Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life.

Hdl Handle:
http://hdl.handle.net/10147/207999
Title:
Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life.
Authors:
Miletin, J; Pichova, K; Dempsey, E M
Affiliation:
Department of Paediatrics and Newborn Medicine, Coombe Women and Infants, University Hospital, Dolphin's Barn, Dublin 8, Ireland. miletinj@yahoo.com
Citation:
Eur J Pediatr. 2009 Jul;168(7):809-13. Epub 2008 Sep 26.
Journal:
European journal of pediatrics
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207999
DOI:
10.1007/s00431-008-0840-9
PubMed ID:
18818945
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.
Language:
eng
MeSH:
*Blood Flow Velocity; *Blood Pressure; Capillaries/*physiopathology; Female; Forehead/blood supply; Humans; Infant, Newborn; *Infant, Very Low Birth Weight; Intensive Care, Neonatal/methods; Lactic Acid/*blood; Male; Prospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Sternum/blood supply; Toes/blood supply; Vena Cava, Superior/*physiopathology/ultrasonography
ISSN:
1432-1076 (Electronic); 0340-6199 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMiletin, Jen_GB
dc.contributor.authorPichova, Ken_GB
dc.contributor.authorDempsey, E Men_GB
dc.date.accessioned2012-02-01T10:57:16Z-
dc.date.available2012-02-01T10:57:16Z-
dc.date.issued2012-02-01T10:57:16Z-
dc.identifier.citationEur J Pediatr. 2009 Jul;168(7):809-13. Epub 2008 Sep 26.en_GB
dc.identifier.issn1432-1076 (Electronic)en_GB
dc.identifier.issn0340-6199 (Linking)en_GB
dc.identifier.pmid18818945en_GB
dc.identifier.doi10.1007/s00431-008-0840-9en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207999-
dc.description.abstractWe 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.en_GB
dc.language.isoengen_GB
dc.subject.mesh*Blood Flow Velocityen_GB
dc.subject.mesh*Blood Pressureen_GB
dc.subject.meshCapillaries/*physiopathologyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshForehead/blood supplyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.mesh*Infant, Very Low Birth Weighten_GB
dc.subject.meshIntensive Care, Neonatal/methodsen_GB
dc.subject.meshLactic Acid/*blooden_GB
dc.subject.meshMaleen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.subject.meshStatistics, Nonparametricen_GB
dc.subject.meshSternum/blood supplyen_GB
dc.subject.meshToes/blood supplyen_GB
dc.subject.meshVena Cava, Superior/*physiopathology/ultrasonographyen_GB
dc.titleBedside detection of low systemic flow in the very low birth weight infant on day 1 of life.en_GB
dc.contributor.departmentDepartment of Paediatrics and Newborn Medicine, Coombe Women and Infants, University Hospital, Dolphin's Barn, Dublin 8, Ireland. miletinj@yahoo.comen_GB
dc.identifier.journalEuropean journal of pediatricsen_GB
dc.description.provinceLeinster-
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