Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Neonatal reference values and nomograms of systemic vascular resistances estimated with electrical cardiometry

Journal of Perinatology volume 45, pages 334–341 (2025)Cite this article

Subjects

Abstract

Objective

Scanty data are available about neonatal systemic vascular resistances (SVR). We aim to provide reference values and nomograms for neonatal SVR.

Design

Multicenter, cross-sectional,descriptive study performed in France and Italy. Neonates with complete hemodynamic stability were enrolled. Non-invasive measurements of SVR by electrical cardiometry performed once, after the first 72 h and before the 7th day of postnatal age.

Results

We studied 1094 neonates: SVR was correlated with gestational age (ρ = −0.55, adj-r = −0.46, p < 0.001) and birth weight (ρ = −0.59, adj-r = −0.45, p < 0.001) irrespective of newborn sex. The relationships between SVR, gestational age and birth weight were represented by power equations and SVR was decreasing with increasing age and weight. Age- and weight-based SVR nomograms had optimal goodness-of-fit (non-linear R2 ≥0.74). Similar results were obtained for body surface indexed-SVR.

Conclusions

In hemodynamically stable neonates, SVR decrease with increasing gestational age and birth weight. Specific gestational age and birth weight-based nomograms are provided for the clinical interpretation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Relationship between systemic vascular resistances and gestational age or birth weight.
Fig. 2: Systemic vascular resistance nomograms for preterm neonates based on gestational age or birth weight.
Fig. 3: Systemic vascular resistance nomograms for term neonates based on gestational age or birth weight.
Fig. 4: Body surface indexed—systemic vascular resistance (SVRI): gestational age-based nomogram.

Similar content being viewed by others

Data availability

Deidentified study dataset is available upon reasonable request to researchers who provide a methodologically sound proposal. Data requestors will need to sign a data transfer agreement and respect all relevant regulations.

References

  1. Pinsky MR, Cecconi M, Chew MS, De Backer D, Douglas I, Edwards M, et al. Effective hemodynamic monitoring. Crit Care. 2022;26:294 https://doi.org/10.1186/s13054-022-04173-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. Duignan SM, Lakshminrusimha S, Armstrong K, de Boode WP, El-Khuffash A, Franklin O, et al. Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology. Pediatr Res. 2024;95:1207–16. https://doi.org/10.1038/s41390-023-02926-2

    Article  PubMed  Google Scholar 

  3. De Boode WP. Advanced hemodynamic monitoring in the neonatal intensive care unit. Clin Perinatol. 2020;47:423–34. https://doi.org/10.1016/j.clp.2020.05.001

    Article  PubMed  Google Scholar 

  4. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020;24:65 https://doi.org/10.1186/s13054-020-2787-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. McNamara PJ, Jain A, El-Khuffash A, Giesinger R, Weisz D, Freud L, et al. Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the neonatal intensive care unit: an update from the American Society of Echocardiography. J Am Soc Echo. 2024;37:171–215. https://doi.org/10.1016/j.echo.2023.11.016

    Article  Google Scholar 

  6. O’Neill R, Dempsey EM, Garvey AA, Schwarz CE. Non-invasive cardiac output monitoring in neonates. Front Pediatr. 2021;8:614585 https://doi.org/10.3389/fped.2020.614585

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pietrini D, Piastra M, Luca E, Mancino A, Conti G, Cavaliere F, et al. Neuroprotection and hypothermia in infants and children. Curr Drug Targets. 2012;13:925–35.

    Article  CAS  PubMed  Google Scholar 

  8. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE initiative. the strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.

    Article  Google Scholar 

  9. Van Zadelhoff AC, Poppe JA, Willemsen S, Mauff K, Van Weteringen W, Goos TG, et al. Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model. Br J Anaesth. 2023;130:585–94.

    Article  PubMed  Google Scholar 

  10. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N. Engl J Med. 2009;361:1349–58.

