Cardiac Output in Newborn Infants

Emmanouilides, George C.; Moss, A. J.; Monset-Couchard, Michelle; Marcano, Bertrand A.; Rzeznic, B.

doi:10.1159/000240225

Cited by 29 publications

(7 citation statements)

References 7 publications

(12 reference statements)

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“…ICG has been used for clinical investigations such as measuring hepatic blood flow, testing liver function and measuring cardiac output for more than 40 years (25,26). It is firmly bound to plasma proteins, excreted in bile in unconjugated form, and rapidly eliminated by the liver within 10 -15 min.…”

Section: Discussionmentioning

confidence: 99%

A New Method for the Measurement of Cerebral Blood Volume and Total Circulating Blood Volume Using Near Infrared Spatially Resolved Spectroscopy and Indocyanine Green: Application and Validation in Neonates

et al. 2004

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A new technique known as tissue dye densitometry (TDD) has been developed to simultaneously measure cerebral blood volume (CBV) and total circulating blood volume (TCV) using near infrared (NIR) spatially resolved spectroscopy (SRS) and the injection of indocyanine green (ICG). Using a medical NIR spectrometer with SRS capability (NIRO-300, Hamamatsu KK), a new parameter is calculated known as the ICG Hb index (IHI), which represents the ratio of ICG concentration to Hb concentration in tissue. Acting as a tracer, ICG is cleared by the liver over 15 min, providing a change of tracer concentration (⌬C ICG ,tis), which allows the calculation of the total Hb concentration in tissue (tcHb) using the equation: tcHb tis ( molar) ϭ ⌬C ICG,tis / ⌬IHI. The CBV can subsequently be calculated from tcHb tis given the absolute Hb concentration in blood (g/dL), from which the ICG concentration in blood (⌬C ICG,bl ) is obtained. By backextrapolating the ⌬C ICG,bl curve to the peak time, the initial ICG concentration in tissue blood (C 0 ICG,bl ) can be found and TCV can then be calculated. The TCV of 17 neonates were measured using the TDD technique and for comparison using the previously reported fetal Hb dilution technique (FHD Achieving a stable circulation in the first hours of life is fundamental to the provision of successful neonatal intensive care. Many clinical studies describe the administration of boluses of fluid to expand the total circulating volume (TCV) in response to clinical signs of poor skin perfusion, hypotension or acidosis and yet studies both in adults and the newborn show the prediction of hypovolemia by clinical assessment to be poor (1, 2). The availability of a simple cotside method to estimate TCV that could be used shortly after birth would be a useful tool both for the neonatal clinician and the researcher. Methods used previously involving the injection of autologous red cells labeled with biotin (3) or repeated blood sampling following injection of a marker such as indocyanine green (4)

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Section: Discussionmentioning

confidence: 99%

A New Method for the Measurement of Cerebral Blood Volume and Total Circulating Blood Volume Using Near Infrared Spatially Resolved Spectroscopy and Indocyanine Green: Application and Validation in Neonates

et al. 2004

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“…Left ventricular output at 12 h is one SD removed from the target data. Table 5 presents target data (34,35) and simulation results for arterial and atrial pressures 24 h after birth. All but one of the simulation results are within one SD of target data.…”

Section: Resultsmentioning

confidence: 99%

A Model for Educational Simulation of Hemodynamic Transitions at Birth

et al. 2010

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Birth is characterized by swift and complex transitions in hemodynamic and respiratory variables. Unrecognized pathologies or incidents may quickly become fatal or cause permanent damage. This article introduces an essential component of an acute perinatal care simulator, namely a model for educational simulation of normal hemodynamic transitions seen during and shortly after birth. We explicitly formulate educational objectives and adapt a preexisting model for the simulation of neonatal cardiovascular physiology to include essential aspects of fetal hemodynamics. From the scientific literature, we obtain model parameters that characterize these aspects quantitatively. The fetal model is controlled by a time-and event-based script of changes occurring at birth, such as onset of breathing and cord clamping, and the transitory phase up to 24 h after birth. Comparison of simulation results with published target data confirms that realistic simulated hemodynamic vital signs are achieved. (Pediatr Res 67: 158-165, 2010) P erinatal acute care is associated with specific clinical demands and challenges. The relatively small number of acute care cases occurring in many institutions, together with the presence of senior staff assuming the responsibility for their management, may hinder the establishment of adequate training for less experienced individuals. In other areas of acute care medicine, realistic simulators contribute to training of healthcare professionals and to patient safety.Clinically relevant learning objectives for medical staff in Neonatology include the recognition of cardiovascular signs and symptoms occurring in pathologies that manifest shortly after birth, such as persistent pulmonary hypertension, left ventricular overload by a patent ductus arteriosus (DA), myocardial depression, and hemorrhage.This article introduces a fundamental component of a perinatal acute care simulator, namely a simulation engine, for normal hemodynamic transitions from the fetal to the early neonatal period. A simulation engine can contribute to a life-like training environment by providing real-time, automatic evolution of clinical signs and monitored signals and of their response to therapeutic interventions. To be able to simulate normal physiology and provide a platform for future simulation of the above-mentioned incidents and pathologies, it is necessary that the engine reflect essential aspects of fetal hemodynamics and its subsequent transition to the neonate. Among others, structures such as lungs, placenta, heart, systemic arterial circulation, and the various fetal shunts need to be included. The simulation engine should be able to simulate realistic blood pressures and flow rates in these structures during fetal, transitional, and neonatal periods. METHODSThe proposed simulation engine for normal hemodynamic transitions from the fetal to the early neonatal period consists of a fetal hemodynamic model controlled by a time-and event-based script (1). The script triggers events occurring at birth such ...

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“…Another drawback is that these methods cannot easily be applied to clinical practice because results are not obtained in real time. There are other methods for plotting a dye dilution curve and measuring plasma volume using ICG and blood collection (9), but these methods require collection of large amounts of blood, which is not possible in infants, particularly in extremely low birth weight infants.…”

Section: Discussionmentioning

confidence: 99%