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Savoia M, Busolini E, Ibarra Rios D, Thomas B, Ruoss JL, McNamara PJ. Integrated Lung Ultrasound and Targeted Neonatal Echocardiography Evaluation in Infants Born Preterm. J Pediatr 2024; 275:114200. [PMID: 39032769 DOI: 10.1016/j.jpeds.2024.114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Marilena Savoia
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy.
| | - Eva Busolini
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy
| | - Daniel Ibarra Rios
- Division of Neonatology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, Mexico, Mexico
| | - Brady Thomas
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - J Lauren Ruoss
- Neonatal Intensive Care Unit, Winnie Palmer Hospital/Orlando Health Regional Hospital, Orlando, Fl
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
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Johnson BA, Shepherd J, Bhombal S, Ali N, Joynt C. Special considerations for the stabilization and resuscitation of patients with cardiac disease in the Neonatal Intensive Care Unit. Semin Perinatol 2024; 48:151989. [PMID: 39477714 DOI: 10.1016/j.semperi.2024.151989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2024]
Abstract
Effective resuscitation of neonates with congenital heart disease (CHD) depends on comprehensive planning, thorough understanding of physiology, vigilant monitoring, and interdisciplinary collaboration to achieve the best outcomes. Neonatal heart disease can affect cardiac structure, rhythm, or ventricular function, and may be either congenital or acquired. Critical congenital heart disease (CCHD) can result in inadequate pulmonary blood flow, impaired intracardiac mixing, airway obstruction, or insufficient cardiac output. Tailored resuscitation strategies are important as early as the delivery room, where some CHD lesions may cause immediate cardiovascular instability during the transition from fetal to postnatal circulation. Premature infants with CHD are at higher risk due to their small size and the complications associated with prematurity, affecting both CHD management and overall clinical stability. Addressing both cardiac and non-cardiac causes of decompensation requires a precise understanding of each patient's unique physiology and trajectory from delivery through postintervention intensive care.
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Key Words
- APV, absent pulmonary valve
- ARC, acute respiratory compromise
- ARF, acute renal failure
- AV, atrioventricular
- AVRT, atrioventricular reentrant tachycardia
- Abbreviations: AHA, American Heart Association
- Ao, aorta
- BP, blood pressure
- CCHB, congenital complete heart block
- CCHD, critical congenital heart disease
- CHD, congenital heart disease
- CLD, chronic lung disease
- CPAP, continuous positive airway pressure
- CPR, cardiopulmonary resuscitation
- CVC, central venous catheter
- DCM, dilated cardiomyopathy
- DR, delivery room
- EAT, ectopic atrial tachycardia
- ECA, extracardiac anomalies
- ECMO, extracorporeal membrane oxygenation
- EKG, electrocardiogram
- HCM, hypertrophic cardiomyopathy
- HLHS, hypoplastic left heart syndrome
- HR, heart rate
- ICU, intensive care unit
- IV, intravenous
- IVC, inferior vena cava
- IVH, intraventricular hemorrhage
- IVS, intact ventricular septum
- LA, left atrium
- LV, left ventricle
- LVOTO, left ventricular outflow tract obstruction
- MI, myocardial infarction
- NCCM, noncompaction cardiomyopathy
- NEC, necrotizing enterocolitis
- NICU, neonatal intensive care unit
- NRP, neonatal resuscitation program
- PA, pulmonary artery
- PALS, pediatric advanced life support
- PDA, patent ductus arteriosus
- PEA, pulseless electrical activity
- PEEP, positive end-expiratory pressure
- PGE, prostaglandin E
- PLCS, Postligation cardiac syndrome
- PPV, positive pressure ventilation
- PS, pulmonary stenosis
- PVR, pulmonary vascular resistance
- Qp, pulmonary blood flow
- Qs, systemic blood flow
- RA, right atrium
- RV, right ventricle
- RVOTO, right ventricular outflow tract obstruction
- SSA, Sjögren's-syndrome-related antigen A
- SVC, superior vena cava
- SVR, systemic vascular resistance
- SVT, supraventricular tachycardia
- SpO(2), pulse oximetry measured oxygen saturation
- SvO(2), mixed venous oxygen saturation
- TAPVR, total anomalous pulmonary venous return
- TGA, transposition of the great arteries
