Noureldeen, M., Abdallah, H., Morgan, D., Hussien, K. (2025). Evaluation of superior vena cava flow and cardiac output in neonatal sepsis using functional echocardiography. test, 6(1), 172-191. doi: 10.21608/ejmr.2023.227259.1435
Mahmoud Mahmoud Noureldeen; Hadeer Mohammed Abdallah; Dalia Saber Morgan; Khaled Mohammed Hussien. "Evaluation of superior vena cava flow and cardiac output in neonatal sepsis using functional echocardiography". test, 6, 1, 2025, 172-191. doi: 10.21608/ejmr.2023.227259.1435
Noureldeen, M., Abdallah, H., Morgan, D., Hussien, K. (2025). 'Evaluation of superior vena cava flow and cardiac output in neonatal sepsis using functional echocardiography', test, 6(1), pp. 172-191. doi: 10.21608/ejmr.2023.227259.1435
Noureldeen, M., Abdallah, H., Morgan, D., Hussien, K. Evaluation of superior vena cava flow and cardiac output in neonatal sepsis using functional echocardiography. test, 2025; 6(1): 172-191. doi: 10.21608/ejmr.2023.227259.1435

Evaluation of superior vena cava flow and cardiac output in neonatal sepsis using functional echocardiography

Egyptian Journal of Medical Research
Volume 6, Issue 1, January 2025, Pages 172-191    PDF (698.05 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2023.227259.1435
Authors
Mahmoud Mahmoud Noureldeen1; Hadeer Mohammed Abdallah* 1; Dalia Saber Morgan1; Khaled Mohammed Hussien2
1Pediatrics department, Faculty of Medicine, Beni-Suef University
2Cardiology department, Faculty of Medicine, Beni-Suef University
Abstract
Background: One of the major causes of newborn mortality is sepsis. The results of sepsis in newborns include cardiovascular problems. Specific hemodynamic phenotypes may be distinguished by echocardiography, which also facilitates physiology-based therapy of sepsis-related cardiovascular dysfunction on an individual basis. The Left Ventricular Output (LVO), Right Ventricular Output (RVO), and Superior Vena Cava Flow (SVCF) are the three parameters that are most often used to evaluate the central blood flow in newborns. Aim: This research used functional echocardiography to assess LVO, RVO, and SVCF in newborns with sepsis. Patients and methods: In the Beni-Suef University Hospital Neonatal Care Unit, this case-control research was carried out. There were 40 newborn sepsis cases and 40 healthy controls in it. All research participants had a meticulous medical history, comprehensive physical examination, and a battery of investigations, including C-reactive protein, complete blood count, blood culture, and a functional echocardiogram on a GE Vivid T8 echocardiography machine.  Results: Patients with neonatal sepsis had considerably greater RVO, LVO, and SVC flow than controls. Additionally, gram-negative sepsis had much greater LVO, RVO, and SVC flow than gram-positive sepsis. Further study revealed that gram-negative LOS had considerably greater LVO, RVO, and SVCF than gram-positive LOS, while gram-negative and gram-positive EOS showed no appreciable differences. Prematurity as well as low birth weight were the commonest risk factors for sepsis. Gram-negative bacteria overwhelmed gram-positive ones. The most prevalent gram-positive and gram-negative bacteria were CONS and Klebsiella pneumoniae respectively. Neonatal sepsis patients had considerably greater levels of WBCs and a prolonged capillary refill time than controls, while their platelet counts were much lower than controls. Conclusions and Recommendations: In newborn sepsis, serious cardiovascular consequences are frequent. To better assess RVO, LVO, and SVCF in newborns with sepsis, multicenter studies on several populations are advised.
Keywords
RVO; LVO; SVCF; Neonatal sepsis
References
  1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. The lancet. 2017 Oct 14;390(10104):1770-80.
  2. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. The Lancet Respiratory Medicine. 2018 Mar 1;6(3):223-30.
  3. Kharrat A, Jain A. Hemodynamic dysfunction in neonatal sepsis. Pediatric Research. 2022 Jan;91(2):413-24.
  4. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW. Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training: writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). European Journal of Echocardiography. 2011 Oct 1;12(10):715-36.
  5. Breatnach CR, Levy PT, James AT, Franklin O, El-Khuffash A. Novel echocardiography methods in the functional assessment of the newborn heart. Neonatology. 2016 Nov 3;110(4):248-60.
  6. Sloot SC, de Waal KA, van der Lee JH, van Kaam AH. Central blood flow measurements in stable preterm infants after the transitional period. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2010 Sep 1;95(5):F369-72.
  7. Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Frontiers in Pediatrics. 2017 Sep 15;5:201.
  8. Kluckow M, Evans N. Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2000 May 1;82(3):F182-7.
  9. Stocker M, Van Herk W, El Helou S, Dutta S, Fontana MS, Schuerman FA, van den Tooren-de RK, Wieringa JW, Janota J, van der Meer-Kappelle LH, Moonen R. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomized controlled trial (NeoPIns). The Lancet. 2017 Aug 26;390(10097):871-81.
  10. Ershad M, Mostafa A, Dela Cruz M, Vearrier D. Neonatal sepsis. Current emergency and hospital medicine reports. 2019 Sep 15;7:83-90.
