Non-invasive Cardiac Output Monitoring in Neonates

Abstract

Circulatory monitoring is currently limited to heart rate and blood pressure assessment in the majority of neonatal units globally. Non-invasive cardiac output monitoring (NiCO) in term and preterm neonates is increasing, where it has the potential to enhance our understanding and management of overall circulatory status. In this narrative review, we summarized 33 studies including almost 2,000 term and preterm neonates. The majority of studies evaluated interchangeability with echocardiography. Studies were performed in various clinical settings including the delivery room, patent ductus arteriosus assessment, patient positioning, red blood cell transfusion, and therapeutic hypothermia for hypoxic ischemic encephalopathy. This review presents an overview of NiCO in neonatal care, focusing on technical and practical aspects as well as current available evidence. We discuss potential goals for future research.

Keywords: bioimpedance; bioreactance; circulatory monitoring; electrical cardiometry; electrical velocimetry; systemic blood flow; transthoracic electrical biosensing technology.

Figure 1

Bioreactance and electrical cardiometry electrodes. Left: Duo-electrode sensors for bioreactance monitoring (Cheetah Medical Inc., Newton, MA, USA), right: ISense neonatal sensors for electrical cardiometry monitoring (Osypka Medical, Berlin, Germany).

Figure 2

Schematic examples for electrode application. (A) Example of Bioreactance electrode placement in neonates. The upper part of the shoulder electrodes is crossing the shoulder and not visible from the anterior. (B) Current manufacturers' recommendation of sensor application in electrical cardiometry monitoring.