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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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2
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Pereira SS, Sinha AK, Shah DK, Kempley ST. Cardiovascular changes following cerebral blood flow measurements using Doppler ultrasound in extremely preterm infants. Acta Paediatr 2022; 111:2098-2099. [PMID: 35766125 DOI: 10.1111/apa.16470] [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: 04/08/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sujith S 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, Queen Mary University of London, London, UK
| | - Ajay K Sinha
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Divyen K Shah
- Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen T Kempley
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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3
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Implementing point of care ultrasound in the neonatal intensive care unit: a safety study. J Perinatol 2021; 41:879-884. [PMID: 33603105 DOI: 10.1038/s41372-021-00955-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Point of care ultrasound (POCUS) use is increasing in pediatrics and has been demonstrated to be superior in identifying central catheter tip location in neonatal intensive care units. However, limited data exist regarding cardiorespiratory changes secondary to POCUS in neonates. STUDY DESIGN A prospective observational equivalence study was performed on 50 POCUS assessments of central catheter tip location in 46 patients ≥23 weeks gestation. Heart rate (HR), respiratory rate (RR), and percent oxygen saturation (SpO2) levels were collected before and after POCUS. Limits of equivalence were set in advance. RESULT Equivalence was demonstrated in HR, RR, and SpO2 before and after POCUS. HR decreased by 3.24 beats per minute (90% CI: -5.36, -1.14). RR increased by 0.71 breath/min (90% CI: -1.84, +3.27). SpO2 increased by 0.54 percentage points (90% CI: -0.23, +1.31). CONCLUSION Identifying central catheter tip location using POCUS in neonates appears safe without affecting cardiorespiratory stability.
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4
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de Waal K, Kluckow M. Superior vena cava flow: Role, assessment and controversies in the management of perinatal perfusion. Semin Fetal Neonatal Med 2020; 25:101122. [PMID: 32467039 DOI: 10.1016/j.siny.2020.101122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The superior vena cava (SVC) is a large vein responsible for the venous return of blood from structures located superior to the diaphragm. The flow in the SVC can be assessed with Doppler ultrasound and can be used as a proxy for cerebral perfusion. Early clinical research studies showed that low SVC flow, particularly if for a prolonged period, was associated with short term morbidity such as intraventricular hemorrhage, mortality, and poorer neurodevelopmental outcomes. However, these findings have not been consistently reported in more recent studies, and the role of SVC flow in early management and as a predictor of poor long-term neurodevelopment has been questioned. This paper provides an overview of SVC assessment, the expected range of findings, and reviews the role of SVC flow as a diagnostic and monitoring tool for the assessment of perinatal perfusion.
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Affiliation(s)
- Koert de Waal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle, NSW, Australia.
| | - Martin Kluckow
- Royal North Shore Hospital Department of Neonatology and University of Sydney, Sydney, NSW, Australia
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5
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Deshpande P, Jain A, Ibarra Ríos D, Bhattacharya S, Dirks J, Baczynski M, McNamara KP, Hahn C, McNamara PJ, Shah P, Guerguerian AM. Combined Multimodal Cerebral Monitoring and Focused Hemodynamic Assessment in the First 72 h in Extremely Low Gestational Age Infants. Neonatology 2020; 117:504-512. [PMID: 32814317 DOI: 10.1159/000508961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Characteristic changes in cerebral saturation (CrSO2), amplitude-integrated electroencephalography (aEEG), and echocardiography (ECHO) may be associated with intraventricular hemorrhage (IVH); however, the feasibility of their combined application is not known. OBJECTIVE The aim of this work was to investigate the feasibility and safety of combined multimodal cerebral and hemodynamic monitoring in extremely low gestational age (ELGA) infants in the first 72 h after birth. METHODS In this prospective -observational study of 50 infants born between 23 + 0 and 27 + 6 weeks gestation, we measured CrSO2 and aEEG, starting <8 h until 72 h of age. Sequential echocardiography and head ultrasound were performed at 4-8, 12-18, 24-30, and 48-60 h of age. The primary outcome was feasibility of multimodal monitoring, defined as >75% of the subjects satisfying at least 3/4 criteria: (a) CrSO2 and (b) aEEG monitoring each for >75% of the time, and (c) at least 2 out of 4 ECHO and (d) head ultrasounds (at least one by age 24 h). Adverse reactions to sensors, desaturation, and bradycardia during ultrasound studies were recorded. RESULTS Fifty infants were enrolled over 14 months. Multimodal monitoring was feasible in 49 (98%) infants. Forty-one (82%) infants fulfilled all 4 criteria. Mild erythema below CrSO2 sensors lasting 3-8 h without skin breakdown was noted in 8/50 subjects (16%). Desaturation was noted during 17/197 (8.6%) of the ultrasound studies. In total, 26/50 (52%) infants developed IVH (grade I/II, n = 22; grade III/IV, n = 4). CONCLUSION Multimodal monitoring is feasible, safe, and well tolerated in ELGA infants in the first 72 h after birth.
