Calibrated abdominal compression assesses fluid responsiveness in preterm neonates with PPHN-related shock.
This prospective, single-center pilot study investigated the feasibility and tolerance of calibrated abdominal compression (ΔSV-AC) as a method to assess fluid responsiveness in critically ill preterm neonates. The cohort consisted of mechanically ventilated and sedated infants under 32 weeks of corrected gestational age who required a 10 mL·kg⁻¹ fluid bolus. A total of 18 fluid boluses were analyzed in this setting within a tertiary neonatal intensive care unit.
The primary intervention involved applying calibrated abdominal compression, with standard fluid bolus administration serving as the comparator context. The study assessed the primary outcome of feasibility and tolerance, alongside secondary outcomes including fluid-responsiveness rates and the diagnostic accuracy of ΔSV-AC. Fluid-responsiveness was observed in 8 of the 18 cases (44%). The area under the receiver operating characteristic curve (AUROC) for ΔSV-AC to predict fluid-responsiveness was 0.76 (95% CI 0.43–1).
Safety and tolerability data indicated three cases of transient but significant decreases in stroke volume or heart rate. Two cases were accompanied by a subjective impression of poor tolerance, while all other cases were subjectively rated as well tolerated. No serious adverse events were attributed to the maneuver. However, the study was limited by its exploratory pilot design, uncertainty regarding overall tolerance, and a population mostly suffering from PPHN-related shock etiologies. Diagnostic accuracy requires further characterization, particularly in more common etiologies of neonatal shock.
The practice relevance suggests that calibrated abdominal compression could be feasible in critically ill preterm neonates. Nevertheless, clinicians should interpret these findings cautiously due to the small sample size, the specific shock etiology of the cohort, and the lack of reported follow-up data. Further investigation is necessary to confirm diagnostic utility and safety across diverse neonatal shock populations.
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