Association of Early Low Superior Vena Cava Flow among Neonates Born Very Preterm and Outcomes: A Systematic Review and Meta-Analysis
In brief
Low early vena cava flow linked to 5-fold odds of severe brain bleeding
In a review of 14 studies involving 1,366 very preterm infants, low superior vena cava flow in the first 48 hours was associated with nearly fivefold higher odds of severe bleeding in the brain and about fourfold higher odds of death. Evidence certainty was low or very low, and no link appeared with other outcomes, so the findings show association, not cause and effect.
- Journal
- The Journal of pediatrics (Q1)
- Published
- 6 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Nishkal Persad, Dwayne Mascarenhas, Catherine Devion, Bonny Jasani, Poorva Deshpande, Prakesh S Shah, et al.
- PMID
- 42838408
- DOI
- 10.1016/j.jpeds.2026.115362
Why clinicians should know about it
- Picked for Epidemiology (paper of the day, 8 October 2026): Systematic review and meta‑analysis of low SVC flow in preterm
Abstract
OBJECTIVE: To review systematically and meta-analyze the association of low superior vena cava flow (SVCF), diagnosed on echocardiography within the first 48 hours after birth, with morbidity, such as intraventricular hemorrhage (IVH), and mortality among preterm neonates (<32 weeks gestational age [GA]). STUDY DESIGN: PROSPERO, Medline, EMBASE, Cochrane Library, and China National Knowledge Infrastructure Database were searched for cohort studies and randomized controlled trials including neonates < 32 weeks' GA evaluating the associations of low vs normal SVCF in the first 48 hours after birth with clinical outcomes. Data were combined using random effects meta-analyses. Main outcome measures included any and severe IVH, all-cause mortality, periventricular leukomalacia, necrotizing enterocolitis and neurodevelopmental impairment in early childhood. RESULTS: Fourteen original studies enrolling 1,366 patients were included. Low SVCF was associated with increased adjusted odds of any IVH (3 studies; n= 381; OR 4.7, 95% confidence interval [CI] 2.3, 9.5; 95% prediction interval [PI] 0.99, 22.1; low certainty) as well as increased unadjusted odds of severe IVH (10 studies; n=996; OR 4.8 95% CI 2.5, 9.2; PI 1.6, 15.1; low certainty) and all-cause mortality (6 studies; n=724; OR 4.2, 95% CI 1.8, 9.7; PI 0.7, 23.7; very low certainty). Low SVCF was not associated with other outcomes. CONCLUSION: Low SVCF within the first 48 hours after birth for very preterm neonates may be associated with increased IVH and mortality.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.