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Affiliation(s)
- Poorva Deshpande
- Mount Sinai Hospital, Toronto, Ontario, Canada, .,Division of Neonatology, University of Toronto, Toronto, Ontario, Canada,
| | - Amish Jain
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Julia Dirks
- Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | | | | | - Cecil Hahn
- Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh Shah
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Toronto, Ontario, Canada
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6
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Cerebral Circulation and Hypotension in the Premature Infant. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Méndez-Abad P, Zafra-Rodríguez P, Lubián-López S, Benavente-Fernández I. Myocardial Function Maturation in Very-Low-Birth-Weight Infants and Development of Bronchopulmonary Dysplasia. Front Pediatr 2019; 7:556. [PMID: 32010652 PMCID: PMC6978685 DOI: 10.3389/fped.2019.00556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Myocardial function in very-low-birth-weight infants (VLBWIs) develops during early postnatal life, but different patterns of temporal evolution that might be related to the development of bronchopulmonary dysplasia (BPD) are not completely understood. Methods: A prospective cohort study including VLBWIs admitted to our NICU from January 2015 to 2017 was conducted. Plasma N-terminal pro B type natriuretic peptide (NTproBNP) levels were measured, and echocardiograms were performed at 24 and 72 h of life and weekly thereafter until 36 weeks of postmenstrual age (PMA). We measured the tricuspid annular plane systolic excursion (TAPSE) by M-mode; the lateral tricuspid E', A', and S' waves; and the myocardial performance index (MPI) by tissue doppler imaging (TDI). The subjects were divided into non-BPD and BPD groups. Results: We included 101 VLBWIs. The TAPSE and E', A', and S' waves increased while MPI-TDI decreased over time. Birth gestational age (GA) and postnatal PMA impacted these parameters, which evolved differently in those who developed BPD compared to those in the non-BPD group. The NTproBNP levels at 14 days of life and different echocardiographic parameters were associated with the development of BPD in different multivariate models. Conclusion: TAPSE and TDI values depend on GA and PMA and follow a different temporal evolution that is related to the later development of BPD. Combined biochemical and echocardiographic biomarkers can help identify which VLBWIs are at higher risk of developing BDP.
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Affiliation(s)
- Paula Méndez-Abad
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Pamela Zafra-Rodríguez
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Simón Lubián-López
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Isabel Benavente-Fernández
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
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8
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Gautheyrou L, Durand S, Jourdes E, De Jonckheere J, Combes C, Cambonie G. Facilitated tucking during early neonatologist-performed echocardiography in very preterm neonates. Acta Paediatr 2018; 107:2079-2085. [PMID: 30144169 DOI: 10.1111/apa.14555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/04/2018] [Accepted: 08/22/2018] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of facilitated tucking (FT), a nonpharmacologic nursing intervention, on echocardiographic parameters and infant comfort collected prospectively during neonatologist-performed echocardiography. METHODS Echocardiography was performed twice, in standard conditions and with FT; the order was randomised by computer. Echocardiography provided data on pulmonary artery flow and pressure, right and left ventricular function, and persistent ductus arteriosus. Comfort was assessed by a behavioural scale of pain, variations in heart rate (HR) and SpO2 , and a newborn infant parasympathetic evaluation index based on the high-frequency variability in HR. RESULTS Fifty newborns, with mean gestational age of 28 [26.6-29.0] weeks and mean birthweight of 950 [780-1190] g, were studied at a postnatal age of 13 [9-27] hours. FT was associated with longer acceleration time/right ventricular ejection time in the main pulmonary artery (p = 0.006), reduced averaged HR variations (p = 0.03) and lower pain scores (p < 0.001). The other haemodynamic parameters and the parasympathetic index were not influenced by FT. CONCLUSION Echocardiography performed soon after birth in very premature neonates may generate mild discomfort. FT during echocardiography is associated with lower pulmonary artery pressures and improves infant's comfort during this examination.
