Comprehensive state-of-the-art overview of neonatologist performed echocardiography: Steps towards standardization of the use of echocardiography in neonatal intensive care

Boode, Willem P. de; Roehr, Charles Christoph; El-Khuffash, Afif

doi:10.1038/s41390-018-0118-5

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…Ten infants (22%) required invasive mechanical ventilation for 1 day (in addition to surfactant administration) and 34 infants required continuous positive airway pressure for a median of 2 [1][2][3][4][5] days. The infants' median hospital stay was 17 [12][13][14][15][16][17][18][19][20][21][22][23] days. All infants survived to hospital discharge without significant morbidity and were free of oxygen.…”

Section: Resultsmentioning

confidence: 99%

“…3 Reference values in addition to changes to those functional measurements secondary to certain disease states in extremely preterm infants (<29 weeks gestation) and in term infants (>37 weeks gestation) are emerging in the literature. 16 However, there is a paucity of data on infants in the later preterm phase, particularly between 30 and 34 weeks gestation. In clinical practise, the haemodynamic management of those infants using echocardiography currently relies on data extrapolated from term infants.…”

Section: Discussionmentioning

confidence: 99%

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Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

et al. 2019

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AbstractBackground:There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants.Methods:Forty-five healthy preterm newborns (mean ± standard deviation) gestation of 32.7 ± 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM™ system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring.Results:Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21–47%] and stroke volume [29%, 16–42%] increased with no change in heart rate [5%, −2 to 12%]. There was a rise in mean blood pressure [11%, 1–21%], but a decline in total peripheral resistance [−14%, −25 to −3%].Conclusion:Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

et al. 2019

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“…Early identification of abnormal heart anatomy enables rapid appropriate treatment strategy and referral, avoids major delay in the patient care and potentially reduces morbidity and mortality. It is important that future curriculum allows to reduce the gap between expectation and actual skill to confidently exclude CHD 19 …”

Section: Discussionmentioning

confidence: 99%

Utilisation of neonatologist‐performed echocardiography in shock among neonatologists with interest in haemodynamic: International survey

2022

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Aim Neonatologist‐performed echocardiography (NPE) is recommended during shock. We aimed to assess factors associated with NPE utilisation in the NICU and physiological information obtained during management of shock. Methods An Internet‐based survey, sent to neonatologists with interest in haemodynamics, studying NPE utilisation in shock management through a real clinical case and correlating its use with responders’ training and NICU settings. Results Fifty‐nine completed surveys were received from the United Kingdom: 38%, Western Europe: 32%, Canada: 23% and other countries: 7%. Whilst managing the given clinical case, 90% of responders expected first NPE to exclude congenital heart disease—although only 61% could exclude it confidently (71% in trained clinicians vs. 29% without training; p < 0.01). NPE utilisation prior to initiate treatment was significantly correlated with mean number of neonatologists able to perform NPE in the NICU (4.9 vs. 2.9 neonatologists per unit; p = 0.02). Similarly, for ongoing therapeutic guidance, NPE was more used in trained clinicians (p < 0.01). 88% and 81% of responders studied a combination of multiple parameters to assess filling and systemic flow, respectively. Conclusion Neonatologist‐performed echocardiography during shock management differs with previous training and number of doctors able to perform echocardiography in NICU. This study highlighted the need for enhanced training implementation.

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“…Such a scoring system requires bedside evaluation of the neonatologist from the TnEcho team. The real-time assessment of the hemodynamic changes, early pathological situations assessment, and response to treatment interventions improves the outcomes of pre-term neonates (124)(125)(126)(127). Still, it is essential to mention the importance of the pediatric cardiologist's echocardiogram or review of the echocardiogram done by TnEcho to rule out anatomical congenital heart disease.…”

Section: Pulmonary Hypertension Diagnosis In Premature Newbornsmentioning

confidence: 99%

The Controversy Persists: Is There a Qualification Criterion to Utilize Inhaled Nitric Oxide in Pre-term Newborns?

et al. 2021

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Inhaled nitric oxide (iNO) use in premature newborns remains controversial among clinicians. In 2014, the American Academy of Pediatrics, Committee on Fetus and Newborn released a statement that the available data do not support routine iNO use in pre-term newborns. Despite the absence of significant benefits, 2016 California data showed that clinicians continue to utilize iNO in pre-term infants. With studies as recent as January 2017, the Cochrane review confirmed no major advantages of iNO in pre-term newborns. Still, it recognized that a subset of pre-term infants with pulmonary hypertension (PHTN) had not been separately investigated. Furthermore, recent non-randomized controlled trials have suggested that iNO may benefit specific subgroups of pre-term newborns, especially those with PHTN, prolonged rupture of membranes, and antenatal steroid exposure. Those pre-term infants who showed a clinical response to iNO had increased survival without disability. These findings underscore the need for future studies in pre-term newborns with hypoxemic respiratory failure and PHTN. This review will discuss the rationale for using iNO, controversies regarding the diagnosis of PHTN, and additional novel approaches of iNO treatment in perinatal asphyxia and neonatal resuscitation in the pre-term population < 34 weeks gestation.

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Comprehensive state-of-the-art overview of neonatologist performed echocardiography: Steps towards standardization of the use of echocardiography in neonatal intensive care

Cited by 9 publications

References 9 publications

Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

Utilisation of neonatologist‐performed echocardiography in shock among neonatologists with interest in haemodynamic: International survey

The Controversy Persists: Is There a Qualification Criterion to Utilize Inhaled Nitric Oxide in Pre-term Newborns?

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