Non-Invasive Assessment of Significant Dehydration In Infants Using The Inferior Vena Cava to Aortic Diameter Ratio: Is it Useful?

ABSTRACTObjective:To assess the accuracy of the inferior vena cava to aorta (IVC/Ao) diameter ratio for predicting significant dehydration in infants relative to their percentage weight change and the clinical diagnosis by a physician.Methods:A prospective observational study was performed on 200 infants with acute diarrhea presenting with clinical evidence of significant dehydration whose treatment required intravenous (IV) fluids as determined by the attending physician at a pediatric emergency department. Weight was recorded at admission before IV fluid treatment and at hospital discharge. The percentage of dehydration was determined using the following formula: (discharge weight − admission weight)/ discharge weight × 100%. Patients with a percentage weight change of  5% were considered significantly dehydrated. The IVC/Ao diameter ratio was measured for all patients before IV fluid rehydration and again at discharge.Results:Only 134 out of 200 dehydrated infants were found to be significantly dehydrated using the gold standard, percentage weight change. Receiver operating characteristics (ROC) curve analysis of the pre-hydration IVC/Ao ratio showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 87% for predicting significant dehydration in infants at a cut-off point of less than 0.75. In contrast, physician clinical diagnosis showed a sensitivity of 70%, a specificity of 63% and an accuracy of 73%.Conclusion:The IVC/Ao diameter ratio can be used as a reliable predictor for diagnosing significant dehydration in infants. Objective: To assess the accuracy of the inferior vena cava to aorta (IVC/Ao) diameter ratio for predicting significant dehydration in infants relative to their percentage weight change and the clinical diagnosis by a physician. Methods: A prospective observational study was performed on 200 infants with acute diarrhea presenting with clinical evidence of significant dehydration whose treatment required intravenous (IV) fluids as determined by the attending physician at a pediatric emergency department. Weight was recorded at admission before IV fluid treatment and at hospital discharge. The percentage of dehydration was determined using the following formula: (discharge weight − admission weight)/ discharge weight × 100%. Patients with a percentage weight change of  5% were considered significantly dehydrated. The IVC/Ao diameter ratio was measured for all patients before IV fluid rehydration and again at discharge. Results: Only 134 out of 200 dehydrated infants were found to be significantly dehydrated using the gold standard, percentage weight change. Receiver operating characteristics (ROC) curve analysis of the pre-hydration IVC/Ao ratio showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 87% for predicting significant dehydration in infants at a cut-off point of less than 0.75. In contrast, physician clinical diagnosis showed a sensitivity of 70%, a specificity of 63% and an accuracy of 73%. Conclusion: The IVC/Ao diameter ratio can be used as a reliable predictor for diagnosing significant dehydration in infants. Address correspondence and reprint requests to Prof. Doaa El Amrousy, MD Pediatrics, assistant professor of Pediatrics, Tanta University Hospital, Tanta, Egypt. Egypt, Tanta, El Motasem street No 6, (e-mail: doaamoha@yahoo.com). Received 21 August, 2017 Accepted 12 December, 2017 Funding: none to declare. Conflict of interest: all authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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