr. Alfred Sokołowski Specialist Hospital in Wałbrzych, Poland, Department of Neonatal Physiology and Pathology with an Intensive Care Sub-Unit, Regional Specialist Hospital "Latawiec" in Świdnica, Poland.
J Ultrason. 2016 Jun;16(65):125-34. doi: 10.15557/JoU.2016.0014. Epub 2016 Jun 29.
Appropriate hydration is a very important prognostic factor for the patient's health. Ultrasonographic assessment of hydration status is rarely used in pediatric medicine and it is not used at all in neonates due to the fact that no reference values have been established for this age group. The aim of the paper was to establish reference values for neonates.
The study included 50 neonates from two hospitals in the Lower Silesia region of Poland; 25 of them were healthy patients (full-term newborns with no perinatal complications) and 25 were sick patients (newborns with heart defects such as ostium secundum atrial septal defect, ventricular septal defect, permanent foramen ovale and patent ductus arteriosus as well as newborns with neonatal jaundice or pneumonia that occurred during the first days of life). The ultrasound scans were conducted during the first days of the children's life. For every child inferior vena cava diameter was measured in the substernal area, longitudinal plane, M-mode in two respiratory phases: inhalation and exhalation. In addition, abdominal aorta diameter was determined (substernal area, transverse plane).
The study demonstrated a statistically significant difference in the calculated inferior vena cava collapsibility index between both groups. Two other indices included the ratio of the inferior vena cava diameter during the expiratory phase to the diameter of the aorta and the ratio of the inferior vena cava diameter during the inspiratory phase to the diameter of the aorta; a statistically significant difference between both groups was found only for the measurements in the inspiratory phase.
Based on the study results normal ranges for hydration indices in neonates were established. The need for the measurement of the abovementioned parameters in the inspiratory phase was determined. In addition, the usefulness of the ultrasound examination for the evaluation of body fluid status in this pediatric age group, particularly in preterm newborns, was noted due to its painless and non-invasive nature as well as easy access to equipment at neonatology wards.
适当的水合作用是影响患者健康的一个非常重要的预后因素。超声评估水合状态在儿科学中很少使用，在新生儿中根本未被使用，因为尚未为该年龄组建立参考值。本文的目的是为新生儿建立参考值。
该研究纳入了波兰下西里西亚地区两家医院的50名新生儿；其中25名是健康患者（足月新生儿，无围产期并发症），25名是患病患者（患有心脏缺陷的新生儿，如继发孔型房间隔缺损、室间隔缺损、永存卵圆孔未闭和动脉导管未闭，以及在出生后几天内出现新生儿黄疸或肺炎的新生儿）。超声扫描在儿童出生后的头几天进行。对每个儿童在胸骨下区域的纵向平面上，通过M型超声在吸气和呼气两个呼吸阶段测量下腔静脉直径。此外，还测定了腹主动脉直径（胸骨下区域，横向平面）。
研究表明两组之间计算出的下腔静脉塌陷指数存在统计学显著差异。另外两个指标包括呼气期下腔静脉直径与主动脉直径的比值以及吸气期下腔静脉直径与主动脉直径的比值；仅在吸气期测量时发现两组之间存在统计学显著差异。
基于研究结果，建立了新生儿水合指数的正常范围。确定了在吸气期测量上述参数的必要性。此外，由于超声检查无痛、无创且在新生儿病房易于获得设备，因此注意到其在评估该儿科年龄组尤其是早产儿的体液状态方面的有用性。
