FoCUS and non-invasive hemodynamics monitoring in neonatal sepsis

Abstract

Sepsis is one of the most encountered pathologies in the neonatal intensive care unit (NICU) and is associated with significant morbidity and mortality, especially in preterm neonates. In this study, we aimed to assess early hemodynamic status in preterm neonates diagnosed with sepsis by electrical cardiometry and compare its utility to functional echocardiography in NICU. This is a case-control prospective observational study that enrolled 70 septic preterm neonates (34 0/7 to 36 6/7 weeks gestational age) who were admitted to Tanta University NICU and met the criteria for diagnosis of neonatal sepsis; meanwhile, cases with septic shock were excluded. A non-sepsis group of 70 newborns matched for gestational age and sex was included as a control group. Bedside focused cardiac ultrasound (FoCUS) and electrical cardiometry monitoring were performed on the 2nd day of the clinical diagnosis of sepsis. Stroke volume (SV), cardiac output (CO), and cardiac index (CI) measurements by both echocardiography and electrical cardiometry were significantly higher in the sepsis group compared to the non-sepsis group. Systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were significantly lower in the septic group compared to the non-sepsis group. Correlations between electrical cardiometry and focused cardiac ultrasound parameters were significantly positive regarding SV, CO, CI, SVR, and SVRI in all the studied groups. CONCLUSIONS: Electrical cardiometry could be considered a useful and promising tool for early assessment of hemodynamics in preterm neonates with sepsis coinciding with echocardiography. WHAT IS KNOWN: • Preterm infants diagnosed with sepsis can develop cardiovascular instability due to the unique features of their cardiovascular function and reserve. • Prompt identification of patients with progression of sepsis severity may be accomplished through frequent clinical assessments and monitoring of the changes in their physiological indices (heart rate, BP, urine output, capillary refill time, and neurologic status) and biochemical variables (blood gas, lactate, electrolytes, and creatinine). WHAT IS NEW: • Electrical cardiometry could be considered a useful and promising tool for the early assessment of hemodynamics in preterm neonates with sepsis coinciding with echocardiography.