Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Objective: To determine the agreement between electrical cardiometry (EC) and trans-thoracic echocardiography (TTE) as bedside tool for hemodynamic monitoring and early diagnosis of cardiovascular compromise in preterm and full term neonates and detection of factors affecting its accuracy. study design: Prospective observational blinded study using EC and TTE. Paired measurements of stroke volume (SV), cardiac output (CO), contractility and systemic vascular resistance (SVR) were carried out on full term and preterm neonates in different status regarding hemodynamics, sepsis and ventilation. results: A total 120 neonates (mean gestational age (GA): 34.14±3.28 weeks) were enrolled. There was agreement between EC and TTE using Bland Altman method as regards SV and CO measurements with bias 6.4%, 6.9%; respectively except in preterm group, bias was 18.2% and this agreement remained the same in the hemodynamically unstable, sepsis, preterm and IUGR subgroups. Parameters that affect the difference in SV measurements between EC and TTE were low tricuspid annular plane systolic excursion (TAPSE), high CO (>0.55 L/min), invasive ventilation and intra-atrial communication with no effect to PDA.A good correlation was found between contractility parameters fraction shortening (FS) by TTE and index of contractility (ICON) by EC (r=0.77;P<0.000) with weak negative correlation between ejection fraction (EF) by TTE and systolic time ratio (STR) by EC (r=-0.203;P<0.000). Heart rate variability (HRV) had 54% sensitivity and 79% specificity (95% CI 0.419{u2013}0.841) for sepsis prediction. conclusion: Measuring SV, CO and contractility with EC in hemodynamically stable and unstable full-term and preterm neonates shows good agreement to that of TTE. Limitations exist at highest values of CO, invasive ventilation and intra-atrial communication. HRV can be measured by EC for sepsis prediction in neonates

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