Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 21008

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : SC20 - SC23 Full Version

Correlation of Baseline Inferior Vena Cava Diameter and Collapsibility with Age and Sex in Normovolaemic Children: A Cross-sectional Study

Published: January 1, 2023 | DOI:
Metty Mathews, Mebin Mathew, Prameela Joji, Neetu Gupta

1. Assistant Professor, Department of Paediatrics, Al Azhar Medical College, Thodupuzha, Kerala, India. 2. Assistant Professor, Department of General Surgery, Al Azhar Medical College, Thodupuzha, Kerala, India. 3. Consultant, Department of Paediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India. 4. Consultant, Department of Paediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India.

Correspondence Address :
Dr. Metty Mathews,
Department of Paediatrics, Al Azhar Medical College, Thodupuzha, Kerala.


Introduction: Ultrasound measurement of Inferior Vena Cava (IVC) diameter and collapsibility is increasingly used for volume status assessment and fluid responsiveness in paediatric and adult population. There is a wide variation in the age specific IVC diameters in paediatric population, whereas age specific variation in IVC collapsibility in euvolaemic children is not much known.

Aim: To analyse the correlation of baseline IVC diameter and collapsibility with age and sex in euvolaemic children.

Materials and Methods: This cross-sectional study was conducted at Kerala Institute of Medical Sciences, a tertiary care hospital in south Kerala, India, over a study period from June 2014 to May 2016. A total of 80 children in the age group of one month to 15 years, who presented without evidence of volume depletion were enrolled. The IVC was assessed approximately 2 cm distal to IVC-hepatic vein junction, Motion mode (M-mode) measurement of maximum (expiratory) and minimum (inspiratory) width of IVC diameter was measured. Collapsibility Index was also calculated for each subject by measuring difference between the maximum and minimum IVC diameters divided by the maximum diameter. The statistical data was analysed using the statistical software Statistical Package for Social Sciences (SPSS) version 16. All the numerical data was expressed as mean±Standard Deviation (SD). Quantitative analysis was performed using Analysis of Variance (ANOVA) and t-test. The correlation of IVC parameters were assessed using Karl Pearson correlation coefficient. The p-value less than 0.05 was considered as significant.

Results: Eighty euvolaemic children between the age one month and 15 years were enrolled in the study. The mean age of study group was 5±4 years. Males 41 (51.3%) and females 39 (48.8%) were almost equally distributed. A significant strong positive correlation was found between IVC expiratory and inspiratory diameter with age using Karl Pearson correlation, r= 0.912, p<0.001; r=0.876, p<0.001, respectively. No significant correlation was found between IVC collapsibility and age, Karl Pearson correlation, r=0.079, p=0.485. No correlation was found between sex and the IVC parameters.

Conclusion: According to the present study results, IVC diameter showed a positive correlation with age but not with sex. The IVC collapsibility had no correlation with either age or sex.


Diagnosis, Measurement, Paediatric, Ultrasonography

Ultrasonographic (USG) assessment of the IVC has been used as a non invasive diagnostic tool for the assessment of intravascular volume (1),(2). Specifically, IVC diameter and collapsibility have been used as methods of assessing intravascular volume (3),(4). Changes in the volume status are reflected as change in diameter of IVC, which is a thin walled compliant vessel (5). The IVC contracts with inspiration and expands with expiration (6). During inspiration, negative pressure creates increased venous return to the heart, briefly collapsing the IVC. During expiration, venous return decreases and the IVC returns to its baseline diameter (7). Changes in volume status are reflected in sonographic evaluation of the IVC. Fluid management is very crucial in the management of children with fluid deficit and fluid overload; as sonographic IVC parameters are increasingly used in volume status assessment, establishing normative data for IVC parameters is very essential. Although a positive correlation is observed in sonographic measurements between IVC diameter and age, there is a lack of universally accepted cut-off of IVC diameter in healthy paediatric population (8),(9),(10). In adult population, IVC diameter at inspiration ranges from 0 to 14 mm at rest, and expiratory diameter of 15 to 20 mm at rest (11). Most of the previous studies focused on correlation of sonographic measurement of IVC diameter with various body parameters (8),(11),(12), and only few studies compared IVC collapsibility and age (8),(10).

In healthy subjects breathing spontaneously, cyclic changes in thoracic pressure, result in collapse of the IVC diameter of approximately 50% (7).

The aim of the present study was to analyse the correlation of IVC diameter and collapsibility with age and sex in euvolaemic paediatric population.