- TOF, tetralogy of Fallot
- VSD, ventricular septal defect
- VT, ventricular tachycardia
- eCPR, extracorporeal cardiopulmonary resuscitation
- pCO(2), partial pressure of carbon dioxide
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Affiliation(s)
- Beth Ann Johnson
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Jennifer Shepherd
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shazia Bhombal
- Children's Healthcare of Atlanta and Department of Pediatrics, Division of Neonatology, Emory University, Atlanta, Georgia, USA
| | - Noorjahan Ali
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Chloe Joynt
- Division of Neonatology, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada
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Schroeder L, Ebach F, Melaku T, Strizek B, Jimenez-Cruz J, Dolscheid-Pommerich R, Mueller A, Kipfmueller F. Longitudinal evaluation of hemodynamic blood and echocardiographic biomarkers for the prediction of BPD and BPD-related pulmonary hypertension in very-low-birth-weight preterm infants. Eur J Pediatr 2024; 184:15. [PMID: 39546006 PMCID: PMC11567987 DOI: 10.1007/s00431-024-05841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/20/2024] [Accepted: 10/28/2024] [Indexed: 11/17/2024]
Abstract
Very-low-birth-weight infants (VLBW, < 1500 g) are at risk of developing bronchopulmonary dysplasia (BPD) and are at risk for BPD-related pulmonary hypertension (PH). The longitudinal measurement of innovative blood and echocardiographic biomarkers might allow for a risk stratification of these infants. A prospective single-center cohort study was conducted between 01/2021 and 06/2023. Inclusion criteria were the combination of a birth weight < 1500 g and a gestational age (GA) ≤ 30/0 weeks. Assessment timepoints: T1 (day 7), T2 (day 28), and T3 (at 36 weeks post-menstrual age, PMA). Overall, 71 preterm infants were included for final analysis. The Zlog-transformed NTproBNPZlog (at T1 AUC 0.772; p = 0.019; at T2 AUC 0.874, p = 0.002), and endothelin-1 (ET1, at T1 AUC 0.789, p = 0.013) were identified as an early predictive biomarker for BPD/death in the univariate analysis. Additionally, echocardiographic markers of ventricular function and PH at T1 were predictive for BPD/death in the univariate analysis, with the highest predictivity found for the tricuspid annular plane systolic excursion-TAPSE (AUC 0.748, p = 0.016) and the pulmonary artery acceleration time to right ventricular ejection time (PAAT/RVET; AUC 0.744, p = 0.043). Regarding predictability of mortality alone NTroBNPZlog (at T1 AUC 0.973, p = 0.000), and CA125 (at T1 AUC 0.747, p = 0.008) were identified as potential predictors, as well as TAPSE (AUC 0.926, p = 0.000), and PAAT/RVET (AUC 0.985, p = 0.000) Several biomarkers including ET-1 (at T1 AUC 0.893, p = 0.000), TAPSE (AUC 0.974, p = 0.000), and PAAT/RVET (AUC 1.0, p = 0.000) at T1 were identified as univariate predictors for BPD-PH. In the multivariate analysis, no biomarker was identified as an independent predictor of the primary endpoint. CONCLUSION Mainly at an early stage of postnatal neonatal care in VLBW preterm infants, several biomarkers were found to be associated with the combined endpoint BPD/death and BPD-PH. New candidates of blood biomarkers (NTproBNPZlog, ET-1, and CA125) and echocardiographic markers (TAPSE, PAAT/RVET) might serve as innovative predictors for BPD, BPD-PH, and adverse outcomes in VBLW infants. WHAT IS KNOWN • VLBW infants are at risk for the development of BPD and BPD-related PH, which both are main contributors for short and long-term morbidity and mortality. Several studies in the past focused on the evaluation of circulating blood biomarkers and biomarkers from echocardiographic assessment of these infants. But to date, there is still a lack on longitudinal prospective studies especially in VLBW infants. WHAT IS NEW • For the first time, this set of selected blood biomarkers (with the first description of Zlog-transformed NTproBNP and CA125 in preterm infants) and several echocardiographic markers were analyzed in a prospective longitudinal study from birth until 36 weeks post menstrual age in VLBW infants. Our data help clinicians to identify preterm infants at risk for BPD, BPD-PH and death and to offer new candidates of biomarkers. This might help to facilitate decision making and guidance of therapy in these highly vulnerable patients.
