The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock

Boode, Willem P. de; Lee, Robin van der; Eriksen, Beate Horsberg; Nestaas, Eirik; Dempsey, Eugene M.; Singh, Yogen; Austin, Topun; El-Khuffash, Afif

doi:10.1038/s41390-018-0081-1

Cited by 83 publications

(82 citation statements)

References 83 publications

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“…Determining whether LV volumes, LVEF and LV output are normal or reduced is valuable in assessment of perfusion, unraveling the mechanisms underlying cardiovascular compromise and help target interventions 29 . Currently, left ventricle output (LVO) determined using the velocity time integral (VTI) method is the most commonly used echocardiographic parameter in preterm neonates for assessment of LV systolic performance 30,31 . However, LVO is not an accurate indicator of systemic blood flow and organ perfusion in the presence of a hemodynamically significant PDA 26 .…”

Section: Discussionmentioning

confidence: 99%

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Phad

Waal

2020

Echocardiography

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Background Biplane left ventricular ejection fraction (LVEF) is a valuable echocardiographic parameter for assessment of LV systolic pump efficiency in adults and children, but not often reported in preterm infants. The primary aim of this study was to longitudinally measure biplane LVEF in very preterm infants during the neonatal intensive care period. Secondary aim was to compare manual and semi‐automatic determination of LVEF for agreement and variability. Methods Stable preterm infants less than 30 weeks gestation were scanned on day 3, day 28, and at 36 weeks postmenstrual age. The LV endocardium was traced manually and semi‐automatically using integrated speckle tracking software in apical 4‐chamber and apical 3‐chamber images to obtain end‐diastolic volume and end‐systolic volume, and calculate LVEF. Agreement between methods and variability within and between observers was determined using an interclass correlation coefficient (ICC) and Bland‐Altman analysis. Results Sixty‐six preterm infants with a mean birth weight of 1100 (239) g were analyzed. The average manual biplane LVEF was 58 (3)%, 59 (3)%, and 55 (4)% at the three respective time points. Manual LVEF showed good agreement with semi‐automatic LVEF (ICC 0.76) with a small bias of −1.5 (3.0)%. Interobserver variability of LVEF improved with semi‐automatic tracing of the LV endocardial border (ICC manual 0.68 vs semi‐automatic 0.80). Conclusion Left ventricular systolic pump efficiency in preterm infants remains stable during the neonatal intensive care period. Semi‐automatic biplane LVEF has less interobserver variability and can be used interchangeably with manual biplane LVEF.

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Section: Discussionmentioning

confidence: 99%

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Phad

Waal

2020

Echocardiography

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“…The committee was united in strongly recommending the use of cardiac ultrasound for hemodynamic evaluation of infants and children with hemodynamic instability. Since cardiac ultrasonography does not provide continuous measurements and is limited by a wide intra and inter-observer variability [9,47] we strongly recommend using serial assessments. Furthermore, cardiac ultrasound is very helpful in patients requiring extra-corporeal membrane oxygenation (ECMO): it is invaluable in placing the ECMO catheter at the appropriate position, assessing cardiac function and evaluation of pericardial effusion [11,47].…”

Section: Echocardiography / Ultrasonographymentioning

confidence: 99%

Recommendations for hemodynamic Monitoring for Critically Ill Children – Expert Consensus Statement issued by the Cardiovascular Dynamics Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Singh

Villaescusa

Cruz

et al. 2020

Preprint

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Background Cardiovascular instability is common in critically-ill children. There is scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature - a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement”, 20 “weak agreement” and 2 had “no agreement”. Six statements were considered as redundant after rephrasing of statements following first round of voting. Due to lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendation may be used to guide clinical practice for hemodynamic monitoring in critically-ill children and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

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“…5 Those reviews provide guidance to image acquisition, measurement, interpretation and reference values for those newer modalities. Four clinically oriented reviews describing the role of NPE in the assessment and management of persistent patent ductus arteriosus (PDA 6 ), neonatal shock, 7 persistent pulmonary hypertension of the newborn (PPHN 8 ), and neonatal heart failure, 9 complete the comprehensive overview of the use of NPE in neonatal care in this supplement.…”

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confidence: 99%

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

2018

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The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock

Cited by 83 publications

References 83 publications

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Recommendations for hemodynamic Monitoring for Critically Ill Children – Expert Consensus Statement issued by the Cardiovascular Dynamics Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

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

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