Clinical performance of an in-line point-of-care monitor in neonates

Objective. To evaluate the bias, precision, and blood loss characteristics of an ex vivo in-line point-of-care testing blood gas and electrolyte monit or designed for use in critically ill newborn infants. Study Design. Study participants included consecutive neonates with an umbi lical artery catheter (UAC) in use for clinical laboratory testing. The in- line monitor (VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medica l, San Diego, CA) was directly connected to the participant's UAC and the m onitor's determinations of pH, PCO2,PO2, sodium, potassium, and hematocrit (Hct) were compared with those simultaneously drawn and measured with a sta ndard bench top laboratory instrument (Radiometer 625 ABL; Radiometer Ameri ca, Inc, Westlake, OH). The bias (the mean difference from the reference me thod) and precision (1 standard deviation of the mean difference) performan ce criteria of the in-line monitor were derived using standard laboratory p rocedures. Results. Sixteen neonates monitored for a total of 37 days had a total of 2 29 paired blood samples available for comparison by the 2 methods. Bias and precision performance characteristics of the in-line monitor were similar to reports of other point-of-care devices (ie, pH: -.003 +/- .024; PCO2: .3 5 +/- 2.84 mm Hg; PO2: .39 +/- 7.30 mm Hg; sodium: .52 +/- 2.34 mmol/ L; po tassium: .17 +/- .18 mmol/ L; and Hct: .61 +/- 2.80%). The range of values observed for each parameter included much of the range anticipated among cr itically ill neonates (ie, pH: 7.15-7.65; PCO2: 25-75 mm Hg; PO2: 25-275 mm Hg; sodium: 127-150 mmol/ L; potassium: 2.6-5.5 mmol/L; and Hct: 32%-60%). Mean blood loss (+/- standard deviation) per sample with the in-line monit or was approximately one-tenth that of the reference method: 24 +/- 7 mu L versus 250 mu L, respectively. There was no evidence of hemolysis and no pa tient related safety issues were identified with use of the in-line monitor . Conclusions. Repeated laboratory testing of critically ill neonates using a n ex vivo in-line monitor designed for use in neonates provides reliable la boratory results. The blood loss and hemolysis data obtained suggests that this monitoring device offers potential for reducing neonatal blood loss-an d possibly transfusion needs-during the first weeks of life. Before this pr omising technology can be routinely recommended for care of critically ill neonates, greater practical experience in a variety of clinical settings is needed.