Use of Targeted Neonatal Echocardiography to Prevent Postoperative Cardiorespiratory Instability after Patent Ductus Arteriosus Ligation

Jain, Amish; Sahni, Mohit; El-Khuffash, Afif; Khadawardi, Emad; Sehgal, Arvind; McNamara, Patrick J.

doi:10.1016/j.jpeds.2011.09.027

Cited by 142 publications

(132 citation statements)

References 23 publications

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“…Preterm infants at high risk of developing cardiac syndrome after surgical ligation of patent ductus arteriosus and treated with milrinone were found to have lower incidence of ventilation failure, less need for inotropes (19% vs 56%; P = .01), and a trend towards improved oxygenation as compared with another historic cohort of infants with similar characteristics not treated with milrinone [69].…”

Section: Evidence and Pd Effectsmentioning

confidence: 87%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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Section: Evidence and Pd Effectsmentioning

confidence: 87%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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“…150,151 Preterm infants are at risk of postligation hemodynamic instability, which may result in cerebral hypoperfusion, neuronal injury, and subsequent NDI. [152][153][154][155][156][157] In our review, only 1 of the included studies 30 reported on an association of VCP and NDI, and no study described an association between postligation hemodynamic …”

Section: Figurementioning

confidence: 92%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks’ gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01–2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98–3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62–3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38–0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58–1.57). CONCLUSIONS: Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.

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“…The use of echocardiography in the neonatal intensive care unit, also referred to as targeted neonatal echocardiography, has been shown to identify cardiovascular compromise earlier, guide therapeutic intervention, monitor treatment response, and improve overall outcome [4][5][6] .…”

mentioning

confidence: 99%

Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart

et al. 2016

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Echocardiography in the neonatal intensive care unit has led to improvements in our ability to assess the neonatal heart in health and disease. Advances in neonatal cardiac imaging have provided the capability to obtain quantitative information that often supersedes the qualitative information provided by conventional methods. Novel quantitative measures of function include the assessment of the velocity of muscle tissue movement during systole and diastole using tissue Doppler velocity imaging, and evaluation of deformation and rotational characteristics of the myocardium utilizing speckle tracking echocardiography or tissue Doppler-derived strain imaging. A comprehensive understanding of these novel functional modalities, their predictive value, and limitations can greatly assist in managing both the normal and maladaptive responses in the newborn period. This article discusses the novel and emerging methods for assessment of left and right heart function in the neonatal population.

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Use of Targeted Neonatal Echocardiography to Prevent Postoperative Cardiorespiratory Instability after Patent Ductus Arteriosus Ligation

Cited by 142 publications

References 23 publications

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

PDA Ligation and Health Outcomes: A Meta-analysis

Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart

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