Association of Early Low Superior Vena Cava Flow among Neonates Born Very Preterm and Outcomes: A Systematic Review and Meta-Analysis.

Objective

To review systematically and meta-analyze the association of low superior vena cava flow (SVCF), diagnosed on echocardiography within the first 48 hours after birth, with morbidity, such as intraventricular hemorrhage (IVH), and mortality among preterm neonates (<32 weeks gestational age [GA]). STUDY

Design

PROSPERO, Medline, EMBASE, Cochrane Library, and China National Knowledge Infrastructure Database were searched for cohort studies and randomized controlled trials including neonates < 32 weeks' GA evaluating the associations of low vs normal SVCF in the first 48 hours after birth with clinical outcomes. Data were combined using random effects meta-analyses. Main outcome measures included any and severe IVH, all-cause mortality, periventricular leukomalacia, necrotizing enterocolitis and neurodevelopmental impairment in early childhood.

Results

Fourteen original studies enrolling 1,366 patients were included. Low SVCF was associated with increased adjusted odds of any IVH (3 studies; n= 381; OR 4.7, 95% confidence interval [CI] 2.3, 9.5; 95% prediction interval [PI] 0.99, 22.1; low certainty) as well as increased unadjusted odds of severe IVH (10 studies; n=996; OR 4.8 95% CI 2.5, 9.2; PI 1.6, 15.1; low certainty) and all-cause mortality (6 studies; n=724; OR 4.2, 95% CI 1.8, 9.7; PI 0.7, 23.7; very low certainty). Low SVCF was not associated with other outcomes.

Conclusion

Low SVCF within the first 48 hours after birth for very preterm neonates may be associated with increased IVH and mortality.