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Affiliation(s)
- Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Fabian Ebach
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tamene Melaku
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Jorge Jimenez-Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Danhaive O, Hocq C. NT-proBNP, to be or not to be a BPD biomarker? Pediatr Res 2024:10.1038/s41390-024-03681-8. [PMID: 39482496 DOI: 10.1038/s41390-024-03681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 10/14/2024] [Indexed: 11/03/2024]
Affiliation(s)
- Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
- Division of Neonatology, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Catheline Hocq
- Division of Neonatology, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
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Hyland RM, Levy PT, Lai WW, McNamara PJ. Targeted Neonatal Echocardiography Based Hemodynamic Consultation in the Neonatal Intensive Care Unit: Subspecialty Evolution in Neonatology. J Am Soc Echocardiogr 2024:S0894-7317(24)00523-6. [PMID: 39477167 DOI: 10.1016/j.echo.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 09/19/2024] [Accepted: 09/22/2024] [Indexed: 11/28/2024]
Affiliation(s)
- Rachael M Hyland
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School Boston, Boston, Massachusetts
| | - Wyman W Lai
- Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, California
| | - Patrick J McNamara
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
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Kirkpatrick JN, Panebianco N, Diaz-Gomez JL, Lu JC. Reply to "Hemodynamic Consultation in the Neonatal Intensive Care Unit: Subspecialty Evolution in Neonatology". J Am Soc Echocardiogr 2024:S0894-7317(24)00524-8. [PMID: 39490454 DOI: 10.1016/j.echo.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 10/21/2024] [Indexed: 11/05/2024]
Affiliation(s)
- James N Kirkpatrick
- Division of Cardiology, Department of Medicine and Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Nova Panebianco
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose L Diaz-Gomez
- Division of Critical Care, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
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Pereira S, Satas S. Comparing qualitative and quantitative echocardiographic markers to assess cardiac contractility in newborn infants: protocol for a prospective cohort study. BMJ Paediatr Open 2024; 8:e002606. [PMID: 39401972 PMCID: PMC11474862 DOI: 10.1136/bmjpo-2024-002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 09/02/2024] [Indexed: 10/17/2024] Open
Abstract
INTRODUCTION Neonatologist-performed echocardiography (NPE) is increasingly used in the neonatal intensive care unit, aiding clinicians in enhancing diagnostic precision and guiding treatment decisions based on underlying pathophysiology. Experienced NPE operators typically use visual estimation of the cardiac contractility and if required confirm findings using quantitative echocardiographic markers.While various quantitative echocardiographic markers are available to assess left and right ventricular contractility, this study aims to compare the proficiency of NPE-experienced and non-experienced providers in accurately assessing cardiac contractility using a combination of commonly used qualitative and quantitative echocardiographic markers. METHODS AND ANALYSIS Newborn infants, both inborn and outborn, undergoing routine NPE by the authors at Homerton University Hospital and Aberdeen Maternity Hospital from 1 April 2024 to 1 October 2024 will be studied. Indications for NPE include murmur evaluation, infants receiving intensive care and the need to assess underlying cardiovascular physiology.Blinded experienced and non-experienced NPE operators will independently assess left and right ventricular contractility using qualitative echocardiographic markers. The results will be compared with standard quantitative echocardiographic markers for cardiac contractility, and reliability studies will also be conducted for quantitative makers.Clinical data will be sourced from electronic patient records and national neonatal database. Sensitivity, specificity, positive predictive and negative predictive values, and positive and negative likelihood ratios will be calculated. ETHICS AND DISSEMINATION The study is approved by the Health and Care Research Wales Research Ethics Committee and the Health Research Authority (HRA) (reference 23/HRA/3066). The study findings will be presented at national/international conferences and published in peer-reviewed scientific journals.
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Affiliation(s)
- Sujith Pereira
- Neonatal Unit, Homerton University Hospital, Homerton Healthcare NHS Foundation Trust, London, UK
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Saulius Satas
- Neonatal Unit, Aberdeen Maternity Hospital, NHS Grampian, Aberdeen, UK
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Ping P, Yu B, Xu R, Zhao P, He S. Monitoring and evaluation of hypotension in the extremely preterm. Front Cardiovasc Med 2024; 11:1477337. [PMID: 39416434 PMCID: PMC11479967 DOI: 10.3389/fcvm.2024.1477337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/18/2024] [Indexed: 10/19/2024] Open
Abstract
With the development of neonatal medicine, more and more extremely preterm infants have been treated. How to deal with hypotension is a big challenge for neonatologist in the process of diagnosis and treatment. The lack of uniformity in the definition of hypotension, challenges in measuring blood pressure accurately, and insufficient consistency between digital hypotension and hypoperfusion are the primary causes. How to check for hypotension and monitor blood pressure is thoroughly explained in the article. To give neonatologists a resource for the clinical management of hypotension in extremely preterm.