    Article  CAS  PubMed  Google Scholar 

  11. Dell’Orto V, Bourgeois-Nicolaos N, Rouard C, Romain O, Shankar-Aguilera S, Doucet-Populaire F, et al. Cell count analysis from nonbronchoscopic bronchoalveolar lavage in preterm infants. J Pediatr. 2018;200:30–37.e2. https://doi.org/10.1016/j.jpeds.2018.04.074

    Article  PubMed  Google Scholar 

  12. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adoles Health. 2017;1:184–94. https://doi.org/10.1016/S2352-4642(17)30069-X

    Article  Google Scholar 

  13. Boet A, Jourdain G, Demontoux S, De Luca D. Stroke volume and cardiac output evaluation by electrical cardiometry: accuracy and reference nomograms in hemodynamically stable preterm neonates. J Perinatol. 2016;36:748–52. https://doi.org/10.1038/jp.2016.65

    Article  CAS  PubMed  Google Scholar 

  14. Osypka MJ, Bernstein DP. Electrophysiologic principles and theory of stroke volume determination by thoracic electrical bioimpedance. AACN Clin Issues. 1999;10(Aug):385–99. https://doi.org/10.1097/00044067-199908000-00008

    Article  CAS  PubMed  Google Scholar 

  15. Dionne JM, Bremner SA, Baygani SK, Batton B, Ergenekon E, Bhatt-Mehta V, et al. Method of blood pressure measurement in neonates and infants: a systematic review and analysis. J Pediatr. 2020;221:23–31.e5. https://doi.org/10.1016/j.jpeds.2020.02.072

    Article  PubMed  Google Scholar 

  16. Kiss JK, Gajda A, Mari J, Nemeth J, Bereczki C. Oscillometric arterial blood pressure in haemodynamically stable neonates in the first 2 weeks of life. Pediatr Nephrol. 2023;38:3369–78. https://doi.org/10.1007/s00467-023-05979-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Trevor Inglis GD, Dunster KR, Davies MW. Establishing normal values of central venous pressure in very low birth weight infants. Physiol Meas. 2007;28:1283–91. https://doi.org/10.1088/0967-3334/28/10/012

    Article  PubMed  Google Scholar 

  18. Loi B, Regiroli G, Foligno S, Centorrino R, Yousef N, Vedovelli L, et al. Respiratory and haemodynamic effects of 6h-pronation in neonates recovering from respiratory distress syndrome, or affected by acute respiratory distress syndrome or evolving bronchopulmonary dysplasia: a prospective, physiological, crossover, controlled cohort study. EClinicalMedicine. 2022;55(Dec):101791 https://doi.org/10.1016/j.eclinm.2022.101791

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schmidt CWP Body Surface Area (BSA). In: Pediatric Oncologic Pharmacy. Cham. Berlin (Germany): Springer International Publishing 2019:141–141.

  20. Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr. 2013;13:92.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hsu KH, Wu TW, Wang YC, Lim WH, Lee CC, Lien R. Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry. J Perinatol. 2016;36:481–5. https://doi.org/10.1038/jp.2016.2

    Article  PubMed  Google Scholar 

  22. Norušis MJ SPSS 13.0 advanced statistical procedures companion. Upper Saddle River, NJ, USA: Prentice Hall 2004.

  23. Colin Cameron A, Windmeijer FAG. An R-squared measure of goodness of fit for some common nonlinear regression models. J Econometr. 1997;77:329–42. https://doi.org/10.1016/S0304-4076(96)01818-0

    Article  Google Scholar 

  24. Katori R. Normal cardiac output in relation to age and body size. Tohoku J Exp Med. 1979;128:377–87. https://doi.org/10.1620/tjem.128.377

    Article  CAS  PubMed  Google Scholar 

  25. Cattermole GN, Leung PY, Mak PS, Chan SS, Graham CA, Rainer TH. The normal ranges of cardiovascular parameters in children measured using the Ultrasonic Cardiac Output Monitor. Crit Care Med. 2010;38:1875–81. https://doi.org/10.1097/CCM.0b013e3181e8adee

    Article  PubMed  Google Scholar 

  26. de Simone G, Devereux RB, Daniels SR, Mureddu G, Roman MJ, Kimball TR, et al. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation. 1997;95:1837–43. https://doi.org/10.1161/01.cir.95.7.1837

    Article  PubMed  Google Scholar 

  27. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020;46:10–67. https://doi.org/10.1007/s00134-019-05878-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Boet A, Jourdain G, Demontoux S, Hascoet S, Tissieres P, Rucker-Martin C, et al. Basic hemodynamic monitoring using ultrasound or electrical cardiometry during transportation of neonates and infants. Pediatr Crit Care Med. 2017;18:e488–93. https://doi.org/10.1097/PCC.0000000000001298

    Article  PubMed  Google Scholar 

  30. Suehiro K, Joosten A, Murphy LS, Desebbe O, Alexander B, Kim SH, et al. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis. J Clin Monit Comput. 2016;30:603–20. https://doi.org/10.1007/s10877-015-9757-9

    Article  PubMed  Google Scholar 

  31. Gatelli IF, Vitelli O, Fossati M, De Rienzo F, Chiesa G, Martinelli S. Neonatal septic shock and hemodynamic monitoring in preterm neonates in an NICU: added value of electrical cardiometry in real-time tailoring of management and therapeutic strategies. Am J Perinatol. 2022;39:1401–4.