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Affiliation(s)
- Laurène Gautheyrou
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Sabine Durand
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Emilie Jourdes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Julien De Jonckheere
- EA 4489, Perinatal Growth and Environment; Lille University; Montpellier Cedex 5 France
- CIC-IT 1403; Lille University Hospital; Lille France
| | - Clémentine Combes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Gilles Cambonie
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
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9
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Hundscheid T, Onland W, van Overmeire B, Dijk P, van Kaam AHLC, Dijkman KP, Kooi EMW, Villamor E, Kroon AA, Visser R, Vijlbrief DC, de Tollenaer SM, Cools F, van Laere D, Johansson AB, Hocq C, Zecic A, Adang E, Donders R, de Vries W, van Heijst AFJ, de Boode WP. Early treatment versus expectative management of patent ductus arteriosus in preterm infants: a multicentre, randomised, non-inferiority trial in Europe (BeNeDuctus trial). BMC Pediatr 2018; 18:262. [PMID: 30077184 PMCID: PMC6090763 DOI: 10.1186/s12887-018-1215-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/09/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28 weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality. As the PDA might have closed spontaneously, treated children are potentially exposed to iatrogenic adverse effects. A conservative approach is gaining interest worldwide, although convincing evidence to support its use is lacking. METHODS This multicentre, randomised, non-inferiority trial is conducted in neonatal intensive care units. The study population consists of preterm infants (GA < 28 weeks) with an echocardiographic-confirmed PDA with a transductal diameter > 1.5 mm. Early treatment (between 24 and 72 h postnatal age) with the cyclooxygenase inhibitor (COXi) ibuprofen (IBU) is compared with an expectative management (no intervention intended to close a PDA). The primary outcome is the composite of mortality, and/or necrotising enterocolitis (NEC) Bell stage ≥ IIa, and/or bronchopulmonary dysplasia (BPD) defined as the need for supplemental oxygen, all at a postmenstrual age (PMA) of 36 weeks. Secondary outcome parameters are short term sequelae of cardiovascular failure, comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. Consequences regarding health economics are evaluated by cost effectiveness analysis and budget impact analysis. DISCUSSION As a conservative approach is gaining interest, we investigate whether in preterm infants, born at a GA less than 28 weeks, with a PDA an expectative management is non-inferior to early treatment with IBU regarding to the composite outcome of mortality and/or NEC and/or BPD at a PMA of 36 weeks. TRIAL REGISTRATION This trial is registered with the Dutch Trial Register NTR5479 (registered on 19 October 2015), the registry sponsored by the United States National Library of Medicine Clinicaltrials.gov NCT02884219 (registered May 2016) and the European Clinical Trials Database EudraCT 2017-001376-28 .
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MESH Headings
- Humans
- Infant, Newborn
- Cost-Benefit Analysis
- Cyclooxygenase Inhibitors/therapeutic use
- Ductus Arteriosus, Patent/complications
- Ductus Arteriosus, Patent/drug therapy
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/surgery
- Enterocolitis, Necrotizing/etiology
- Ibuprofen/therapeutic use
- Infant, Extremely Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/mortality
- Ligation
- Research Design
- Time-to-Treatment
- Watchful Waiting/economics
- Multicenter Studies as Topic
- Equivalence Trials as Topic
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Affiliation(s)
- Tim Hundscheid
- Department of Paediatrics, Division of Neonatology, Radboud university medical centre Nijmegen, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Internal postal code 804, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Wes Onland
- Department of Neonatology, Academic Medical Centre Amsterdam, Emma Children’s hospital, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands
| | - Bart van Overmeire
- Department of Paediatrics, Division of Neonatology, Cliniques Universitaires de Bruxelles, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Peter Dijk
- Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen, Beatrix Children’s Hospital, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Anton H. L. C. van Kaam
- Department of Paediatrics, Division of Neonatology, VU University Medical Centre Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Koen P. Dijkman
- Department of Neonatology, Maxima Medical Centre Veldhoven, de Run 4600, Postbus 7777, 5500 MB Veldhoven, The Netherlands
| | - Elisabeth M. W. Kooi
- Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen, Beatrix Children’s Hospital, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Eduardo Villamor
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - André A. Kroon
- Department of Paediatrics, Division of Neonatology, Erasmus Medical Centre Rotterdam, Sophia Children’s Hospital, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Remco Visser
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Willem Alexander Children’s Hospital, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Daniel C. Vijlbrief
- Department of Paediatrics, Division of Neonatology, University Medical Centre Utrecht, Utrecht University, Wilhelmina Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Susanne M. de Tollenaer