Material and Methods

This was a cross-sectional study conducted in the emergency room of Kerala Institute of Medical Sciences, Trivandrum, a tertiary care hospital in Kerala, India. After obtaining Institutional Ethical Committee clearance (ECR/284/284/KIMS/Inst/Ker/2013), over the study period of two years from June 2014 to May 2016. Written informed consent was obtained from parents of eligible children.

Inclusion criteria: During the study period all children who presented to emergency room without any signs and symptoms of volume depletion and consented for study were included in the study.

Exclusion criteria: Children who were having dehydration or shock were not included in the study. Children with congenital heart disease and those who have not consented were also excluded from the study.

Sample size calculation: According to the study by Kathuria N et al., considering the correlation between IVC diameter and age as 0.79 at 95% confidence interval with 95% power, the sample size was calculated as (9):

N = {(Z 1-α/2 + Z 1-β) 2*4/(ln(1+r/1-r))2}+3.

(Z1-α/2- two tailed probability for 95% confidence interval=1.96, Z1-β-two tailed probability for 95% power= 1.64, r-Correlation between diameter and age=0.79)

N= {(1.96 + 1.64)^ 2*4/(ln(1+ 0.79/1-0.79))^2}+3=14.32

Thus the total minimum sample size required for the study is 14.32. Non response rate of 50% was added to get a minimum sample size of 22.

Study Procedure

Eighty children in age group 1 month to 15 years, who were not having signs and symptoms of volume depletion and clinically judged to be euvolaemic were enrolled for study. For clinical judgment of euvolemia focused history obtained included absence of diarrhoea, vomiting, decreased oral intake/feeding difficulty, lethargy and focused examination included measurement of heart rate, respiratory rate, blood pressure, temperature and capillary refill time.

After taking focused history and examination, one measurement of IVC was obtained.

Method of IVC measurement: Portable sonosite micromax machine (Brand–Fujifilm, Model-M-Turbo) was used to perform the necessary measurements during this study. With the child in supine position, the standard curvilinear low frequency abdominal ultrasound probe (3.5-5 MHz) was placed on the patient’s midline, in the subxiphoid region angling to right and a longitudinal view of images were recorded over several respiratory and cardiac cycles. The IVC was assessed approximately 2 cm distal to IVC-hepatic vein junction (13), where it’s anterior and posterior walls are clearly visualised. The M-mode measurement of maximum and minimum width of IVC diameter was measured. The maximum IVC diameter was obtained during the expiratory phase of the respiratory cycle and the minimum during the inspiratory phase. The IVC collapsibility index was calculated using formula (14):

IVC Expiratory Diameter-IVC inspiratory Diameter/ IVC Expiratory Diameter ×100

Ultrasound measurements were performed by either of the two principal investigators (either a paediatric emergency attending consultant who underwent formal emergency ultrasound training with Indian Academy of Paediatrics, workshop on paediatric critical care imaging, and or a paediatric resident who underwent training under the above consultant).

Statistical Analysis

Data was collected using a structured proforma which was filled by the principal investigators. The proforma was used to collect essential demographic and clinical data along with the measurements of IVC of the study population. The statistical data was analysed using the statistical software SPSS version 16. All the numerical data was expressed as mean±standard deviation. Quantitative analysis was performed using ANOVA and t-test. The correlation of IVC diameter and collapsibility with age and sex was calculated using Karl Pearson correlation, a p<0.05 was considered significant.


The present study evaluated 80 children, for correlation between sonographic measurement of IVC parameters with age and sex in children.

Of the total population enrolled in the study, one-third (33.8%, n=27) were less than 2 years of age, majority (42.5%, n=34) were between more than 2 to 7 years of age and others (23.8%, n=19) were older than 7 years of age. In this study, males and females were almost equally distributed (51.3%, n=41 vs 48.8%, n=39) (Table/Fig 1).

The mean IVC expiratory diameter among study participants was 8.2±2.8 mm. In children less than 2 years of age, mean IVC expiratory diameter was 5.7±0.9 mm, between more than 2 to 7 years of age, it was 8.9 mm±1.8 and in more than 7 years of age, it was 11.9±1.8 mm. The mean inspiratory IVC diameter among study population was 5.1±1.7 mm. In children less than 2 years of age mean IVC inspiratory diameter was 3.4±0.6 mm, between more than 2 to 7 years age 5.3 mm±1.1 mm and in more than 7 years 7.0 mm±1.0 mm.

The difference in mean IVC expiratory and inspiratory diameter in three age groups were statistically significant (p<0.001 for both expiratory and inspiratory diameters), but the difference IVC diameters among males and females were not statistically significant. (p=0.332 expiratory and p=0.404 inspiratory) (Table/Fig 2),(Table/Fig 3).

