Koert de Waal1, Nick Evans2. 1. Emma Children's Hospital AMC, Department of Neonatology, Amsterdam, the Netherlands; John Hunter Hospital, Department of Neonatology, Newcastle, Australia. Electronic address: koert.dewaal@hnehealth.nsw.gov.au. 2. Royal Prince Alfred Hospital, Newborn Care, and University of Sydney, Sydney, Australia.
Abstract
OBJECTIVE: To describe the hemodynamic changes with time in preterm infants with clinical sepsis. STUDY DESIGN: Blood pressure, right ventricular output (RVO), left ventricular output (LVO), and superior vena cava (SVC) flow of infants who had a suspected infection and showed signs of cardiovascular compromise were measured every 12 hours or until there was considered clinical improvement. RESULTS: Twenty infants with a median gestational age of 27 weeks (range, 25-32 weeks) and weight of 995 g (range, 650-1980 g) were examined. Five patients died. The mean (SD) RVO, LVO, and SVC flow at the first measurement were 555 (133), 441 (164), and 104 (39) mL/kg/min, respectively. The calculated systemic vascular resistance (SVR) was 0.08 (0.04) mm Hg/mL/kg/min. There was no significant change in flow in the 15 surviving infants. Blood pressure and SVR increased from the first to the last measurement (mean difference: blood pressure, 8 mm Hg; 95% CI 3 to -13; systemic vascular resistance, 0.02 mm Hg/mL/kg/min; 95% CI, 0.01 to -0.04). Flows decreased and SVR increased in the 5 non-surviving infants (mean difference: RVO, -318 mL/kg/min; 95% CI, -463 to -174; LVO, -292 mL/kg/min; 95% CI, -473 to -111; SVC flow, -46 mL/kg/min; 95% CI, -77 to -16). CONCLUSION: Preterm neonates with sepsis have relatively high left and right cardiac outputs and low SVRs. A decrease in RVO or LVO >50% compared with the initial measurement is associated with mortality. Copyright 2010 Mosby, Inc. All rights reserved.
OBJECTIVE: To describe the hemodynamic changes with time in preterm infants with clinical sepsis. STUDY DESIGN: Blood pressure, right ventricular output (RVO), left ventricular output (LVO), and superior vena cava (SVC) flow of infants who had a suspected infection and showed signs of cardiovascular compromise were measured every 12 hours or until there was considered clinical improvement. RESULTS: Twenty infants with a median gestational age of 27 weeks (range, 25-32 weeks) and weight of 995 g (range, 650-1980 g) were examined. Five patients died. The mean (SD) RVO, LVO, and SVC flow at the first measurement were 555 (133), 441 (164), and 104 (39) mL/kg/min, respectively. The calculated systemic vascular resistance (SVR) was 0.08 (0.04) mm Hg/mL/kg/min. There was no significant change in flow in the 15 surviving infants. Blood pressure and SVR increased from the first to the last measurement (mean difference: blood pressure, 8 mm Hg; 95% CI 3 to -13; systemic vascular resistance, 0.02 mm Hg/mL/kg/min; 95% CI, 0.01 to -0.04). Flows decreased and SVR increased in the 5 non-surviving infants (mean difference: RVO, -318 mL/kg/min; 95% CI, -463 to -174; LVO, -292 mL/kg/min; 95% CI, -473 to -111; SVC flow, -46 mL/kg/min; 95% CI, -77 to -16). CONCLUSION: Preterm neonates with sepsis have relatively high left and right cardiac outputs and low SVRs. A decrease in RVO or LVO >50% compared with the initial measurement is associated with mortality. Copyright 2010 Mosby, Inc. All rights reserved.
Authors: Alan M Groves; Yogen Singh; Eugene Dempsey; Zoltan Molnar; Topun Austin; Afif El-Khuffash; Willem P de Boode Journal: Pediatr Res Date: 2018-07 Impact factor: 3.756