Electrical Cardiometry for Non-Invasive Cardiac Output Monitoring in Neonatal and Pediatric Critical Care: A Bayesian Systematic Review and Meta-Analysis

ObjectivesTo evaluate the agreement between electrical cardiometry and established reference methods for cardiac output measurement in neonatal and pediatric critical care using Bayesian meta-analysis, while synthesizing evidence on stroke volume bias, prognostic associations, and hemodynamic-guided management.DesignSystematic review and Bayesian hierarchical random-effects meta-analysis conducted according to PRISMA 2020 recommendations.SettingNeonatal and pediatric intensive care units, emergency care settings, and interhospital transport services.Data SourcesMEDLINE via PubMed, Embase, Google Scholar, and ScienceDirect were searched from database inception through March 2026. Reference lists and forward citation tracking were additionally performed to identify eligible studies.Measurements and Main ResultsSix studies including 448 neonates and children met the eligibility criteria. Three method-comparison studies enrolled 223 participants, of which two studies comprising 193 participants and four datasets contributed to the primary Bayesian synthesis. The pooled posterior mean percentage error was 26.9% (95% credible interval [CrI], 24.3%-29.5%), with a 98.3% posterior probability that the true percentage error remained ≤30%. A secondary analysis showed a pooled stroke volume bias of 2.82 mL (95% CrI, 1.71-3.86) and a 99.5% posterior probability that the absolute bias remained <5 mL. Observational evidence associated lower cardiac output with longer mechanical ventilation, while a pilot randomized trial suggested that electrical cardiometry-guided management reduced fluid administration and accelerated vasoactive therapy initiation.ConclusionsPooled evidence indicated a high posterior probability of clinically acceptable agreement between electrical cardiometry and reference methods for cardiac output measurement. Its prognostic and therapeutic value should be confirmed in larger multicenter prospective studies.