Background and Aims No validated scoring system to diagnose PPS in LBWI is available. Echocardiography (Echo)-derived low superior vena cava flow (SVCF) is a biomarker of PPS in this population as associates adverse outcome. We examined the ability of clinical surrogates of low systemic blood flow to indicate PPS as defined by low SVCF.
Methods One hundred LBWI [27.4 (2) wks; 1014 (316) g] who reached disease score below threshold, underwent early (< 12h) and serial Echo scans during the first 96hs after birth. Mean blood pressure (MBP), lactate, base excess (BE), core-to- peripheral temperature gap (DT) and diuresis were registered at the time of Echo assessment. N-terminal probrain natriuretic peptide (NT-proBNP) and troponine were measured within 24h and at postnatal day 4.
Results No association between SVCF and MBP, lactate, BE, DT, diuresis or troponine was found. NT-proBNP was inversely related to SVCF (p=0.006). Low SVCF (< 41 mL/k/min) was present in the first Echo (4.2h) in 27 patients. At that time, the sensitivity and specificity of the clinical parameters to predict low SVCF was, respectively: lactate > 4.5 mmol/L (22.2%; 89.4%); BE < –9 (6.9%; 92.9%); MBP<30 mmHg (25%; 64.6%); DT (15%; 78.8%). Combination of lactate and BE did not improve accuracy.
Conclusions PPS is a common condition early after birth in the sick LBWI. The role of Echo-derived systemic blood flow assessment to identify PPS cannot be replaced by clinical assessment solely.
Disclaimer Supported by the Spanish Health Ministry and the SAMID network.