Comparison of Cardiac Output Measurement by Electrical Velocimetry with Echocardiography in Extremely Low Birth Weight Neonates

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mohammad Ahmad Hassan ◽  
Manuel B. Bryant ◽  
Helmut D. Hummler
Keyword(s):  
Cardiac Output ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Ductus Arteriosus ◽  
Extremely Low Birth Weight ◽  
Altman Analysis ◽  
Output Measurement ◽  
Bland Altman Analysis ◽  
Electrical Velocimetry ◽  
Elbw Neonates

<b><i>Introduction:</i></b> Electrical velocimetry (EV) offers a noninvasive tool for continuous cardiac output (CO) measurements which might facilitate hemodynamic monitoring and targeted therapy in low birth neonates, in whom other methods of CO measurement are not practicably feasible. <b><i>Methods:</i></b> This prospective observational study compared simultaneous cardiac output measurements by electrical velocimetry (CO<sub>EV</sub>) with transthoracic echocardiography (CO<sub>TTE</sub>) in extremely low birth weight (ELBW) neonates in the neonatal intensive care unit (NICU). Echocardiography was performed by 1 single examiner. Data were analyzed by Bland-Altman analysis and independent-samples analysis of variance. A mean percentage error (MPE) of &#x3c;30% and limits of agreement (LOA) up to ±30% were considered clinically acceptable. <b><i>Results:</i></b> Thirty-eight ELBW neonates were studied and yielded 85 pairs of CO<sub>EV</sub> and CO<sub>TTE</sub> measurements. Bland-Altman analysis showed an overall bias (the mean difference) and LOA of −126 and −305 to +52 mL min<sup>−1</sup>, respectively, and an MPE of 66%. Patients with patent ductus arteriosus had a higher bias with LOA and MPE of −166.8, −370.7 to +37 mL min<sup>−1</sup>, and 69%, respectively. The overall true precision was 58%. <b><i>Conclusion:</i></b> This study showed high bias and lack of agreement between EV and TTE for measurement of CO in ELBW infants in NICU, limiting applicability of EV to monitor absolute values.

scholarly journals Amikacin or Vancomycin Exposure Alters the Postnatal Serum Creatinine Dynamics in Extreme Low Birth Weight Neonates

2021 ◽  
Vol 18 (2) ◽  
pp. 662
Author(s):  
Tamara van Donge ◽  
Anne Smits ◽  
John van den Anker ◽  
Karel Allegaert
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Creatinine ◽  
Potential Effect ◽  
Extremely Low Birth Weight ◽  
Treatment Modalities ◽  
Antibiotic Exposure ◽  
Sensitive Tool ◽  
Elbw Neonates ◽  
The Impact

Background: Disentangling renal adverse drug reactions from confounders remains a major challenge to assess causality and severity in neonates, with additional limitations related to the available tools (modified Kidney Disease Improving Global Outcome, or Division of Microbiology and Infectious Diseases pediatric toxicity table). Vancomycin and amikacin are nephrotoxic while still often prescribed in neonates. We selected these compounds to assess their impact on creatinine dynamics as a sensitive tool to detect a renal impairment signal. Methods: A recently developed dynamical model that characterized serum creatinine concentrations of 217 extremely low birth weight (<1000 g, ELBW) neonates (4036 observations) was enhanced with data on vancomycin and/or amikacin exposure to identify a potential effect of antibiotic exposure by nonlinear mixed-effects modelling. Results: Seventy-seven percent of ELBW patients were exposed to either vancomycin or amikacin. Antibiotic exposure resulted in a modest increase in serum creatinine and a transient decrease in creatinine clearance. The serum creatinine increase was dependent on gestational age, illustrated by a decrease with 56% in difference in serum creatinine between a 24 or 32-week old neonate, when exposed in the 3rd week after birth. Conclusions: A previously described model was used to explore and quantify the impact of amikacin or vancomycin exposure on creatinine dynamics. Such tools serve to explore minor changes, or compare minor differences between treatment modalities.

scholarly journals Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life

2020 ◽  
Author(s):  
Tamara van Donge ◽  
Karel Allegaert ◽  
Verena Gotta ◽  
Anne Smits ◽  
Elena Levtchenko ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Mode Of Delivery ◽  
Extremely Low Birth Weight ◽  
Reference Ranges ◽  
Mixed Effect ◽  
Postnatal Maturation ◽  
Elbw Neonates

Abstract Background Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging. Methods We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated. Results A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth. Conclusions We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.

scholarly journals IMPACT OF MULTIPLE BIRTHS ON THE OUTCOME IN EXTREMELY LOW BIRTH WEIGHT NEWBORNS

2021 ◽  
Vol 27 (3) ◽  
pp. 3985-3991
Author(s):  
Victoria Atanasova ◽  
◽  
Petar Ivanov ◽  
Elitsa Gyokova ◽  
Desislava Georgieva ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Assisted Reproductive Technologies ◽  
Ductus Arteriosus ◽  
Intraventricular Haemorrhage ◽  
Reproductive Technologies ◽  
University Hospital ◽  
Extremely Low Birth Weight ◽  
Gastrointestinal Problems

Objective: To evaluate the outcome of the extremely low birth weight newborns (ELBWNs) from single and twin pregnancies. Material and methods: The study lasts from 2005 to 2017 and includes all life born ELBWNs treated in University Hospital, Pleven, Bulgaria. Patients' groups: singletons (1) and twins (2); twins conceived naturally(2.1) and after assisted reproductive technologies – ART(2.2). Results: One hundred and eighty two (182) ELBWNs are examined, 65 (35.7%) of them are twins. The twins, compared to singletons, are significantly more often conceived by ART (47.7 vs 4.3%, p<0.001) and significantly more rarely infected prenatally (18 vs 41%, p 0.002). The survival rate is 51.3% for singletons and 56.6% for twins, NS. Survived twins (n 37) achieve later their optimal nutritive tolerance (30±11 vs 25±10 days, p 0.046), require more blood transfusions (3.6±1.9 vs 2.6±1.8 per patient, p 0.009) and longer mechanical ventilation (16±15 vs 9±12 days, p 0.03) than survival singletons (n 60). The twins suffer more often from intraventricular haemorrhage (46 vs 18%, p 0.004), patent ductus arteriosus (35 vs 15%, p 0.02) and long-term complications (51 vs 30%, p 0.04) than singletons. ART-twins (n 31)compared to the subgroup 2.1 (n 34) are more frequently intubated in the delivery room (81 vs. 50%, p 0.01)but suffer less frequently from nosocomial infections (53 vs. 85%, p 0.03). Conclusions: According to our data, ELBW-twins frequently suffer from respiratory, haemorrhagic, and gastrointestinal problems than ELBW-singletons, resulting in more long-term complications. Our study proves that ART does not influence the outcome in multiples.

Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

2018 ◽  
Vol 93 (1) ◽  
pp. 89-96 ◽  
Author(s):  
Shyam Sathanandam ◽  
Kaitlin Balduf ◽  
Sandeep Chilakala ◽  
Kristen Washington ◽  
Kimberly Allen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Patent Ductus Arteriosus Closure ◽  
Patent Ductus
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