- Department of Paediatrics, Division of Neonatology, Isala Women’s and Children’s Hospital Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel – Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - David van Laere
- Department of Paediatrics, Division of Neonatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Anne-Britt Johansson
- Department of Paediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Jean Joseph Crocqlaan 15, 1020 Brussels, Belgium
| | - Catheline Hocq
- Department of Paediatrics, Division of Neonatology, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Alexandra Zecic
- Department of Paediatrics, Division of Neonatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Eddy Adang
- Department of Health Evidence, Radboud university medical centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Rogier Donders
- Department of Health Evidence, Radboud university medical centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Willem de Vries
- Department of Paediatrics, Division of Neonatology, University Medical Centre Utrecht, Utrecht University, Wilhelmina Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Arno F. J. van Heijst
- Department of Paediatrics, Division of Neonatology, Radboud university medical centre Nijmegen, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Internal postal code 804, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Willem P. de Boode
- Department of Paediatrics, Division of Neonatology, Radboud university medical centre Nijmegen, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Internal postal code 804, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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10
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Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life. Eur J Pediatr 2018; 177:541-550. [PMID: 29374830 DOI: 10.1007/s00431-018-3096-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/14/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Haemodynamic assessment during the transitional period in preterm infants is challenging. We aimed to describe the relationships between cerebral regional tissue oxygen saturation (CrSO2), perfusion index (PI), echocardiographic, and clinical parameters in extremely preterm infants in their first 72 h of life. Twenty newborns born at < 28 weeks of gestation were continuously monitored with CrSO2 and preductal PI. Cardiac output was measured at H6, H24, H48, and H72. The median gestational age and birth weight were 25.0 weeks (24-26) and 750 g (655-920), respectively. CrSO2 and preductal PI had r values < 0.35 with blood gases, lactates, haemoglobin, and mean blood pressure. Cardiac output significantly increased over the 72 h of the study period. Fifteen patients had at least one episode of low left and/or right ventricular output (RVO), during which there was a strong correlation between CrSO2 and superior vena cava (SVC) flow (at H6 (r = 0.74) and H24 (r = 0.86)) and between PI and RVO (at H6 (r = 0.68) and H24 (r = 0.92)). Five patients had low SVC flow (≤ 40 mL/kg/min) at H6, during which PI was strongly correlated with RVO (r = 0.98). CONCLUSION CrSO2 and preductal PI are strongly correlated with cardiac output during low cardiac output states. What is Known: • Perfusion index and near-infrared spectroscopy are non-invasive tools to evaluate haemodynamics in preterm infants. • Pre- and postductal perfusion indexes strongly correlate with left ventricular output in term infants, and near-infrared spectroscopy has been validated to assess cerebral oxygenation in term and preterm infants. What is New: • Cerebral regional tissue oxygen saturation and preductal perfusion index were strongly correlated with cardiac output during low cardiac output states. • The strength of the correlation between cerebral regional tissue oxygen saturation, preductal perfusion index, and cardiac output varied in the first 72 h of life, reflecting the complexity of the transitional physiology.
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Abstract
Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.
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12
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Nguyen J, Amirnovin R, Ramanathan R, Noori S. The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 2016; 36:972-976. [PMID: 27513327 DOI: 10.1038/jp.2016.126] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current state of point-of-care ultrasonography (POCUS) use and education in neonatal-perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs. STUDY DESIGN A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs. RESULTS The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively. Over 90% of respondents in both groups believe that fellows and attendings should receive POCUS training. PCCM programs, compared with NPM, had greater access to POCUS machines (97% vs 63%, P<0.001), and more often used POCUS for diagnoses and management (76% vs 29%, P<0.001) and procedural guidance (95% vs 37%, P<0.001). The most common indications were cardiac/hemodynamics, pulmonary pathology and vascular access in both specialties. PCCM reported more training to fellows (90% vs 29%, P<0.001). Both group perceived lack of time to learn, lack of equipment/funds, liability concerns, lack of personnel to train physicians and cardiology/radiology resistance as significant barriers to POCUS implementation. CONCLUSIONS Both NPM and PCCM fellowship programs believe in the benefits of POCUS and that their physicians should receive the necessary training. Compared with PCCM, NPM fellowships programs have less access to POCUS machines and less frequently use POCUS and train their fellows and attendings. There remain significant barriers to utilization of POCUS, especially in NPM.