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Affiliation(s)
| | - Beimeng Yu
- Shaoxing Maternity and Child Health Care Hospital, Maternity and Child Health Care Affiliated Hospital, Shaoxing University, Shaoxing, China
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Mkhize SA, Manilall A, Mokotedi L, Gunter S, Michel FS. Involvement of pentraxin-3 in the development of hypertension but not left ventricular hypertrophy in male spontaneously hypertensive rats. Physiol Rep 2024; 12:e70086. [PMID: 39414396 PMCID: PMC11483509 DOI: 10.14814/phy2.70086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 09/26/2024] [Accepted: 10/03/2024] [Indexed: 10/18/2024] Open
Abstract
Hypertension drives the development of concentric left ventricular hypertrophy (LVH). However, the relative contribution of pentraxin-3 (PTX-3), a novel marker for inflammatory cardiovascular disease, in the hypertrophic response to pressure overload has not been adequately elucidated. We investigated the role of PTX-3 in the development of LVH in spontaneously hypertensive rats (SHR), untreated and treated with either captopril (an ACE inhibitor) or hydralazine (a non-specific vasodilator). Three-month-old SHR received either 20 mg/kg/day hydralazine (SHR + H, n = 6), 40 mg/kg/day captopril (SHR + C, n = 6), or plain gelatine cubes (untreated SHR, n = 7) orally for 4 months. Wistar Kyoto rats (WKY, n = 7) were used as the normotensive controls. Blood pressure (BP) was measured using the tail-cuff method. Cardiac geometry and function were determined using M-mode echocardiography. Circulating concentrations of inflammatory markers were measured in plasma by ELISA. LV fibrosis and cardiomyocyte width were assessed by histology. Relative mRNA expression of PTX-3 was determined in the LV by RT-PCR. Untreated SHR exhibited greater systolic BP and relative wall thickness (RWT) compared to WKY. Captopril and hydralazine normalized BP but only captopril reversed RWT in SHR. Circulating PTX-3 and VCAM-1 levels were elevated in untreated SHR and reduced with captopril and hydralazine. Circulating PTX-3 was positively associated with systolic BP but lacked independent relations with indices of LVH. LV relative mRNA expression of PTX-3 was similar between the groups. PTX-3 may not be involved in the development of LVH in SHR, but plausibly reflects the localized inflammatory milieu associated with hypertension.
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Affiliation(s)
- Siluleko A. Mkhize
- Integrated Molecular Physiology Research Initiative, Faculty of Health Sciences, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ashmeetha Manilall
- Integrated Molecular Physiology Research Initiative, Faculty of Health Sciences, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lebogang Mokotedi
- Integrated Molecular Physiology Research Initiative, Faculty of Health Sciences, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Physiology, School of MedicineSefako Makgatho Health Sciences UniversityPretoriaSouth Africa
| | - Sule Gunter
- Integrated Molecular Physiology Research Initiative, Faculty of Health Sciences, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Frederic S. Michel
- Integrated Molecular Physiology Research Initiative, Faculty of Health Sciences, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
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Ivy D, Rosenzweig EB, Abman SH, Beghetti M, Bonnet D, Douwes JM, Manes A, Berger RMF. Embracing the challenges of neonatal and paediatric pulmonary hypertension. Eur Respir J 2024; 64:2401345. [PMID: 39209483 PMCID: PMC11525338 DOI: 10.1183/13993003.01345-2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Paediatric pulmonary arterial hypertension (PAH) shares common features with adult disease, but is associated with several additional disorders and challenges that require unique approaches. This article discusses recent advances, ongoing challenges and distinct approaches for caring for infants and children with PAH, as presented by the paediatric task force of the 7th World Symposium on Pulmonary Hypertension. We provide updates on diagnosing, classifying, risk-stratifying and treating paediatric pulmonary hypertension (PH) and identify critical knowledge gaps. An updated risk stratification tool and treatment algorithm is provided, now also including strategies for patients with associated cardiopulmonary conditions. Treatment of paediatric PH continues to be hindered by the lack of randomised controlled clinical trials. The challenging management of children failing targeted PAH therapy is discussed, including balloon atrial septostomy, lung transplantation and pulmonary-to-systemic shunt (Potts). A novel strategy using a multimodal approach for the management of PAH associated with congenital heart diseases with borderline pulmonary vascular resistance is included. Advances in diagnosing neonatal PH, especially signs and interpretation of PH by echocardiography, are highlighted. A team approach to the rapidly changing physiology of neonatal PH is emphasised. Challenges in drug approval are discussed, particularly the challenges of designing accurate paediatric clinical trials with age-appropriate end-points and adequate enrolment.
