Superior vena cava flow in newborn infants: A novel marker of systemic blood flow

Abstract

Background - Ventricular outputs cannot be used to assess systemic blood flow in preterm infants because they are confounded by shunts through the ductus arteriosus and atrial septum. However, flow measurements in the superior vena cava (SVG) can assess blood returning from the upper body and brain. Objectives - To describe a Doppler echocardiographic technique that measures blood flow in the SVG, to test its reproducibility, and to establish normal ranges. Design - SVG flow was assessed together with right ventricular output and atrial or ductal shunting. Normal range was established in 14 infants born after 36 weeks' gestation (2 measurements taken in the first 48 hours) and 25 uncomplicated infants born before 30 weeks (4 measurements taken in the first 48 hours). Intraobserver and interobserver variability were tested in 20 preterm infants. Results - In 14 infants born after 36 weeks, median SVC flow rose from 76 ml/kg/min on day 1 to 93 ml/kg/min on day 2; in 25 uncomplicated very preterm infants, it rose from 62 ml/kg/min at 5 hours to 86 ml/kg/min at 48 hours. The lowest SVG flow for the preterm babies rose from 30 ml/kg/min at 5 hours to 46 ml/kg/min by 48 hours. Median intraobserver and interobserver variability were 8.1% and 14%, respectively. In preterm babies with a closed duct, SVG flow was a mean of 37% of left ventricular output and the two measures correlated significantly. Conclusions - This technique can assess blood flow from the upper body, including the brain, in the crucial early postnatal period, and might allow more accurate assessment of the status of systemic blood flow and response to treatment.