Clinical Investigation
Echocardiography in Children
Echocardiographic Nomograms for Ventricular, Valvular and Arterial Dimensions in Caucasian Children with a Special Focus on Neonates, Infants and Toddlers

https://doi.org/10.1016/j.echo.2013.10.001Get rights and content

Background

A quantitative echocardiographic assessment is often essential for the management of congenital heart disease, especially in the first months of life. Despite this, pediatric echocardiographic nomograms are limited and heterogeneous, particularly for neonates and infants. The aim of this study was to establish reliable echocardiographic nomograms in a broad population of healthy Caucasian children.

Methods

Two-dimensional and M-mode measurements of 22 cardiovascular structures were performed. Models using linear, logarithmic, exponential, and square root relationships were tested. Heteroscedasticity was tested using the White and Breusch-Pagan tests. Age, weight, height, and body surface area (BSA; calculated using seven different formulas) were used as the independent variables in different analyses to predict the mean value of each echocardiographic measurement. Structured Z scores were then computed.

Results

A total of 445 consecutive Caucasian Italian healthy subjects (age range, 0 days to 36 months; 49% female subjects) with BSAs ranging from 0.12 to 0.67 m2 were prospectively enrolled. The calculation of BSA using the Haycock formula provided the best results, while other formulas either underestimated (DuBois, Mosteller, Dreyer, and Meban) or overestimated (Boyd and Gehan) BSA. The Haycock formula has been used when presenting data as predicted values (mean ± 2 SDs) for a given BSA and within equations relating echocardiographic measurements to BSA. For all the measurements, there was no significant intraobserver or interobserver variability.

Conclusions

The investigators report new, reliable echocardiographic Z scores derived from a large population of Caucasian neonates, infants, and toddlers calculated using a rigorous statistical design. These nomograms represent a valid diagnostic tool for echocardiographic quantification in this age group.

Section snippets

Subject Enrollment

All consecutive Caucasian neonates, infants, and toddlers (age range, 0 days to 36 months) evaluated in the outpatient of the Pediatric Cardiology Department for screening for CHD at Fondazione G. Monasterio CNR-Regione Toscana of Massa eligible for inclusion in the study were prospectively enrolled.

Our department provides an outpatient service reserved for neonatologists from nearby hospitals and pediatricians in our territory to refer children with suspicion for congenital cardiac defects for

Population Description

The study population consisted of 445 consecutive children (226 male, 219 female) prospectively enrolled from November 2011 to July 2013 who met the inclusion and exclusion criteria. The mean age was 5.5 ± 7.9 months (median, 1.9 months; interquartile range, 0.4–7.8 months; range, 0 days to 36 months). Ninety-one subjects (20.4%) were premature and 26.7% had cesarean deliveries. Body weight ranged from 1.3 to 16.0 kg (median, 4.7 kg; interquartile range, 3.1–8.0 kg). Height ranged from 40.8 to

Discussion

The importance of accurate pediatric nomograms has recently been addressed by various investigators,1, 2, 3, 4, 17, 33, 34 with recommendations to use Z scores for various reasons. Current pediatric nomograms, however, present a few methodologic limitations, particularly in terms of data in neonates.

In the present study, we have established nomograms for ventricular, valvular, and arterial dimensions in a wide population of healthy neonates, infants, and toddlers. These nomograms introduce some

Conclusions

Our nomograms provide useful quantitative tools for clinicians to evaluate and manage neonates, infants, and toddlers with congenital and acquired heart disease.

In addition, this work offers a solid methodologic design and a distinct advantage by including measurements for several cardiac structures (such as the aortic arch at different sites, the pulmonary arteries, and the inferior vena cava) that have not been well evaluated in previous studies. Further studies are needed to evaluate other

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