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Affiliation(s)
- Dunbar Ivy
- Pediatric Cardiology, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Maria Fareri Children's Hospital at WMC Health and New York Medical College of Touro University, Valhalla, NY, USA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Maurice Beghetti
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paediatric Cardiology, Paris, France
| | - Johannes Menno Douwes
- Center for Congenital Heart Diseases, Paediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alessandra Manes
- Cardiology Unit IRCCS, S. Orsola University Hospital, Bologna, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Paediatric and Congenital Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Bisceglie V, Loi B, Vitelli O, Proto A, Ferrari ME, Vivalda L, Di Nardo M, Martinelli S, De Luca D. Neonatal reference values and nomograms of systemic vascular resistances estimated with electrical cardiometry. J Perinatol 2024:10.1038/s41372-024-02115-x. [PMID: 39289555 DOI: 10.1038/s41372-024-02115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Scanty data are available about neonatal systemic vascular resistances (SVR). We aim to provide reference values and nomograms for neonatal SVR. DESIGN Multicenter, cross-sectional,descriptive study performed in France and Italy. Neonates with complete hemodynamic stability were enrolled. Non-invasive measurements of SVR by electrical cardiometry performed once, after the first 72 h and before the 7th day of postnatal age. RESULTS We studied 1094 neonates: SVR was correlated with gestational age (ρ = -0.55, adj-r = -0.46, p < 0.001) and birth weight (ρ = -0.59, adj-r = -0.45, p < 0.001) irrespective of newborn sex. The relationships between SVR, gestational age and birth weight were represented by power equations and SVR was decreasing with increasing age and weight. Age- and weight-based SVR nomograms had optimal goodness-of-fit (non-linear R2 ≥0.74). Similar results were obtained for body surface indexed-SVR. CONCLUSIONS In hemodynamically stable neonates, SVR decrease with increasing gestational age and birth weight. Specific gestational age and birth weight-based nomograms are provided for the clinical interpretation.
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Affiliation(s)
- Valeria Bisceglie
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France
| | - Ottavio Vitelli
- Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano "Niguarda", Milan, Italy
| | - Alice Proto
- Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano "Niguarda", Milan, Italy
| | - Maria Elena Ferrari
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France
| | - Laura Vivalda
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Martinelli
- Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano "Niguarda", Milan, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France.
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France.
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Cîrstoveanu C, Bratu A, Filip C, Bizubac M. The Role of POCUS and Monitoring Systems during Emergency Pericardial Effusion in the NICU. Life (Basel) 2024; 14:1104. [PMID: 39337888 PMCID: PMC11433190 DOI: 10.3390/life14091104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Central venous catheterization is, now, one of the most routinely used procedures in the NICUs, helping during the care of very sick infants. Pericardial effusion is a very rare but severe complication, with a high mortality. The cases described are part of an ongoing retrospective study where the use of central catheters inserted in our surgical NICU, and its complications is being analyzed. 16 cases over 13 years are presented in this article, varying in severity from mild, self-resolving cases that were discovered during routine cardiac POCUS to cases with important hemodynamic impact associated with cardiac tamponade and cardiac arrest. Due to immediate intervention, only one of the cases led to catheter-related mortality and that was under particular conditions. Our aim is to highlight the severity of this complication, the importance of early intervention, and the impact of a highly technologized unit and widely available cardiac POCUS.
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Affiliation(s)
- Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Alexandra Bratu
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
- Department of Pediatrics, Pediatric Cardiology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
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13
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Solís-García G, Bravo MC, Pellicer A. Cardiorespiratory interactions during the transitional period in extremely preterm infants: a narrative review. Pediatr Res 2024:10.1038/s41390-024-03451-6. [PMID: 39179873 DOI: 10.1038/s41390-024-03451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 08/26/2024]
Abstract
We aimed to review the physiology and evidence behind cardiorespiratory interactions during the transitional circulation of extremely preterm infants with fragile physiology and to propose a framework for future research. Cord clamping strategies have a great impact on initial haemodynamic changes, and appropriate transition can be facilitated by establishing spontaneous ventilation before cord clamping. Mechanical ventilation modifies preterm transitional haemodynamics, with positive pressure ventilation affecting the right and left heart loading conditions. Pulmonary vascular resistances can be minimized by ventilating with optimal lung volumes at functional residual capacity, and other pulmonary vasodilator treatments such as inhaled nitric oxide can be used to improve ventilation/perfusion mismatch. Different cardiovascular drugs can be used to provide support during transition in this population, and it is important to understand both their cardiovascular and respiratory effects, in order to provide adequate support to vulnerable preterm infants and improve outcomes. Current available non-invasive bedside tools, such as near-infrared spectroscopy, targeted neonatal echocardiography, or lung ultrasound offer the opportunity to precisely monitor cardiorespiratory interactions in preterm infants. More research is needed in this field using precision medicine to strengthen the benefits and avoid the harms associated to early neonatal interventions. IMPACT: In extremely preterm infants, haemodynamic and respiratory transitions are deeply interconnected, and their changes have a key impact in the establishment of lung aireation and postnatal circulation. We describe how mechanical ventilation modifies heart loading conditions and pulmonary vascular resistances in preterm patients, and how hemodynamic interventions such as cord clamping strategies or cardiovascular drugs affect the infant respiratory status. Current available non-invasive bedside tools can help monitor cardiorespiratory interactions in preterm infants. We highlight the areas of research in which precision medicine can help strengthen the benefits and avoid the harms associated to early neonatal interventions.
