Arch Dis Child Fetal Neonatal Ed 2000;82:F182-F187 ( May )

Superior vena cava flow in newborn infants: a novel marker of systemic blood flow

Martin Kluckow^b, Nick Evans^a

^a Department of Neonatal Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney 2050, Australia, ^b Royal North Shore Hospital and University of Sydney, Sydney, Australia

Correspondence to: Dr Evans email: nevans{at}med.usyd.edu.au

Accepted 3 September 1999

BACKGROUNDVentricular outputs cannot be used to assess systemic blood flow in preterm infants because they are confounded by shunts through the ductus arteriosus and atrial septum. However, flow measurements in the superior vena cava (SVC) can assess blood returning from the upper body and brain.
OBJECTIVESTo describe a Doppler echocardiographic technique that measures blood flow in the SVC, to test its reproducibility, and to establish normal ranges.
DESIGNSVC flow was assessed together with right ventricular output and atrial or ductal shunting. Normal range was established in 14 infants born after 36 weeks' gestation (2 measurements taken in the first 48 hours) and 25 uncomplicated infants born before 30 weeks (4 measurements taken in the first 48 hours). Intra-observer and interobserver variability were tested in 20 preterm infants.
RESULTSIn 14 infants born after 36 weeks, median SVC flow rose from 76 ml/kg/min on day 1 to 93 ml/kg/min on day 2; in 25 uncomplicated very preterm infants, it rose from 62 ml/kg/min at 5 hours to 86 ml/kg/min at 48 hours. The lowest SVC flow for the preterm babies rose from 30 ml/kg/min at 5 hours to 46 ml/kg/min by 48 hours. Median intra-observer and interobserver variability were 8.1% and 14%, respectively. In preterm babies with a closed duct, SVC flow was a mean of 37% of left ventricular output and the two measures correlated significantly.
CONCLUSIONSThis technique can assess blood flow from the upper body, including the brain, in the crucial early postnatal period, and might allow more accurate assessment of the status of systemic blood flow and response to treatment.

Key messages Superior vena cava flow offers a non-invasive means to assess systemic blood flow in newborn infants Superior vena cava flow increases over the first 48 hours in well term and preterm infants

Keywords: preterm infants; superior vena cava; systemic blood flow; reproducibility

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© 2000 by Archives of Disease in Childhood
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