  11. Odabasi IO, Bulbul A. Neonatal sepsis. Şişli Etfal Hastanesi Tip Bülteni. 2020;54(2):142-58.
  12. Alzahrani AK. Cardiac function affection in infants with neonatal sepsis. J Clin Trials. 2017;7(1):2167-0870.
  13. Wu TW, Noori S. Recognition and management of neonatal hemodynamic compromise. Pediatrics & Neonatology. 2021 Feb 1;62:S22-9.
  14. Mohsen L, Ramy N, Saied D, Akmal D, Salama N, Abdel Haleim MM, Aly H. Emerging antimicrobial resistance in early and late-onset neonatal sepsis. Antimicrobial Resistance & Infection Control. 2017 Dec;6(1):1-9.
  15. Awad HA, Mohamed MH, Badran NF, Mohsen M, Abd-Elrhman AS. Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt. Journal of the Egyptian Public Health Association. 2016 Mar 1;91(1):31-8.
  16. Ogundare E, Akintayo A, Aladekomo T, Adeyemi L, Ogunlesi T, Oyelami O. Presentation and outcomes of early and late-onset neonatal sepsis in a Nigerian Hospital. African health sciences. 2019 Nov 5;19(3):2390-9.
  17. Belachew A, Tewabe T. Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis. BMC Pediatrics. 2020 Dec;20:1-7.
  18. Greenberg RG, Kandefer S, Do BT, Smith PB, Stoll BJ, Bell EF, Carlo WA, Laptook AR, Sánchez PJ, Shankaran S, Van Meurs KP. Late-onset sepsis in extremely premature infants: 2000–2011. The Pediatric infectious disease journal. 2017 Aug;36(8):774.
  19. Seliem WA, Sultan AM. Etiology of early-onset neonatal sepsis in neonatal intensive care unit–Mansoura, Egypt. Journal of neonatal-perinatal medicine. 2018 Jan 1;11(3):323-30.
  20. Gaballah AH, Shawky S, Amer AN. Microbiological profiles of neonatal sepsis in northern Egypt. Microbes and Infectious Diseases. 2022 Aug 1;3(3):645-56.
  21. Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, Robinson MJ, Collinson A, Heath PT. Neonatal infections in England: the NeonIN surveillance network. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2011 Jan 1;96(1):F9-14.
  22. Meshram RM, Gajimwar VS, Bhongade SD. Predictors of mortality in outborns with neonatal sepsis: A prospective observational study. Nigerian Postgraduate Medical Journal. 2019 Oct 1;26(4):216-22.
  23. Fleming S, Gill P, Jones C, Taylor JA, Van den Bruel A, Heneghan C, Roberts N, Thompson M. The diagnostic value of capillary refill time for detecting serious illness in children: a systematic review and meta-analysis. PloS one. 2015 Sep 16;10(9):e0138155.
  24. Aydın B, Dilli D, Zenciroğlu A, Karadağ N, Beken S, Okumuş N. Mean platelet volume and uric acid levels in neonatal sepsis. The Indian Journal of Pediatrics. 2014 Dec;81:1342-6.
  25. O’Reilly D, Murphy CA, Drew R, El-Khuffash A, Maguire PB, Ainle FN, Mc Callion N. Platelets in pediatric and neonatal sepsis: novel mediators of the inflammatory cascade. Pediatric Research. 2022 Jan;91(2):359-67.
  26. Claushuis TA, van Vught LA, Scicluna BP, Wiewel MA, Klein Klouwenberg PM, Hoogendijk AJ, Ong DS, Cremer OL, Horn J, Franitza M, Toliat MR. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood, The Journal of the American Society of Hematology. 2016 Jun 16;127(24):3062-72.
  27. Sorsa A. Diagnostic significance of white blood cell count and c-reactive protein in neonatal sepsis; Asella Referral Hospital, South East Ethiopia. The open microbiology journal. 2018;12:209.
  28. De Waal K, Evans N. Hemodynamics in preterm infants with late-onset sepsis. The Journal of Pediatrics. 2010 Jun 1;156(6):918-22.
  29. Murase M, Ishida A. Echocardiographic assessment of early circulatory status in preterm infants with suspected intrauterine infection. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2006 Mar 1;91(2):F105-10.
  30. Deshpande S, Suryawanshi P, Chaudhary N, Maheshwari R. Cardiac Output in Late Onset Neonatal Sepsis. Journal of Clinical & Diagnostic Research. 2017 Nov 1;11(11).
  31. Saini SS, Kumar P, Kumar RM. Hemodynamic changes in preterm neonates with septic shock: a prospective observational study. Pediatric Critical Care Medicine. 2014 Jun 1;15(5):443-50.
  32. Suffredini AF, Fromm RE, Parker MM, Brenner M, Kovacs JA, Wesley RA, Parrillo JE. The cardiovascular response of normal humans to the administration of endotoxin. New England Journal of Medicine. 1989 Aug 3;321(5):280-7.
  33. Abtahi S, Jafari A. Assessment of neonatal sepsis on myocardial function by tissue Doppler imaging. Iranian Journal of Pediatrics. 2014 Oct 1;24(S2):S3.
  34. Abdel-Hady HE, Matter MK, El-Arman MM. Myocardial dysfunction in neonatal sepsis: a tissue Doppler imaging study. Pediatric Critical Care Medicine. 2012 May 1;13(3):318-23.
  35. Brierley J, Peters MJ. Distinct hemodynamic patterns of septic shock at presentation to pediatric intensive care. Pediatrics. 2008 Oct 1;122(4):752-9.
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