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Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 65-66

Normative data of inferior vena cava diameters of Indian children: Need of the hour

Department of Pediatric Critical Care, Advanced Pediatric Critical Care Unit, Wanless Hospital, Miraj, Maharashtra, India

Date of Submission10-Feb-2021
Date of Acceptance17-Feb-2021
Date of Web Publication10-Mar-2021

Correspondence Address:
Dr. Vinayak Patki
Department of Pediatric Critical Care, Advanced Pediatric Critical Care Unit, Wanless Hospital, Miraj - 416 410, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_13_21

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How to cite this article:
Patki V. Normative data of inferior vena cava diameters of Indian children: Need of the hour. J Pediatr Crit Care 2021;8:65-6

How to cite this URL:
Patki V. Normative data of inferior vena cava diameters of Indian children: Need of the hour. J Pediatr Crit Care [serial online] 2021 [cited 2022 Dec 6];8:65-6. Available from: http://www.jpcc.org.in/text.asp?2021/8/2/65/311048

Ultrasonography has emerged as a safe, rapid, noninvasive bedside radiological tool, which can provide a focused evaluation to answer a clinical question. Around 9% of children presenting to the emergency department are dehydrated, but there is a lack of reliable objective method to measure the degree of intravascular hypovolemia.[1] The changes in inferior vena cava (IVC) diameters have been shown to predict the volume status in adults.[2] Prior studies have shown that these changes provide accurate estimate of right atrial pressure and volume status and also appear to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated children with septic shock.[3],[4]

Readily available baseline data of IVC diameter in normal children are of great help in the rapid assessment of variations in sick children. In the recent past, few studies published the baseline diameters of IVC in normal children.[5],[6] There is a lack of normative data for children and adolescents from India in this context.

In the current issue of Journal of Pediatric Critical Care,[7] Ghosh et al. in their observational study at a tertiary care hospital of South India formulated the normative values for IVC diameter in children and adolescents and assessed its correlation with various somatic parameters in Indian children aged 6 months to 16 years. They observed that the mean maximum and minimum IVC diameter increased significantly with age (r = 0.738, P = 0.00; r = 0.789 P = 0.000) and with body surface area (BSA) (r = 0.73, P = 0.0001; r = 0.77, P = 0.0001).

This study is one of those few Indian studies which published normative data for IVC dimensions and collapsibility index (CI) in children.[8] Authors have provided reference values of IVC diameters for healthy Indian children aged 1 month to 12 years. They revealed a positive correlation of age, height, and weight with both maximum and minimum IVC diameters.

In the present study, the authors also measured IVC-CI of all participants, which was measured by the difference between the maximal (expiratory) and minimal (inspiratory) IVC diameters divided by the maximal diameter. The mean CI was 23.1 ± 11.9 among males and 20.1 ± 11.7 among females from the current study. Taneja et al.'s study found that mean CI was 0.34 ± 0.10 which was slightly higher than the present study and can be contributed to different subject population. Normal range of IVC-CI is 0.35–0.50 in adults with optimal values of 0.40, high as >0.55 and low as <0.35[2] Like previous studies, the authors did not find any statistically significant correlation between CI and age, height, weight or BSA. Such finding can be explained by the fact that CI does not depend on the somatic parameters of an individual, rather it is dependent on the fluid status.[9],[10]

The inclusion of children from all age groups and prospective design of the study are the strengths of this study. However, small sample size, exclusion of malnourished children, and selection of subject from the outpatient department of hospital rather than healthy volunteers from community are the limitation of this study. This study represents participants from a specific region of India, and the results cannot be extrapolated to children all over India, where regional differences in the built and nourishment of the children may reflect different IVC values. Further multicentric research with a large sample of healthy volunteer children from the different parts of the country is required to overcome these shortcomings.

  References Top

Ayvazyan S, Dickman E, Likourezos A, Wu S, Hannan H. Ultrasound of the inferior vena cava can assess volume status in pediatric patients. J Emerg Med 2009;37:219.  Back to cited text no. 1
Ginghina C, Beladan CC, Iancu M, Calin A, Popescu BA. Respiratory maneuvers in echocardiography: A review of clinical applications. Cardiovasc Ultrasound 2009;7:42.  Back to cited text no. 2
Premkumar M, Rangegowda D, Kajal K, Khumuckham JS. Noninvasive estimation of intravascular volume status in cirrhosis by dynamic size and collapsibility indices of the inferior vena cava using bedside echocardiography. JGH Open 2019;3:322-8.  Back to cited text no. 3
Ali M, Eeman N. Respiratory variation of inferior vena cava diameter and central venous pressure in ventilated and non-ventilated children in fluid refractory septic shock: An observational study. Int J Contempor Pediatr 2019;6:1947-51.  Back to cited text no. 4
Kutty S, Li L, Hasan R, Peng Q, Rangamani S, Danford DA. Systemic venous diameters, collapsibility indices, and right atrial measurements in normal pediatric subjects. J Am Soc Echocardiogr 2014;27:155-62.  Back to cited text no. 5
Kathuria N, Ng L, Saul T, Lewiss RE. The baseline diameter of the inferior vena cava measured by sonography increases with age in normovolemic children. J Ultrasound Med 2015;34:1091-6.  Back to cited text no. 6
Ghosh V, Ranjit S, Balasubramaniam R, Agrwal S. Normative data for Inferior vena cava diameters and collapsibility index in healthy Indian children from a tertiary care hospital of Chennai. J Pediatr Crit Care 2021;8:86-90.  Back to cited text no. 7
  [Full text]  
Taneja K, Kumar V, Anand R, Pemde HK. Normative data for IVC diameter and its correlation with the somatic parameters in healthy Indian children. Indian J Pediatr 2018;85:108-12.  Back to cited text no. 8
Levine AC, Shah SP, Umulisa I, Munyaneza RB, Dushimiyimana JM, Stegmann K, et al. Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Acad Emerg Med 2010;17:1035-41.  Back to cited text no. 9
Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: A comparative study: Ultrasound and hypovolemia. Am J Emerg Med 2013;31:763-7.  Back to cited text no. 10


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