• Himanshu Popat, Kristy P Robledo, Lucille Sebastian, Nicholas Evans, Andrew Gill, Martin Kluckow, Sanjay Sinhal, Waal Koert de K John Hunter Children's Hospital, New Lambton, New South Wales, Australia., William Tarnow-Mordi, and David Osborn.
• Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, NSW, Australia.
• Arch. Dis. Child. Fetal Neonatal Ed. 2018 May 1; 103 (3): F257-F263.

ObjectiveFunctional 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 SettingImage 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.ResultsQuality 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.ConclusionInterobserver 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.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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