The clinical value of ultrasonic cardiac output monitor in very-low birth-weight and extremely-low-birth-weight infants undergoing PDA ligation

Yu-Mei Liu; Man-Li Zheng; Xin Sun; Xiao-Bo Chen; Yun-Xia Sun; Zhi-Chun Feng; Shao-Ru He

doi:10.1016/j.earlhumdev.2021.105522

The clinical value of ultrasonic cardiac output monitor in very-low birth-weight and extremely-low-birth-weight infants undergoing PDA ligation

Early Hum Dev. 2022 Feb:165:105522. doi: 10.1016/j.earlhumdev.2021.105522. Epub 2021 Dec 7.

Authors

Yu-Mei Liu¹, Man-Li Zheng², Xin Sun², Xiao-Bo Chen², Yun-Xia Sun², Zhi-Chun Feng³, Shao-Ru He⁴

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China; Department of Neonatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
² Department of Neonatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
³ Department of Neonatology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing 100853, China.
⁴ The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China; Department of Neonatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. Electronic address: shaoruhe7@126.com.

PMID: 34959193
DOI: 10.1016/j.earlhumdev.2021.105522

Abstract

Background: Cardiorespiratory instability occurs very often in very-low-birth-weight (VLBW) and extremely-low-birth-weight (ELBW) infants undergoing patent ductus arteriosus (PDA) ligation during the early postoperative period. This study aimed to investigate ultrasonic cardiac output monitor (USCOM) as a bedside tool by evaluating the hemodynamic changes in preterm infants following PDA ligation and assessing factors that may influence these changes.

Methods: This was a single-center prospective observational study at a third-level neonatal intensive care unit. A total of 33 infants, including 21 VLBW and 12 ELBW infants, were involved. Hemodynamic measurements were performed in these infants using a USCOM preoperatively as well as 0-1 h, 8-10 h, and 24 h postoperatively.

Results: The PDA ligation was associated with reductions of the left ventricular cardiac output (LVCO) (P < 0.001), cardiac index (P < 0.001), flow time corrected (FTC) (P < 0.001), Smith-Madigan inotropy index (SMII) (P < 0.001), oxygen delivery (DO₂) (P < 0.001), and oxygen delivery index (DO₂I) (P < 0.001) and an increase of the systemic vascular resistance index (SVRI) (P < 0.001) at 0-1 h, 8-10 h, and 24 h post-ligation compared with the respective preoperative values. Compared with the respective values at 0-1 h post-ligation, there was no significant difference in the CI, SMII, or FTC at 8-10 h and 24 h post-ligation. However, the SVRI decreased at 8-10 h and 24 h post-ligation. Moreover, the DO₂I increased at 8-10 h and 24 h post-ligation, and the LVCO and DO₂ increased at 24 h post-ligation.

Conclusion: Our study confirmed that the hemodynamic changes measured by the USCOM were similar to those measured by echocardiography in previous reports. Thus, USCOM is a useful and convenient bedside tool for assessing hemodynamic changes to guide the use of fluids, inotropic agents, and vasopressors and help modify the post-ligation course, and they may be a surrogate for repeated echocardiography during the early post-ligation period in preterm infants or a preliminary screening method.

Keywords: Extremely low-birth-weight infant; Hemodynamics; PDA ligation; Patent ductus arteriosus; Very-low-birth-weight infant.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Output
Ductus Arteriosus, Patent* / diagnostic imaging
Ductus Arteriosus, Patent* / surgery
Humans
Infant
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature
Ligation / methods
Ultrasonics