correlation of ultrasonographic measurement of inferior vena cava collapsibility index with central venous pressure in diagnosis and management of neonatal shock

Background: neonatal intensive care unit (nicu)conventionally, central venous pressure (cvp) monitoring has been used by intensivists to measure intravascular volume. however, it is an invasive procedure resulting in many complications. non-invasive ultrasonographic measurement of inferior vena cava collapsibility index (ivc-ci) is a promising alternative. therefore, this study wasconducted to evaluate the correlation of central venous pressure with ivc-ciand establish the cut off valuesfor ivc-ci to diagnose and manage neonatal shock. methods: the current research was a prospective longitudinal study.all sick neonates requiring intensive hemodynamic monitoring were enrolled in the study and umbilical vein catheterization was performedto measure cvp. ivc diameters and ivc-ci were measured using ultrasound. based on cvp, the patients were classified into three categories: hypovolemic (cvp<5 cmh2o), euvolemic (cvp 5-8 cmh2o), and hypervolemic (cvp>8 cmh2o) and managed with intravenous fluid boluses and/or inotropes, accordingly. cvp and ivc-ci were again recorded after the intervention and compared with the previous values. results: a total of 76(62.3%) males and 46 (37.7%) females were included in the study with a mean age of 27.16±17.5 years. there was a strong negative correlation,which was statistically significant, between cvp and ivc-ci (r= -0.913, n=122, p<0.001). after luid resuscitation in the hypovolemic group, cvp improved from 2.31±0.92 to 5.88±1.79 cmh2o and ivc-ci changed from 62.39±6.005 to 33.02±2.64% which was statistically signi icant(p<0.001). after the administration of inotropes in the hypervolemic group, cvp dropped from 10.86±9.07 to 9.07±1.85cmh2o and ivc-ci changed from 11.27±4.71 to 24.3±13.3% which was again statistically signi icant(p<0.001). the receiver operator characteristic (roc) curve analysis indicated that the ivc-ci cut-off of 55% predicted cvp <5 cmh2o with 87.9% sensitivity, 82% speci icity, 75.3%positive predictive value and 58.9% negative predictive value. ivc-ci cut-off of 20% predicted cvp >8 cmh2o with 91.1% sensitivity, 83.2% speci icity, 71.8% positive predictive value and 50.6% negative predictive value. conclusion: the obtained results revealed an inverse correlation between cvp and ivc-ci, and it was concluded that ivc-ci can provide a useful guide in the diagnosis and management of shock in sick newborns.