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Affiliation(s)
- Gonzalo Solís-García
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain.
| | - María Carmen Bravo
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
- Consultant Neonatologist, Rotunda Hospital, Dublin, Ireland
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
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14
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Wren JT, McNamara PJ. More than a consult: integrating hemodynamics into neonatal care and research. Pediatr Res 2024:10.1038/s41390-024-03525-5. [PMID: 39174652 DOI: 10.1038/s41390-024-03525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Affiliation(s)
- John T Wren
- Stead Family Department of Pediatrics, Division of Neonatology, University of Iowa Healthcare, Iowa City, IA, USA.
| | - Patrick J McNamara
- Stead Family Department of Pediatrics, Division of Neonatology, University of Iowa Healthcare, Iowa City, IA, USA
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15
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Vasquez AM, Bischoff AR, Giesinger RE, McNamara PJ. Impact of therapeutic hypothermia (TH) on echocardiography indices of pulmonary hemodynamics among neonates with hypoxic ischemic encephalopathy (HIE). J Perinatol 2024; 44:1212-1215. [PMID: 38565651 DOI: 10.1038/s41372-024-01958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Angelica M Vasquez
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, New York, NY, 10032, USA
| | - Adrianne R Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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16
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Zhang K, Ray AM, DiNardo JA. Optimizing Hemodynamic Management in the Neonatal Intensive Care Unit: Leveraging Neonatal Echocardiography. J Cardiothorac Vasc Anesth 2024; 38:1630-1633. [PMID: 38834443 DOI: 10.1053/j.jvca.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Kan Zhang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Anna M Ray
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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17
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Holden KI, Rintoul NE, McNamara PJ, Harting MT. Congenital diaphragmatic hernia-associated pulmonary hypertension. Semin Pediatr Surg 2024; 33:151437. [PMID: 39018718 DOI: 10.1016/j.sempedsurg.2024.151437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Congenital diaphragmatic hernia (CDH) is characterized by a developmental insult which compromises cardiopulmonary embryology and results in a diaphragmatic defect, allowing abdominal organs to herniate into the hemithorax. Among the significant pathophysiologic components of this condition is pulmonary hypertension (PH), alongside pulmonary hypoplasia and cardiac dysfunction. Fetal pulmonary vascular development coincides with lung development, with the pulmonary vasculature evolving alongside lung maturation. However, in CDH, this embryologic development is impaired which, in conjunction with external compression, stifle pulmonary vascular maturation, leading to reduced lung density, increased muscularization of the pulmonary vasculature, abnormal vascular responsiveness, and altered molecular signaling, all contributing to pulmonary arterial hypertension. Understanding CDH-associated PH (CDH-PH) is crucial for development of novel approaches and effective management due to its significant impact on morbidity and mortality. Antenatal and postnatal diagnostic methods aid in CDH risk stratification and, specifically, pulmonary hypertension, including fetal imaging and gas exchange assessments. Management strategies include lung protective ventilation, fluid optimization, pharmacotherapies including pulmonary vasodilators and hemodynamic support, and extracorporeal life support (ECLS) for refractory cases. Longitudinal re-evaluation is an important consideration due to the complexity and dynamic nature of CDH cardiopulmonary physiology. Emerging therapies such as fetal endoscopic tracheal occlusion and pharmacological interventions targeting key CDH pathophysiological mechanisms show promise but require further investigation. The complexity of CDH-PH underscores the importance of a multidisciplinary approach for optimal patient care and improved outcomes.
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MESH Headings
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/therapy
- Hernias, Diaphragmatic, Congenital/physiopathology
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/therapy
- Hypertension, Pulmonary/physiopathology
- Infant, Newborn
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Affiliation(s)
- Kylie I Holden
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Natalie E Rintoul
- Department of Neonatology, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J McNamara
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA.