The mean collapsibility index of IVC among the study population was 39.5±5.7%. The IVC collapsibility showed no statistically significant variation with age or sex; p=0.786 for age vs p=0.161 for sex (Table/Fig 2),(Table/Fig 3).

A strong positive correlation which was statistically significant was found between IVC expiratory diameter with age using Karl Pearson correlation, r=0.912, p<0.001(Table/Fig 4).

Similarly, strong positive correlation was found between IVC inspiratory diameters and age. The baseline IVC inspiratory diameter measured by ultrasonography, in longitudinal view, increased with increasing age. Karl Pearson correlation was r= 0.876, p<0.001 (Table/Fig 5).

Karl Pearson correlation with gender for expiratory diameter was r=-0.108 p=0.340 and for inspiratory diameter was r=-0.090, p=0.426 (Table/Fig 6).

Correlation of IVC collapsibility with age and sex was negligible. Karl Pearson correlation coefficient for IVC collapsibility and age was, r=0.079, p=0.485; and for sex r=-0.071, p=0.530 (Table/Fig 6).


Bedside ultrasound is a useful non invasive tool to estimate intravascular volume status by measuring IVC diameter and collapsibility index (15),(16).

The present study presents the data regarding relationship between IVC parameters with age and sex in paediatric population.

This study enrolled 80 children in the age group 1 month to 15 years, who were not having clinical signs of volume depletion. The IVC diameters of all children, during inspiration and expiration were categorised as per age of children. A significant positive correlation was found between IVC expiratory and inspiratory diameter with age using Karl Pearson correlation; r= 0.912, p<0.001 for expiratory IVC diameter and r= 0.876, p<0.001 for inspiratory IVC diameter. Whereas negligible correlation was there between IVC collapsibility with age (r=0.079, p=0.485) and sex (r=-0.071, p=0.530). Similar positive correlation of IVC diameter with age was observed in previous studies also.

In the study by Ghosh V et al., enrolling 100 children in age group 6 months to 16 years, the mean expiratory IVC diameter was 7.6 -13.5 mm and inspiratory diameter 5.6-10.5 mm (8). The mean maximum and minimum IVC diameter increased significantly with age (r=0.738, p<0.001, r=0.789, p<0.001). Collapsibility index did not show significant correlation with age.

Similarly, study by Taneja K et al., also showed positive correlation of maximum (r=0.794, p<0.001) and minimum (r=0.752, p<0.001) IVC diameters with age, while collapsibility index was almost similar in all age groups (10). The maximum IVC diameter was 7.24±2.97 mm, minimum IVC diameter 4.71±1.97 mm and collapsibility was 34±1.1 %. This study was done by radiologist and had IVC diameter and collapsibility similar to the present study done by clinicians. Whereas in an adult study by Pail S et al., no correlation of IVC diameter with age of population was seen and with respect to gender r=-0.032, p=0.172 for females and r=-0.001, p=0.952 for males were found (17). The IVC maximum diameter was 9.7-22.6 mm, minimum diameter was 4.6-15.4 mm and average collapsibility was 38% in the adult study by Pail S et al., (17). In another study by Kutty S et al., where 120 healthy volunteer children were enrolled, the mean maximum and minimum IVC diameters were higher than the present study 12.1± 3.8mm and 8.9±3.8mm, respectively (18). But similar to the present study, they also showed correlation of these diameters with age while IVC collapsibility index was not correlated with age.

Haines EJ et al., derived an IVC dimension growth curve as a function of age among the children aged 4 weeks to 20 years and found linear correlation between IVC dimensions and age (12). The mean IVC dimeter was 1.2 to 22.6 mm.

The difference in mean IVC diameters observed in these studies may be due to difference in the age group enrolled in the studies.

Measurement of IVC diameter and collapsibility with respiration are increasingly being used to guide fluid management decisions in patients (19). Fluid management is very precarious in children, and it is crucial to know the fluid deficit or fluid overload before administering more fluid. Literature suggests IVC diameter measurements as a useful tool in recognising patients who may get benefited from volume challenge (3),(20),(21),(22). On the other side, many studies suggest that changes in sonographic IVC measurement do not strongly predict fluid responsiveness (23),(24).

As there was a strong positive correlation of IVC diameter with age and negligible correlation of IVC collapsibility with age, IVC collapsibility would be a better tool for volume status assessment in paediatric population.


Patients were assumed to be euvolaemic based on their clinical signs and symptoms at presentation to emergency room. Limitation of this study was inclusion of children from a specific region, which was not enough to extrapolate these measurements on the general population. Further multicentric studies with large sample size are required to derive IVC normogram based on age.


