219 - Electrical Cardiometry in the transitional Period is not associated with short-term Outcome in Very Preterm Infants

Poster Number: 219
Publication Number: 219.221

Christoph E. Schwarz, University of Tübingen, Tübingen, Baden-Wurttemberg, Germany; John M. O'Toole, University College Cork, Cork, Cork, Ireland; David B. Healy, University College Cork, Cork, Cork, Ireland; Jurate Panaviene, INFANT, UCC, Cork, Cork, Ireland; Vicki Livingstone, University College Cork, Cork, Cork, Ireland; Eugene Dempsey, University Colleeg Cork, Cork, Cork, Ireland

Background: Electrical cardiometry (EC) provides continuous non-invasive monitoring of cardiac output (CO). Parameters measured include CO indexed to body weight (cardiac index: CI). The course of CI using a comparable but different technology (bioreactance) in the first 48 hours was recently linked to brain injury or NEC in infants with a birthweight < 1250 grams. Lower CI during the first but higher CI during the second day were found in infants with adverse outcome. Data pertaining to EC are lacking.

Objective: To evaluate whether EC-derived CI up to 48 hours of life is associated with adverse outcome in preterm infants and to investigate if changes in CI over time differed by outcome group.

Design/Methods: A prospective observational study of preterm infants < 32 weeks gestational age (GA) at a tertiary neonatal unit was performed. Exclusion criteria included major congenital anomalies including congenital heart defects and refusal of parental informed consent. CI values were obtained from continuous EC (ICON, Osypka Medical) starting as soon as possible after birth until 48 hours of life. Adverse outcome was predefined as mortality and/or abnormal cranial ultrasound (any grade peri- or intraventricular hemorrhage or periventricular leukomalacia) within the first two weeks of life. Logistic regression models were used to investigate the association between median CI and clinical outcome. Linear mixed-effects models were fitted to the data to compare CI trajectory over time in the two clinical outcome groups.

Results: Fifty-three preterm infants (median(IQR) GA 29+0(25+3 to 30+4) weeks+days, birthweight 1020 (745 to 1505) grams) were included in the analysis. The combined adverse outcome occurred in 21 (40%) of the infants. Median(IQR) CI was 241(197 to 275) for infants with an adverse outcome and 198(175 to 227) for those without adverse outcome (odds ratio (OR)(95% CI): 1.01(1.00-1.03), p=.028). Higher median CI was not associated with significantly higher odds of adverse event after adjustment for GA (adjusted OR(95% CI): 1.01(1.00-1.02), p=.219). CI trajectory did not significantly differ for the outcome groups (p=.352).
CI was found to increase over time (+17 mL/kg/min/day, p< .001) and to be lower for very (≥28weeks) compared to extremely ( < 28weeks) preterm infants (-39 mL/kg/min, p=.002).Conclusion(s): This study revealed that EC-derived CI in very preterm infants in the first 48 hours was not independently associated with adverse outcome. The potential role of EC needs to be further evaluated before it becomes standard practice.
Funding Supported by Deutsche Forschungsgemeinschaft (420536451)
TableI Baseline characteristics