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Interobserver agreement and image quality of functional cardiac ultrasound measures used in a randomised trial of delayed cord clamping in preterm infants
  1. Himanshu Popat1,2,
  2. Kristy P Robledo2,3,
  3. Lucille Sebastian2,3,
  4. Nicholas Evans2,4,
  5. Andrew Gill5,
  6. Martin Kluckow2,6,
  7. Sanjay Sinhal7,
  8. Koert de Waal8,
  9. William Tarnow-Mordi2,3,
  10. David Osborn2,4
  1. 1Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, NSW, Australia
  2. 2University of Sydney, Sydney, Australia
  3. 3NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
  4. 4Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  5. 5Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
  6. 6Royal North Shore Hospital, St Leonards, New South Wales, Australia
  7. 7Flinder's Medical Centre, Bedford Park, South Australia, Australia
  8. 8John Hunter Children's Hospital, New Lambton, New South Wales, Australia
  1. Correspondence to Dr Himanshu Popat, Grace Centre for Newborn Care, The Children’s Hospital at Westmead,Locked Bag 4001, Westmead, NSW 2145, Australia; himanshu.popat{at}health.nsw.gov.au

Abstract

Objective Functional cardiac ultrasound measures are used clinically and in trials for assessing the haemodynamic status of newborn infants. Superior vena cava (SVC) flow and right ventricular output (RVO) are established measures of systemic blood flow on the first postnatal day. The objective was to assess image quality and interobserver agreement of these measures in preterm infants enrolled in a randomised trial of immediate versus delayed cord clamping.

Design and setting Image quality and interobserver agreement for SVC flow, RVO and ductus arteriosus (DA) size were assessed on measurements taken at 3–6, 6–12 and 20–28 hours for the first 10 infants enrolled at each of four sites (total 40). Bland-Altman plots were constructed; mean difference (bias) and limits of agreement (LOA) were calculated. Potential sources of variation were explored.

Results Quality was judged satisfactory for >97% of images. The mean difference and LOA between the observers were 5.4 mL/kg/min and −49.0 to 59.8 mL/kg/min for SVC flow, −26.6 mL/kg/min and −131.4 to 78.2 mL/kg/min for RVO, and 0 mm and −0.8 to 0.8 mm for DA diameter, respectively. The principal source of measurement error for SVC flow was diameter, and for RVO, diameter and velocity time integral. The difference between observers for both SVC and RVO was significantly associated with site.

Conclusion Interobserver variability for SVC flow is consistent with that previously reported, but higher for RVO. The findings should be incorporated into clinical practice, training, accreditation and trial design.

  • preterm infant
  • echocardiography
  • inter-observe
  • quality

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Footnotes

  • Contributors HP participated in study design, patient recruitment, data analysis, data interpretation and drafted the initial manuscript. KPR participated in study design, data collection and data analysis. LS supervised the project design and participated in data collection. NE participated in the design of the study and participated in patient recruitment and data acquisition. AG participated in the design of the study and participated in patient recruitment and data acquisition. MK participated in the design of the study and participated in patient recruitment and data acquisition. SS participated in patient recruitment and data acquisition. KdW participated in the design of the study and participated in patient recruitment and data acquisition. WT-M conceptualised and designed the study and participated in data analysis and interpretation. DO conceptualised and designed the study, participated in patient recruitment, data analysis and interpretation, and drafted the initial manuscript. All authors revised it critically for important intellectual content, approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding National Health and Medical Council project grant 571309.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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