PT  - JOURNAL ARTICLE
AU  - Osborn, D A
AU  - Evans, N
AU  - Kluckow, M
TI  - Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference
AID  - 10.1136/adc.2002.023796
DP  - 2004 Mar 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F168--F173
VI  - 89
IP  - 2
4099  - http://fn.bmj.com/content/89/2/F168.short
4100  - http://fn.bmj.com/content/89/2/F168.full
SO  - Arch Dis Child Fetal Neonatal Ed2004 Mar 01; 89
AB  - Objective: To determine the accuracy of blood pressure (BP), capillary refill time (CRT), and central-peripheral temperature difference (CPTd) for detecting low upper body blood flow in the first day after birth. Methods: A prospective, two centre cohort study of 128 infants born at < 30 weeks gestation. Invasive BP (n = 108), CRT (n = 128), and CPTd (n = 46) were performed immediately before echocardiographic measurement of superior vena cava (SVC) flow at three, 5–10, and 24 hours after birth. Results: Forty four (34%) infants had low SVC flow (< 41 ml/kg/min) in the first day, 13/122 (11%) at three hours, 39/126 (31%) at 5–10 hours, and 4/119 (3%) at 24 hours. CPTd did not detect infants with low flows. Combining all observations in the first 24 hours, CRT ⩾ 3 seconds had 55% sensitivity and 81% specificity, mean BP < 30 mm Hg had 59% sensitivity and 77% specificity, and systolic BP < 40 mm Hg had 76% sensitivity and 68% specificity for detecting low SVC flow. Combining a mean BP < 30 mm Hg and/or central CRT ⩾ 3 seconds increases the sensitivity to 78%. Conclusions: Low upper body blood flow is common in the first day after birth and strongly associated with peri/intraventricular haemorrhage. BP and CRT are imperfect bedside tests for detecting low blood flow in the first day after birth.