Medline ® Abstract for Reference 9

OBJECTIVE: To determine the accuracy of blood pressure (BP), capillary refill time (CRT), and central-peripheral temperature difference (CPTd) for detecting low upper body blood flow in the first day after birth.

METHODS: A prospective, two centre cohort study of 128 infants born at<30 weeks gestation. Invasive BP (n = 108), CRT (n = 128), and CPTd (n = 46) were performed immediately before echocardiographic measurement of superior vena cava (SVC) flow at three, 5-10, and 24 hours after birth.

RESULTS: Forty four (34%) infants had low SVC flow (<41 ml/kg/min) in the first day, 13/122 (11%) at three hours, 39/126 (31%) at 5-10 hours, and 4/119 (3%) at 24 hours. CPTd did not detect infants with low flows. Combining all observations in the first 24 hours, CRT>or = 3 seconds had 55% sensitivity and 81% specificity, mean BP<30 mm Hg had 59% sensitivity and 77% specificity, and systolic BP<40 mm Hg had 76% sensitivity and 68% specificity for detecting low SVC flow. Combining a mean BP<30 mm Hg and/or central CRT>or = 3 seconds increases the sensitivity to 78%.

CONCLUSIONS: Low upper body blood flow is common in the first day after birth and strongly associated with peri/intraventricular haemorrhage. BP and CRT are imperfect bedside tests for detecting low blood flow in the first day after birth.