Validation study of the accuracy of echocardiographic measurements of systemic blood flow volume in newborn infants
Open accessAbstract
BACKGROUND: The echocardiographic assessment of circulatory function in sick newborn infants has the potential to improve patient care. However, measurements are prone to error and have not been sufficiently validated. Phase-contrast magnetic resonance imaging (MRI) provides highly validated measures of blood flow and has recently been applied to the newborn population. The aim of this study was to validate measures of left ventricular output and superior vena caval flow volume in newborn infants. METHODS: Echocardiographic and MRI assessments were performed within 1 working day of each other in a cohort of newborn infants. RESULTS: Examinations were performed in 49 infants with a median corrected gestational age at scan of 34.43 weeks (range, 27.43-40 weeks) and a median weight at scan of 1,880 g (range, 660-3,760 g). Echocardiographic assessment of left ventricular output showed a strong correlation with MRI assessment (R(2) = 0.83; mean bias, -9.6 mL/kg/min; limits of agreement, -79.6 to +60.0 mL/kg/min; repeatability index, 28.2%). Echocardiographic assessment of superior vena caval flow showed a poor correlation with MRI assessment (R(2) = 0.22; mean bias, -13.7 mL/kg/min; limits of agreement, -89.1 to +61.7 mL/kg/min; repeatability index, 68.0%). Calculating superior vena caval flow volume from an axial area measurement and applying a 50% reduction to stroke distance to compensate for overestimation gave a slightly improved correlation with MRI (R(2) = 0.29; mean bias, 2.6 mL/kg/min; limits of agreement, -53.4 to +58.6 mL/kg/min; repeatability index, 54.5%). CONCLUSIONS: Echocardiographic assessment of left ventricular output appears relatively robust in newborn infant. Echocardiographic assessment of superior vena caval flow is of limited accuracy in this population, casting doubt on the utility of the measurement for diagnostic decision making.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Similar levels of variability have been noted in comparison to cardiac MRI.
“Similar levels of variability have been noted in comparison to cardiac MRI [56].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [56]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
Beckett, A. H., Rowland, M., & TURNER, P. (1965) · The Lancet · doi:10.1016/s0140-6736(65)91037-8 · Cited by 16,917 · see citing works
Superior vena cava flow in newborn infants: a novel marker of systemic blood flow
Kluckow, M. R., & Evans, N. (2000) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fn.82.3.f182 · Cited by 404 · see citing works
Mertens, L., Seri, I., Marek, J., Arlettaz, R., Barker, P. C. A., McNamara, P. J., Moon‐Grady, A. J., Coon, P. D., Noori, S., Simpson, J. M., et al. (2011) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2011.07.014 · Cited by 391 · see citing works
Towards rational management of the patent ductus arteriosus: the need for disease staging: Table 1
McNamara, P. J., & Sehgal, A. (2007) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2007.118117 · Cited by 385 · see citing works
Hypotensive Extremely Low Birth Weight Infants Have Reduced Cerebral Blood Flow
Munro, M. J., WALKER, A. M., & Barfield, C. P. (2004) · PEDIATRICS · doi:10.1542/peds.2004-1073 · Cited by 270 · see citing works
Kondo, C., Caputo, G. R., Semelka, R. C., Foster, E., Shimakawa, A. S., & Higgins, C. B. (1991) · American Journal of Roentgenology · doi:10.2214/ajr.157.1.2048544 · Cited by 261 · see citing works
Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow
Osborn, D. A., Evans, N., & Kluckow, M. R. (2002) · The Journal of Pediatrics · doi:10.1067/mpd.2002.120834 · Cited by 236 · see citing works
Tyszczuk, L., Meek, J. H., Elwell, C. E., et al. (1998) · PEDIATRICS · doi:10.1542/peds.102.2.337 · Cited by 235 · see citing works
Mertens, L., Seri, I., Marek, J., Arlettaz, R., Barker, P. C. A., McNamara, P. J., Moon‐Grady, A. J., Coon, P. D., Noori, S., Simpson, J. M., et al. (2011) · European Journal of Echocardiography · doi:10.1093/ejechocard/jer181 · Cited by 228 · see citing works
Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants
Hunt, R. W., Evans, N., Rieger, I., et al. (2004) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.06.056 · Cited by 227 · see citing works