    Article  PubMed  Google Scholar 

  32. De Luca D, Romain O, Yousef N, Adriamanamirija D, Shankar-Aguilera S, Walls E, et al. Monitorages physiopathologiques en réanimation néonatale. J Pediatr Puer 2015;28:276–300. https://doi.org/10.1016/j.jpp.2015.06.004

    Article  Google Scholar 

  33. Chakkarapani AA, Roehr CC, Hooper SB, Te Pas AB, Gupta S; ESPR Neonatal Resuscitation section writing group. Transitional circulation and hemodynamic monitoring in newborn infants. Pediatr Res. 2023. https://doi.org/10.1038/s41390-022-02427-8

  34. Doni D, Nucera S, Rigotti C, Arosio E, Cavalleri V, Ronconi M, et al. Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor. Ital J Pediatr. 2020;46:112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ma M, Noori S, Maarek J-M, Holschneider DP, Rubinstein EH, Seri I. Prone positioning decreases cardiac output and increases systemic vascular resistance in neonates. J Perinatol. 2015;35:424–7.

    Article  CAS  PubMed  Google Scholar 

  36. Martini S, Gatelli IF, Vitelli O, Vitali F, De Rienzo F, Parladori R, et al. Impact of patent ductus arteriosus on non-invasive assessments of lung fluids in very preterm infants during the transitional period. Eur J Pediatr. 2023;182:4247–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Luecke T, Pelosi P. Clinical review: positive end-expiratory pressure and cardiac output. Crit Care. 2005;9:607–21. https://doi.org/10.1186/cc3877

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rodríguez Sánchez De La Blanca A, Sánchez Luna M, González Pacheco N, Arriaga Redondo M, Navarro Patiño N. Electrical velocimetry for non-invasive monitoring of the closure of the ductus arteriosus in preterm infants. Eur J Pediatr. 2018;177:229–35.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France

    Valeria Bisceglie, Barbara Loi, Maria Elena Ferrari, Laura Vivalda & Daniele De Luca

  2. Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France

    Barbara Loi & Daniele De Luca

  3. Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy

    Ottavio Vitelli, Alice Proto & Stefano Martinelli

  4. Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Matteo Di Nardo

Authors
  1. Valeria Bisceglie
    View author publications

    Search author on:PubMed Google Scholar

  2. Barbara Loi
    View author publications

    Search author on:PubMed Google Scholar

  3. Ottavio Vitelli
    View author publications

    Search author on:PubMed Google Scholar

  4. Alice Proto
    View author publications

    Search author on:PubMed Google Scholar

  5. Maria Elena Ferrari
    View author publications

    Search author on:PubMed Google Scholar

  6. Laura Vivalda
    View author publications

    Search author on:PubMed Google Scholar

  7. Matteo Di Nardo
    View author publications

    Search author on:PubMed Google Scholar

  8. Stefano Martinelli
    View author publications

    Search author on:PubMed Google Scholar

  9. Daniele De Luca
    View author publications

    Search author on:PubMed Google Scholar

Contributions

VB and BL collected and interpreted the data, performed the statistical analysis and wrote the original draft of the manuscript. OV, AP, MEF, LV helped to collect and interpret the data and critically revised the manuscript. MDN and SM helped in data design and data interpretation and critically revised the manuscript. DDL conceived the study and designed it, performed the statistical analysis and prepared the figures and provide the study general supervision. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Daniele De Luca.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

French Critical Care Ethical Commission n.14/13 and Niguarda Hospital Institutional Ethical Board n.149674. The study respected the Helsinki Declaration.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bisceglie, V., Loi, B., Vitelli, O. et al. Neonatal reference values and nomograms of systemic vascular resistances estimated with electrical cardiometry. J Perinatol 45, 334–341 (2025). https://doi.org/10.1038/s41372-024-02115-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-024-02115-x

This article is cited by

Search

Advanced search

Quick links