Martini Silvia, Annunziata Mariarosaria, Lenzi Jacopo, Gupta Samir, Austin Topun, Corvaglia Luigi
Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero, Universitaria Di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Eur J Pediatr. 2025 Apr 15;184(5):299. doi: 10.1007/s00431-025-06132-6.
This prospective observational study aimed to assess the agreement of cardiac output measurements obtained with transthoracic echocardiography (CO) and electrical velocimetry (CO) and the impact of relevant variables on CO accuracy in preterm infants during the transitional period. Simultaneous measurements of CO and CO were performed in preterm infants < 32 weeks' gestation and/or < 1500 g during the first 72 h of life. Bland-Altman analysis was performed and bias and mean percentage error (MPE) were calculated. The impact of a hemodynamically significant duct (hsPDA), ongoing cardiovascular drugs and ventilatory support was also assessed using a generalized least squares random-effects model. A total of 170 pairs of CO-CO measurements were obtained from 65 preterm neonates. Mean bias was 9.7 ml/kg/min (95%CI 1.3-18.2) on day 1, 8.3 ml/kg/min (95%CI 0.3-16.4) on day 2, and 10.6 ml/kg/min (95%CI 4.5-16.6) on day 3 of life. The corresponding MPE was 7.2% (95%CI 4.8-10.6%), 7.5% (95%CI 4.7-12.8%) and 7.0% (95%CI 5.4-9.1%), respectively. A CO overestimation was observed in the presence of hsPDA (mean bias = 17.0 ml/kg/min, 95%CI 7.1-30.8, p = 0.003) and during dobutamine treatment (mean bias = 12.5 ml/kg/min, 95%CI 1.5-22.4, p = 0.018). No significant differences were observed according to dopamine administration and respiratory support modality.
Although a slight overestimation may occur during inotropic treatments and in the presence of a hsPDA, this study shows an acceptable accuracy and precision of CO in preterm infants during postnatal transition, thus supporting the role for EV monitoring in this critical phase.
• Electrical velocimetry allows a continuous and non-invasive monitoring of cardiac output (CO) in the neonatal population. • Available data comparing the accuracy of electrical velocimetry against transthoracic echocardiography for CO assessment in preterm infants are still controversial.
• The present data report a satisfactory accuracy of electrical velocimetry for CO assessment, with low bias and mean percentage error when compared to echocardiographic CO measurements. • Inotropic treatment with dobutamine and a hemodynamically significant duct may be associated with a slight but significant overestimation of CO measurements by electrical velocimetry.
这项前瞻性观察性研究旨在评估经胸超声心动图（CO）和电测速法（CO）所测得的心输出量的一致性，以及相关变量对过渡期早产儿CO测量准确性的影响。在出生后72小时内，对孕周<32周和/或出生体重<1500克的早产儿同时进行CO和CO测量。进行布兰德-奥特曼分析并计算偏差和平均百分比误差（MPE）。还使用广义最小二乘随机效应模型评估了具有血流动力学意义的动脉导管（hsPDA）、正在使用的心血管药物和通气支持的影响。共从65例早产儿中获得170对CO-CO测量值。出生第1天的平均偏差为9.7毫升/千克/分钟（95%CI 1.3-18.2），第2天为8.3毫升/千克/分钟（95%CI 0.3-16.4），出生第3天为10.6毫升/千克/分钟（95%CI 4.5-16.6）。相应的MPE分别为7.2%（95%CI 4.8-10.6%）、7.5%（95%CI 4.7-12.8%）和7.0%（95%CI 5.4-9.1%）。在存在hsPDA（平均偏差=17.0毫升/千克/分钟，95%CI 7.1-30.8，p=0.003）和多巴酚丁胺治疗期间（平均偏差=12.5毫升/千克/分钟，95%CI 1.5-22.4，p=0.018）观察到CO高估。根据多巴胺给药和呼吸支持方式未观察到显著差异。
尽管在使用正性肌力药物治疗期间和存在hsPDA时可能会出现轻微高估，但本研究表明，出生后过渡期早产儿的CO测量准确性和精密度是可接受的，从而支持了在这一关键阶段进行电测速监测的作用。
• 电测速法可对新生儿群体的心输出量（CO）进行连续、无创监测。• 关于在早产儿中比较电测速法与经胸超声心动图评估CO准确性的现有数据仍存在争议。
• 本数据报告了电测速法评估CO的准确性令人满意，与超声心动图CO测量值相比，偏差和平均百分比误差较低。• 多巴酚丁胺正性肌力治疗和具有血流动力学意义的动脉导管可能与电测速法对CO测量值的轻微但显著高估有关。
