Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life |
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Authors: | J Miletin K Pichova E M Dempsey |
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Institution: | (1) Department of Paediatrics and Newborn Medicine, Coombe Women and Infants University Hospital, Dolphin’s Barn, Dublin 8, Ireland;(2) Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland;(3) Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic |
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Abstract: | We aimed to assess the relationship between the clinical and biochemical parameters of perfusion and superior vena cava (SVC)
flow in a prospective observational cohort study of very low birth weight (VLBW) infants. Newborns with congenital heart disease
were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Capillary refill time (forehead,
sternum and toe), mean blood pressure, urine output and serum lactate concentration were also measured simultaneously. Thirty-eight
VLBW infants were examined. Eight patients (21%) had SVC flow less than 40 ml/kg/min. There was a poor correlation between
the capillary refill time (in all sites), mean blood pressure, urine output and SVC flow. The correlation coefficient for
the serum lactate concentration was r = −0.28, p = 0.15. The median serum lactate concentration was 3.5 (range 2.8–8.5) vs. 2.7 (range 1.2–6.9) mmol/l (p = 0.01) in low flow versus normal flow states. A serum lactate concentration of >2.8 was 100% sensitive and 60% specific
for detecting a low flow state. Combining a capillary refill time of >4 s with a serum lactate concentration of >4 mmol/l
had a specificity of 97% for detecting a low SVC flow state. Serum lactate concentrations are higher in low SVC flow states.
A capillary refill time of >4 s combined with serum lactate concentrations >4 mmol/l increased the specificity and positive
and negative predictive values of detecting a low SVC flow state. |
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Keywords: | Very low birth weight Low superior vena cava flow Lactate Capillary refill time |
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