This study established a wide variation in the absolute values of IVC diameter with age in paediatric population, hence relaying absolute IVC diameter for volume status assessment was difficult in paediatric population. The IVC collapsibility did not vary much with age or sex in euvolaemic children. There was a strong positive correlation between IVC diameter and age in paediatric population; whereas no positive correlation was established between IVC collapsibility and age.


Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emer Radiol. 2007;14(3):181-85. [crossref] [PubMed]
Yanagawa Y, Nishi K, Sakamoto T, Okada Y. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma. 2005;58(4):825-29. [crossref] [PubMed]
Gan H, Cannesson M, Chandler JR, Ansermino JM. Predicting fluid responsiveness in children: a systematic review. Anesth Analg 2013;117(6):1380-92. [crossref] [PubMed]
Bodson L, Vieillard-Baron A. Respiratory variation in inferior vena cava diameter: surrogate of central venous pressure or parameter of fluid responsiveness? Let the physiology reply. Crit Care. 2012;16(6):181. [crossref] [PubMed]
Beigel R, Cercek B, Luo H, Siegel RJ. Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr. 2013;26(9):1033-42. [crossref] [PubMed]
Standring S, Borley NR. Gray's Anatomy the Anatomical Basis of Clinical Practice. 40th ed. London: Churchill Livingstone; 2008. 1069-83.
Pinsky MR, Brochard L, Mancebo J. Applied physiology in intensive care medicine. 2nd ed. New York: Springer-verlag 2009.
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 Paediatr Crit Care. 2021;8(2):86-90. [crossref]
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(6):1091-96. [crossref] [PubMed]
Taneja K, Kumar V, Anand R, Pemde KH. Normative data for IVC diameter and its correlation with the somatic parameters in healthy Indian children. Indian J Paediatr. 2018;85(2)108-12. [crossref] [PubMed]
Field JM, Bresler MJ. The textbook of emergency cardiovascular care and CPR. Philadelphia: Lipincott ww. 2009.
Haines EJ, Chiricolo GC, Aralica K, Briggs WM, Van Amerongen R, Laudenbach A, et al. Derivation of a paediatric growth curve for inferior vena caval diameter in healthy paediatric patients: brief report of initial curve development. Crit Ultrasound J. 2012;4(1):12. [crossref] [PubMed]
Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50. [crossref] [PubMed]
Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, et al. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Surg. 2009;209(1):55-61. [crossref] [PubMed]
Chen L, Baker MD. Novel applications of ultrasound in paediatric emergency medicine. Paediatric Emergency Care. 2007;23(2):115-23. [crossref] [PubMed]
Pershad J, Myers S, Plouman C, Rosson C, Elam K, Wan J, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Paediatrics. 2004;114(6):e667-71. [crossref] [PubMed]
Pail S, Jayadev S,Setty N, Kharge J, Pettegowda B, Ramalingam R, et al. Assessment of inferior vena cava diameter by echocardiography in normal Indian population: A prospective observational study. In Heart J. 2016; 68(3):S26-30. [crossref] [PubMed]
Kutty S, Li L, Hasan R, Peng Q, Rangamani SA, Danford D. Systemic venous diameters, collapsibility indices, and right atrial measurements in normal paediatric subjects. J Am Soc Echocardiogr. 2014; 27(2):155-62. [crossref] [PubMed]
Lanspa MJ, Grissom CK, Hirshberg EL. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock. Shock. 2013;39(2):155-60. [crossref] [PubMed]
Feissel M, Michard F, Faller JP. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensiv Care Med. 2004;30(9):1834-37. [crossref] [PubMed]
Boyd JH, Sirounis D, Maizel J, Slama M. Echocardiography as a guide for fluid management. Crit Care. 2016; 20(1):274-74. [crossref] [PubMed]
Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill paediatric patients. J Ultrason. 2020; 20(82):e205-09. [crossref] [PubMed]
Airapetian N., Maizel J., Alyamani O. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care. 2015;19(1):01-08. [crossref] [PubMed]
Juhl-Olsen P, Vistisen ST, Christiansen LK, Rasmussen LA, Frederiksen CA, Sloth E. Ultrasound of the inferior vena cava does not predict hemodynamic response to early haemorrhage. J Emerg Med. 2013;45(4):592-97. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/58949.17407

Date of Submission: Jul 10, 2022
Date of Peer Review: Aug 10, 2022
Date of Acceptance: Nov 24, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 12, 2022
• Manual Googling: Nov 02, 2022
• iThenticate Software: Nov 22, 2022 (18%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)