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18
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Altit G, Lapointe A, Kipfmueller F, Patel N. Cardiac function in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151438. [PMID: 39018716 DOI: 10.1016/j.sempedsurg.2024.151438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Cardiac function is known to play critical role in the pathophysiological progression and ultimate clinical outcome of patients with congenital diaphragmatic hernia (CDH). While often anatomically normal, the fetal and neonatal heart in CDH can suffer from both right and left ventricular dysfunction. Here we explore the abnormal fetal heart, early postnatal right and left ventricular dysfunction, the interplay between cardiac dysfunction and pulmonary hypertension, evaluation and echocardiographic assessment of the heart, and therapeutic strategies for managing and supporting the pathophysiologic heart and CDH. Further, we take a common clinical scenario and provide clinically relevant guidance for the diagnosis and management of this complex process.
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MESH Headings
- Humans
- Hernias, Diaphragmatic, Congenital/diagnosis
- Hernias, Diaphragmatic, Congenital/physiopathology
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/therapy
- Infant, Newborn
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/diagnosis
- Echocardiography
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/diagnosis
- Fetal Heart/diagnostic imaging
- Fetal Heart/physiopathology
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Affiliation(s)
- Gabriel Altit
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Centre, Montréal, Canada
| | - Anie Lapointe
- Division of Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital University of Bonn, Germany
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK.
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19
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Cantinotti M, Di Salvo G, Voges I, Raimondi F, Greil G, Ortiz Garrido A, Bharucha T, Grotenhuis HB, Köstenberger M, Bonnello B, Miller O, McMahon CJ. Standardization in paediatric echocardiographic reporting and critical interpretation of measurements, functional parameters, and prediction scores: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:1029-1050. [PMID: 38833586 DOI: 10.1093/ehjci/jeae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
This document has been developed to provide a guide for basic and advanced reporting in paediatric echocardiography. Furthermore, it aims to help clinicians in the interpretation of echocardiographic measurements and functional data for estimating the severity of disease in different paediatric age groups. The following topics will be reviewed and discussed in the present document: (i) the general principle in constructing a paediatric echocardiographic report, (ii) the basic elements to be included, and (iii) the potential and limitation of currently employed tools used for disease severity quantification during paediatric reporting. A guide for the interpretation of Z-scores will be provided. Use and interpretation of parameters employed for quantification of ventricular systolic function will be discussed. Difficulties in the adoption of adult parameters for the study of diastolic function and valve defects at different ages and pressure and loading conditions will be outlined, with pitfalls for the assessment listed. A guide for careful use of prediction scores for complex congenital heart disease will be provided. Examples of basic and advanced (disease-specific) formats for reporting in paediatric echocardiography will be provided. This document should serve as a comprehensive guide to (i) structure a comprehensive paediatric echocardiographic report; (ii) identify the basic morphological details, measures, and functional parameters to be included during echocardiographic reporting; and (iii) correctly interpret measurements and functional data for estimating disease severity.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Congenital Heart Disease, National Research Council-Tuscany Region G. Monasterio Foundation (FTGM), Massa, Pisa 54100, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease, Woman and Children's Health Department, University of Padua; Experimental Cardiology, Paediatric Research Institute (IRP), Padua, Italy
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Gerald Greil
- Division Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Heynric B Grotenhuis
- Department Pediatric Cardiology, Wilhelmina Children's Hospital/UMCU, Utrecht, The Netherlands
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of Gratz, Gratz, Austria
| | | | - Owen Miller
- Department Pediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Colin J McMahon
- Department Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Maastricht School of Health Professions Education, Maastricht, The Netherlands
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20
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Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, West FM. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. J Am Soc Echocardiogr 2024; 37:S0894-7317(24)00222-0. [PMID: 39230540 DOI: 10.1016/j.echo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Point-of-care ultrasound (POCUS) involves the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician. The current state of cardiac POCUS terminology is heterogeneous and ambiguous, in part because it evolved through siloed specialty practices. In particular, the medical literature and colloquial medical conversation contain a wide variety of terms that equate to cardiac POCUS. While diverse terminology aided in the development and dissemination of cardiac POCUS throughout multiple specialties, it also contributes to confusion and raises patient safety concerns. This statement is the product of a diverse and inclusive Writing Group from multiple specialties, including medical linguistics, that employed an iterative process to contextualize and standardize a nomenclature for cardiac POCUS. We sought to establish a deliberate vocabulary that is sufficiently unrelated to any specialty, ultrasound equipment, or clinical setting to enhance consistency throughout the academic literature and patient care settings. This statement (1) reviews the evolution of cardiac POCUS-related terms; (2) outlines specific recommendations, distinguishing between intrinsic and practical differences in terminology; (3) addresses the implications of these recommendations for current practice; and (4) discusses the implications for novel technologies and future research.