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Affiliation(s)
- J Nguyen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Amirnovin
- Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Noori
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Analysis of lawsuits related to point-of-care ultrasonography in neonatology and pediatric subspecialties. J Perinatol 2016; 36:784-6. [PMID: 27078203 DOI: 10.1038/jp.2016.66] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Point-of-care ultrasonography (POCUS) is becoming increasingly available for neonatologists and pediatric subspecialists (PSS); however, concerns over potential litigation from possible missed diagnoses or incorrect management have been documented. This study aims to define the extent and quality of lawsuits filed against neonatologists and PSS related to POCUS. STUDY DESIGN We conducted a retrospective study of all United States reported state and federal cases in the Westlaw database from January 1990 through October 2015. Cases were reviewed and included if either a neonatologist or PSS were accused of misconduct or the interpretation or failure to perform an ultrasound/echocardiogram was discussed. Descriptive statistics were used to evaluate the data. RESULTS Our search criteria returned 468 results; 2 cases were determined to be relevant to the study objective. The two cases alleged a failure to perform a diagnostic test and implicated POCUS as an option. There were no cases of neonatologists and PSS being sued for POCUS performance or interpretation. CONCLUSION This study of a major legal database suggests that POCUS use and interpretation is not a significant cause of lawsuits against neonatologists and PSS.
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14
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Mukerji A, Diambomba Y, Lee SK, Jain A. Use of Targeted Neonatal Echocardiography and Focused Cardiac Sonography in Tertiary Neonatal Intensive Care Units: Time to Embrace It? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1579-91. [PMID: 27269001 DOI: 10.7863/ultra.15.06037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/02/2015] [Indexed: 05/28/2023]
Abstract
Focused cardiac sonography and targeted neonatal echocardiography refer to goal-directed cardiac imaging using ultrasound, typically by noncardiologic specialists. Although the former consists of a rapid qualitative assessment of cardiac function, which is usually performed by acute care practitioners, the latter refers to detailed functional echocardiography to obtain quantitative and qualitative indexes of pulmonary and systemic hemodynamics in sick neonates and is typically performed by neonatologists. Although the use of these modalities is increasing, they still remain unavailable in most North American centers providing acute care to neonates, partly because of limited data regarding their direct impact on patient care. Here we present a series of 5 cases from a large perinatal unit in which immediate availability of relevant expertise led to important and arguably life-saving clinical interventions. In 4 of these cases, focused cardiac sonography was sufficient to make the diagnosis, whereas in 1 case, clinical integration of detailed systemic hemodynamics measured on target neonatal echocardiography was required.
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Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Yenge Diambomba
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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15
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Lavoie PM, Stritzke A, Ting J, Jabr M, Jain A, Kwan E, Chakkarapani E, Brooks P, Brant R, McNamara PJ, Holsti L. A Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography. PLoS One 2015; 10:e0141015. [PMID: 26496361 PMCID: PMC4619855 DOI: 10.1371/journal.pone.0141015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE). Design Factorial, double blind, randomized controlled trial. Setting Tertiary neonatal intensive care unit (NICU). Patients Infants born between 26 and 42 weeks of gestation (GA). Interventions One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother. Main Outcome Measure Change in Behavioral Indicators of Infant Pain (BIIP) scores. Results 104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans. Conclusions In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition. Clinical Trial Registration Clinical Trials.gov: NCT01253889
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Affiliation(s)
- Pascal M. Lavoie
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
- * E-mail: (PML); (LH)
| | - Amelie Stritzke
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
| | - Mohammad Jabr
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Amish Jain
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Eddie Kwan
- Department of Pharmacy, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Ela Chakkarapani
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Paul Brooks
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Rollin Brant
- Child & Family Research Institute, Vancouver, Canada
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Patrick J. McNamara
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Liisa Holsti
- Child & Family Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- * E-mail: (PML); (LH)
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