Flow Measurement by Magnetic Resonance: A Unique Asset Worth Optimising
Kilner, P. J., Gatehouse, P. D., & Firmin, D. N. (2007) · Journal of Cardiovascular Magnetic Resonance · doi:10.1080/10976640701465090 · Cited by 211 · see citing works
Powell, A. J., Maier, S. E., Chung, T., & Geva, T. (2000) · Pediatric Cardiology · doi:10.1007/s002469910014 · Cited by 205 · see citing works
Jain, A., Sahni, M., EL-Khuffash, A. F., et al. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.09.027 · Cited by 157 · see citing works
Neonatologist-performed functional echocardiography in the neonatal intensive care unit
EL-Khuffash, A. F., & McNamara, P. J. (2010) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2010.05.001 · Cited by 149 · see citing works
Paradisis, M., Evans, N., Kluckow, M. R., & Osborn, D. A. (2008) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2008.07.059 · Cited by 136 · see citing works
Point-of-care ultrasound in the neonatal intensive care unit: international perspectives
Evans, N., Gournay, V., Cabañas, F., Kluckow, M. R., Leone, T. A., Groves, A. M., McNamara, P. J., & Mertens, L. (2010) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2010.06.005 · Cited by 130 · see citing works
Self-citationPoint-of-Care Echocardiography by Pediatric Emergency Physicians
Longjohn, M., Wan, J. Y., Joshi, V. V., & Pershad, J. (2011) · Pediatric Emergency Care · doi:10.1097/pec.0b013e318226c7c7 · Cited by 106 · see citing works
Cardiopulmonary Limited Ultrasound Examination for “Quick-Look” Bedside Application
Kimura, B. J., Yogo, N., O'Connell, C. W., Phan, J. N., Showalter, B. K., & Wolfson, T. J. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.03.091 · Cited by 93 · see citing works
Does point-of-care functional echocardiography enhance cardiovascular care in the NICU?
Sehgal, A., & McNamara, P. J. (2008) · Journal of Perinatology · doi:10.1038/jp.2008.100 · Cited by 92 · see citing works
Groves, A. M., Kuschel, C. A., Knight, D. B., & Skinner, J. R. (2007) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2006.109512 · Cited by 91 · see citing works
Self-citationJain, A., McNamara, P. J., Ng, E., et al. (2011) · American Journal of Perinatology · doi:10.1055/s-0031-1295649 · Cited by 89 · see citing works
Blood Pressure, Anti-Hypotensive Therapy, and Neurodevelopment in Extremely Preterm Infants
Batton, B., Zhu, X., Fanaroff, J. M., et al. (2008) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2008.09.017 · Cited by 87 · see citing works
Relationship between blood pressure and blood flow in newborn preterm infants
Groves, A. M., Kuschel, C. A., Knight, D. B., & Skinner, J. R. (2007) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2006.109520 · Cited by 86 · see citing works
Self-citationAssessment of PDA shunt and systemic blood flow in newborns using cardiac MRI
Broadhouse, K. M., Price, A. N., Durighel, G., et al. (2013) · NMR in Biomedicine · doi:10.1002/nbm.2927 · Cited by 84 · see citing works
Self-citationIncompetence of the foramen ovale in preterm infants supported by mechanical ventilation
Evans, N., & Iyer, P. U. (1994) · The Journal of Pediatrics · doi:10.1016/s0022-3476(06)80184-8 · Cited by 83 · see citing works
Functional cardiac MRI in preterm and term newborns
Groves, A. M., Chiesa, G. B., Durighel, G., Goldring, S., Fitzpatrick, J. A., Uribe, S. A., Razavi, R., Hajnal, J. V., & Edwards, A. D. (2010) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2010.189142 · Cited by 74 · see citing works
Self-citationEarly Treated Hypotension and Outcome in Very Low Birth Weight Infants
Kuint, J., Barak, M., Morag, I., et al. (2008) · Neonatology · doi:10.1159/000180113 · Cited by 70 · see citing works
Superior vena cava flow: feasibility and reliability of the off-line analyses
Lee, A., Liestøl, K., Nestaas, E., Brunvand, L. I., Lindemann, R., & Fugelseth, D. (2009) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2009.176883 · Cited by 49 · see citing works
Axler, O., Tousignant, C. P., Thompson, C., DALL'AVA-SANTUCCI, J., Phang, P. T., Russell, J. A., & Walley, K. R. (1996) · Journal of Critical Care · doi:10.1016/s0883-9441(96)90006-4 · Cited by 48 · see citing works
Acolet, D., Elbourne, D. R., McIntosh, N., Weindling, M., Korkodilos, M., Haviland, J., Modder, J., Macintosh, M. C. M., & Health, O. B. O. T. C. E. I. M. A. C. (2005) · PEDIATRICS · doi:10.1542/peds.2004-2691 · Cited by 44 · see citing works