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Affiliation(s)
- James N Kirkpatrick
- Division of Cardiology and Department of Bioethics and Humanities, Department of Medicine, University of Washington, Seattle, Washington
| | - Nova Panebianco
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - José L Díaz-Gómez
- Critical Care Institute, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | | | - Yuriy S Bronshteyn
- Duke University School of Medicine, Durham Veterans Health Administrations, Durham, North Carolina
| | - Sara Damewood
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - Amer Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Bruce J Kimura
- Echocardiography and Vascular Ultrasound Lab, Scripps Mercy Hospital, San Diego, California
| | - Smadar Kort
- Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Arthur Labovitz
- Department of Cardiovascular Sciences, NCH Rooney Heart Institute, Naples, Florida
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Irene W Y Ma
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon L Mulvagh
- Dalhousie University, Women's Heart Health Clinic, Halifax, Nova Scotia, Canada
| | - Sara Nikravan
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington
| | - Sheela Pai Cole
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Michael H Picard
- Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Vincent L Sorrell
- University of Kentucky, Gill Heart and Vascular Institute, Lexington, Kentucky
| | | | - Ritu Thamman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Gabriele Via
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frances Mae West
- Division of Pulmonary & Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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21
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Varghese NP, Altit G, Gubichuk MM, Siddaiah R. Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia. J Clin Med 2024; 13:3417. [PMID: 38929946 PMCID: PMC11204350 DOI: 10.3390/jcm13123417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant.
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Affiliation(s)
- Nidhy P. Varghese
- Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, 6701 Fannin St., Ste 1040, Houston, TX 77030, USA
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Megan M. Gubichuk
- Division of Pulmonary and Sleep Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
| | - Roopa Siddaiah
- Department of Pediatrics, Penn State Health Children’s Hospital, Hershey, PA 17033, USA;
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22
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Recker F, Kipfmueller F, Wittek A, Strizek B, Winter L. Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature. Life (Basel) 2024; 14:658. [PMID: 38929641 PMCID: PMC11204601 DOI: 10.3390/life14060658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Point-of-care ultrasound (POCUS) integration into neonatology offers transformative potential for diagnostics and treatment, enhancing immediacy and precision of clinical decision-making in this vulnerable patient population. This systematic review aims to synthesize evidence on POCUS applications, benefits, challenges, and educational strategies in neonatology. Literature search was conducted using SPIDER scheme keywords and MeSH terms related to POCUS and neonatology. Studies focusing on POCUS applications, its impact on clinical outcomes, and educational interventions for skill acquisition were included and analyzed using standardized tools, followed by a narrative synthesis of the findings. The search yielded 68 relevant publications, encompassing original research, reviews, and guidelines. POCUS applications varied across cardiovascular, pulmonary, neurological, and abdominal assessments. Key benefits included a reduced need for invasive procedures and rapid bedside diagnosis. Challenges included steep learning curves for clinicians and the need for standardized training and guidelines. Educational strategies highlighted the effectiveness of simulation-based training in enhancing ultrasound proficiency among neonatal care providers. POCUS represents a significant advancement in neonatal medicine, offering benefits for patient care. Addressing identified challenges through comprehensive training programs and developing standardized guidelines is crucial for optimized use. Future research should focus on evaluating educational outcomes and long-term impacts of POCUS integration into neonatal care.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany;
| | - Agnes Wittek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Lone Winter
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
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23
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Singh Y. Echocardiography in the neonatal unit: current status and future prospects. Expert Rev Med Devices 2024; 21:307-316. [PMID: 38526192 DOI: 10.1080/17434440.2024.2334449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. AREA COVERED Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. EXPERT OPINION Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.
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Affiliation(s)
- Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Division of Neonatology, University of Southern California, Los Angeles, USA
- Department of Pediatrics, University of Cambridge Clinical School of Medicine, Cambridge, UK
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24
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Eidem BW. International Congenital Heart Defects Awareness - Be an ASE Advocate! J Am Soc Echocardiogr 2024; 37:A13. [PMID: 38432850 DOI: 10.1016/j.echo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
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25
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Pellikka PA. This Focus Issue on Pediatric, Neonatal, and Congenital Heart Disease Echocardiography. J Am Soc Echocardiogr 2024; 37:117-118. [PMID: 38309833 DOI: 10.1016/j.echo.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
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26
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Hébert A, Bischoff AR, Lai W, Levy PT, McNamara PJ. Educational Framework for Trainees in Neonatal Hemodynamics. J Am Soc Echocardiogr 2024; 37:270-271. [PMID: 38309837 DOI: 10.1016/j.echo.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Audrey Hébert
- Centre Mère-Enfant Soleil, CHU de Québec, Quebec, Quebec, Canada
| | | | - Wyman Lai
- Division of Pediatric Cardiology, CHOC Children's Specialists, Orange, California
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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