Low Superior Vena Cava Flow On Day One And Adverse Outcome In The Very Low Birth Weight Infant
- Jan Miletin (miletinj{at}yahoo.com)
Abstract
Background: Superior vena cava (SVC) flow assesses blood flow from the upper body, and may provide a reliable of assessment of systemic blood flow.
Aim:(i) To assess the relationship between SVC flow in first 24 hours and adverse outcome in very low birth weight infants (VLBW) (ii) To assess correlation between SVC flow and left and right ventricular output and anterior cerebral artery (ACA) velocity measurements.
Methods: A prospective observational cohort study. Neonates with birth weight less than 1500g were eligible for enrollment. Newborns with congenital heart disease (excluding patent ductus arteriosus) or major congenital malformations were excluded. Echocardiographic evaluation of superior vena cava flow, right and left ventricular output and ductal patency was performed in the first 24 hours life. Capillary refill time, blood pressure and urine output were also measured simultaneously. The primary outcome was intraventricular hemorrhage grade > II and/or early neonatal death (<7 days).
Results: 40 VLBW neonates were enrolled following parental consent. Two patients were excluded. 8 babies (21%) had low flow states. There was no difference in median birth weight 1.14 kg vs. 1.17 kg (P=0.76), gestational age 26.5 vs. 28.0 weeks (P=0.12) or hours of life at exam 18.5hrs vs. 21hrs respectively (P=0.36). The incidence of primary outcome (IVH > grade II and/or early neonatal death) was 50% vs. 6.7% respectively (P=0.01). There was no correlation between SVC flow and RVO, LVO, blood pressure measurements or ACA velocity measurements.
Conclusions: Low SVC blood flow occurred in 21% of our very low birth weight infants in the first 24 hours and was associated with early neonatal death and/or severe IVH.