A patient care system for early 3.0Tesla magnetic resonance imaging of very low birth weight infants
Merchant, N. M., Groves, A. M., Larkman, D. J., Counsell, S. J., Thomson, M., Doria, V., Groppo, M., Arichi, T., Foreman, S., Herlihy, D. J., et al. (2009) · Early Human Development · doi:10.1016/j.earlhumdev.2009.10.007 · Cited by 43 · see citing works
Self-citationGe, S., Bu, L., Zhang, H., et al. (2005) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2004.08.021 · Cited by 41 · see citing works
Benders, M. J. N. L., Hendrikse, J., de Vries, L. S., et al. (2011) · Pediatric Research · doi:10.1203/pdr.0b013e3182176aab · Cited by 26 · see citing works
Lehmann, K. G., & Platt, M. S. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(98)00639-1 · Cited by 26 · see citing works
Mehwald, P., Rusk, R. A., Mori, Y., Li, X.-N., Zetts, A. D., Jones, M., & Sahn, D. J. (2002) · Journal of the American Society of Echocardiography · doi:10.1067/mje.2002.122103 · Cited by 24 · see citing works
Cardiorespiratory stability during echocardiography in preterm infants
Groves, A. M. (2004) · Archives of Disease in Childhood · doi:10.1136/adc.2003.045013 · Cited by 24 · see citing works
Self-citationDesandes, R., Jellimann, J.-M., Rouabah, M., et al. (2011) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e31822882b5 · Cited by 19 · see citing works
Harabor, A., & Fruitman, D. S. (2012) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2012.31.12.1901 · Cited by 16 · see citing works
Cardiac magnetic resonance in the study of neonatal haemodynamics
Groves, A. M. (2010) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2010.10.002 · Cited by 10 · see citing works
Self-citationThe cardiopulmonary system: research and training opportunities
Jobe, A. H. (2006) · Journal of Perinatology · doi:10.1038/sj.jp.7211522 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Singh, Y., Tissot, C., Fraga, M. V., Yousef, N., Cortes, R. G., Lopez, J., Sanchez-de-Toledo, J., Brierley, J., Colunga, J. M., Raffaj, D., et al. (2020) · Critical Care · doi:10.1186/s13054-020-2787-9 · Cited by 659 · see citing works
Echocardiographic Evaluation of Ventricular Function—For the Neonatologist and Pediatric Intensivist
Tissot, C., Singh, Y., & Sekarski, N. (2018) · Frontiers in Pediatrics · doi:10.3389/fped.2018.00079 · Cited by 181 · see citing works
Echocardiographic Evaluation of Hemodynamics in Neonates and Children
Singh, Y. (2017) · Frontiers in Pediatrics · doi:10.3389/fped.2017.00201 · Cited by 116 · see citing works
Advanced Hemodynamic Monitoring in the Neonatal Intensive Care Unit
de Boode, W.-P. (2020) · Clinics in Perinatology · doi:10.1016/j.clp.2020.05.001 · Cited by 34 · see citing works
Nedelcu, C., Ionescu, N. S., Bizubac, A. M., Filip, C., & Cirstoveanu, C. (2025) · Life · doi:10.3390/life15101621 · Cited by 2 · see citing works
“Similar levels of variability have been noted in comparison to cardiac MRI [56].”
- Authors
- Ficial, B., Finnemore, A. E., Cox, D. J., Broadhouse, K. M., Price, A. N., Durighel, G., Ekitzidou, G., Hajnal, J. V., Edwards, A. D., & Groves, A. M.
- Affiliations
- University of Verona (IT)
- King's College London (GB)
- Imperial College London (GB)
- Corresponding author
- Groves, Alan M.
- ORCID
- Venue
- Journal of the American Society of Echocardiography
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 26
- Issue
- 12
- Pages
- 1365-1371
- ISSN
- 0894-7317 (ISSN-L)
- PMC
- PMC3852205
- OpenAlex
- W2000595347
- Cited by
- 102
- References
- 41
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 12 · 2022: 6 · 2021: 13 · 2020: 10 · 2019: 6 · 2018: 15 · 2017: 6 · 2016: 4 · 2015: 8 · 2014: 6
- FWCI
- 4.37
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American Society of Echocardiography (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research
- British Heart Foundation (FS/11/75/29030)
- King's College London
- Sparks (12KCLRTF07)
- Medical Research Council (MR/K006355/1)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- neonates, left ventricular output, repeatability
- MeSH terms
- Blood Volume, Blood Volume Determination, Echocardiography, Female, Heart Ventricles, Humans, Infant, Newborn, Male, Sensitivity and Specificity, Vena Cava, Superior, Reproducibility of Results, Ventricular Function, Left
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review