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Noori S, Ramanathan R, Lakshminrusimha S, Singh Y. Hemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model. Pediatr Res 2024:10.1038/s41390-024-03248-7. [PMID: 38778230 DOI: 10.1038/s41390-024-03248-7] [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: 12/31/2023] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
Hemodynamic instability is very common in sick neonates and the currently used traditional hemodynamic monitoring tools lack sensitivity and specificity. Hemodynamic evaluation on echocardiography can provide direct information regarding the pathophysiology causing the hemodynamic instability and help the bedside clinician in making a personalized treatment approach based upon the deranged pathophysiology. Assessment of cardiac function and hemodynamics is essential in the management of neonates with cardiorespiratory failure, and hence neonatologist-performed echocardiography is becoming an essential tool in modern neonatal care. Depending on the level and size of the NICU, there is a daily need for echocardiography, and for a subset of sick infants, serial echocardiographic assessments are warranted. Comprehensive guidelines for neonatologists performing echocardiography and targeted neonatal echocardiography have been published providing a framework for training and quality assurance. There has been a significant interest among the providers to learn echocardiography skills. This manuscript explores the various needs of neonatal care providers around echocardiography, the current challenges neonatologists face in learning echocardiography, and how they, especially neonatal fellows, can learn these important skills during their training.
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Affiliation(s)
- Shahab Noori
- 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.
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children's Hospital, UC Davis Health, Sacramento, CA, USA
| | - Yogen Singh
- Department of Pediatrics - Division of Neonatology, Loma Linda University Children's Hospital and Loma Linda University School of Medicine, Loma Linda, CA, USA
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Raschetti R, Torchin H, Marchand-Martin L, Gascoin G, Cambonie G, Brissaud O, Rozé JC, Storme L, Ancel PY, Mekontso-Dessap A, Durrmeyer X. In-hospital Outcomes and Early Hemodynamic Management According to Echocardiography Use in Hypotensive Preterm Infants: A National Propensity-Matched Cohort Study. Front Cardiovasc Med 2022; 9:852666. [PMID: 35911541 PMCID: PMC9329625 DOI: 10.3389/fcvm.2022.852666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypotension is a common condition during the first postnatal days of very preterm infants and has been associated with an increased risk of adverse outcomes but its management remains controversial. There is a consensus to promote the use of neonatologist-performed echocardiography (NPE) in hypotensive very preterm infants, although no clinical trial ever assessed this practice. Methods We conducted a retrospective analysis of prospectively collected data from the French national EPIPAGE-2 cohort to evaluate the association of NPE with survival, severe morbidity, and therapeutic management in very preterm infants with early hypotension. Reasons for administering antihypotensive treatments were also analyzed. We included infants born before 30 weeks of gestation with hypotension within 72 h of birth. Infants managed with (NPE group) or without (no-NPE group) NPE use were compared after matching on gestational age and a propensity score, reflecting each patient's probability of having an NPE based on his/her baseline covariates. This matching procedure intended to control for the indication bias of NPE. Results Among 966 eligible infants, 809 were included (NPE group, n = 320; no-NPE group, n = 489), and 229 from each group could be matched. The NPE group did not differ significantly from the no-NPE group for survival (OR 1.01, 95% CI 0.64 to 1.60; p = 0.95) or survival without severe morbidity at discharge (OR 0.92, 95% CI 0.63 to 1.34; p = 0.66), but received more antihypotensive treatments [144/229 (62.9%) vs. 99/229 (43.0%), p < 0.001]. Isolated hypotension was the main reason for treatment in both groups. Among treated infants, volume expansion was administered at equal rates to the NPE and no-NPE groups [118/144 (82.1%) vs. 79/99 (80.1%), p = 0.67], but the NPE group received inotropic drugs more often [77/144 (53.7%) vs. 37/99 (37.8%), p = 0.023]. Conclusion NPE use in hypotensive preterm infants was not associated with in-hospital outcomes and had little influence on the nature of and reasons for antihypotensive treatments. These results suggest the need to optimize NPE use.
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Affiliation(s)
- Roberto Raschetti
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France
- *Correspondence: Roberto Raschetti
| | - Héloïse Torchin
- Université Paris Cité, CRESS, INSERM, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neonatal Medicine, Maternité Cochin-Port Royal, Paris, France
| | | | - Géraldine Gascoin
- Department of Neonatal Medicine, Toulouse University Hospital, Toulouse, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Olivier Brissaud
- Department of Pediatric and Neonatal Intensive Care, Hôpital Pellegrin-Enfants, CHU Pellegrin, Université Bordeaux II, Bordeaux, France
| | | | - Laurent Storme
- Department of Neonatal Medicine, Lille University Hospital, Lille, France
| | | | - Armand Mekontso-Dessap
- Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, Créteil, France
| | - Xavier Durrmeyer
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France
- Université Paris Cité, CRESS, INSERM, INRA, Paris, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, Créteil, France
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