Non-invasive Cardiac Output Monitoring in Neonates.

Roisin O'Neill,Eugene M Dempsey,Aisling A Garvey,Christoph E Schwarz

doi:10.3389/fped.2020.614585

Abstract

Circulatory monitoring is currently limited to heart rate and blood pressure assessment in the majority of neonatal units globally. Non-invasive cardiac output monitoring (NiCO) in term and preterm neonates is increasing, where it has the potential to enhance our understanding and management of overall circulatory status. In this narrative review, we summarized 33 studies including almost 2,000 term and preterm neonates. The majority of studies evaluated interchangeability with echocardiography. Studies were performed in various clinical settings including the delivery room, patent ductus arteriosus assessment, patient positioning, red blood cell transfusion, and therapeutic hypothermia for hypoxic ischemic encephalopathy. This review presents an overview of NiCO in neonatal care, focusing on technical and practical aspects as well as current available evidence. We discuss potential goals for future research.

Highlights

Monitoring and assessment of the cardiovascular system is an essential component in the care of term and preterm infants in neonatal intensive care units
Findings depict a single point in time, and extensive standardized training is required to ensure the quality of the measurements, before it can be safely implemented as a tool for cardiac assessment in neonatal intensive care units [8, 9]
Despite questionable interchangeability with Echo and evidence for its various confounders, both electrical cardiometry (EC) and BR are frequently used in various research settings

Summary

Introduction

Monitoring and assessment of the cardiovascular system is an essential component in the care of term and preterm infants in neonatal intensive care units. In order to accurately evaluate the cardiovascular status, two other factors need to be considered: cardiac output (CO) and systemic vascular resistance (SVR). Together, these determine systemic blood flow and subsequently end organ perfusion. Echo use in the neonatal intensive care unit has grown exponentially over the last decade and has improved the evaluation of infants with suspected cardiovascular instability [7]. Findings depict a single point in time, and extensive standardized training is required to ensure the quality of the measurements, before it can be safely implemented as a tool for cardiac assessment in neonatal intensive care units [8, 9]. There is the risk of destabilizing an infant, given that a full cardiac assessment with echo can take a considerable period of time

Objectives

Findings

Discussion

Conclusion