Cardiac Blood Flow Measurements in Stable Full Term Small for Gestational Age Neonates

Abstract

Background: Cardiac blood flow measurements are useful in the haemodynamic management of neonates. Cardiac blood flows can be estimated with functional echocardiography as follows; flow in Superior Vena Cava (SVC), Right Ventricular Outflow (RVO) and Left Ventricular Outflow (LVO). Studies in preterm infants have shown that abnormal superior vena cava flow is associated with poor neurodevelopmental outcomes. To date, normative data on LVO, RVO and SVC flows has been established for term appropriate for gestational age neonates and preterm neonates, but no data is available on RVO, LVO and SVC flows for term small for gestational age neonates.Objective: To determine Right Ventricular Output (RVO), Left Ventricular Output (LVO) and Superior Vena Cava (SVC) flow after the transitional period in stable full term Small for Gestational Age (SGA) neonates. Design: Observational study.Setting: A tertiary care, perinatal centre in western Maharashtra, India. Participants:Full term (37 to 41 weeks) small for gestational age (weight below 10th percentile for gestational age) infants who were born during the study period.Methods: RVO, LVO and SVC flows were measured by functional echocardiography on day 7 of life in stable full term SGA neonates from January 2011 to August 2011. Infants who required respiratory or cardiovascular support and intensive care unit admissions for any indication and those with a clinical suspicion of an infection within 48 hours after data collection were excluded from the study.

Chronological Echocardiographic Changes in Healthy Term Neonates within Postnatal 72 Hours Using Doppler Studies

“…It is known that they can show differences by multiple causes, including gestational age, birth weight, medical conditions, PDA flow, and imaging modalities. 33 34 Our results are meaningful in that chronologic neonatal changes of systolic, diastolic, and TDI parameters are represented within early postnatal period with short-term intervals. They can be used to compile normal baseline data of neonates.…”

Survey of Point-of-Care Ultrasound Uptake in Indian Neonatal Intensive Care Units: Results and Recommendations

“…This is also evident from several studies reporting NP-POCU experiences in Indian NICUs in recent years. 14-16 As per a recent survey from the Australia–New Zealand region, the number of NICUs having at least 1 clinician with functional echocardiography skills has increased from 40% to more than 90% of units in a period of 10 years. 9, 17…”

A review of superior vena cava flow measurement in the neonate by functional echocardiography

“…Babies developing low SVC flow are less likely to have completed antenatal steroids and less likely to be born to a mother on antihypertensive medication (38,40). Interestingly, although babies developing low SVC flows are more likely to be of lower birthweight (40), a study performed solely on growthrestricted infants showed that symmetrically small infants had significantly higher SVC flow than those babies who were asymmetrically small (50). Interestingly, although babies developing low SVC flows are more likely to be of lower birthweight (40), a study performed solely on growthrestricted infants showed that symmetrically small infants had significantly higher SVC flow than those babies who were asymmetrically small (50).…”

“…Lower gestational age, larger PDA and failure of early PDA constriction are also known to be risk factors for low flow in the SVC (14,16,38,40). Interestingly, although babies developing low SVC flows are more likely to be of lower birthweight (40), a study performed solely on growthrestricted infants showed that symmetrically small infants had significantly higher SVC flow than those babies who were asymmetrically small (50). This observation may relate more to the nature of foetal growth or the underlying cause of growth restriction rather than birthweight per se, with recent evidence showing that growth-restricted babies have complex changes in the nature of the cardiovascular system (51)(52)(53)(54).…”