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Cardiac output measurement in preterm neonates: validation of USCOM against echocardiography

Objective measurement of cardiac output (CO) in preterm neonates is important for optimisation of haemodynamic management, and may have outcome benefits. Doppler ultrasound is the preferred method for measurement of CO; however, the pulmonary and aortic diameters for calculating flow volumes are small, and measurement using 2D ultrasound requires expertise and experience, particularly for analysis of transpulmonary flow. The USCOM (USCOM Ltd, Sydney, Australia) is a novel 2D independent device using CW Doppler and anthropometrics to determine both right and left flow volumes. The device is simpler to operate and less expensive than the conventional echocardiography.

This study was to compare 2D echo and USCOM CO measurements in preterm neonates.

After IRB approval 66 paired measures of transpulmonary CO were acquired in 37 preterm neonates (mean weight 1.13 ± 0.47 kg) using conventional echocardiography, combining 2D and CW Doppler, and the USCOM device. Signals were acquired and analysed independently and in a blinded fashion, and values compared by two-tailed t tests and Bland-Altman bias analysis.

Mean values of transpulmonary CO were 0.36 ± 0.19 l/min by echocardiography and 0.37 ± 0.14 l/min by USCOM and were not significantly different (r = 0.9134, P < 0.005). The mean difference between measures was 0.00 ± 0.08 l/min, with a mean of the means of 0.36 ± 0.16 l/min and a mean percentage error of -3.7%. The smaller SDs associated with USCOM convert to smaller 95% CIs and a possible increased sensitivity for detection of haemodynamic change.

figure 1

Figure 1

These results suggest that the USCOM is as accurate for measurement of neonatal CO as conventional echocardiography, and may be a simple cost-effective alternative for neonatal haemodynamic management.

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Phillips, R., Paradisis, M., Evans, N. et al. Cardiac output measurement in preterm neonates: validation of USCOM against echocardiography. Crit Care 10 (Suppl 1), P343 (2006).

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