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Does point-of-care functional echocardiography enhance cardiovascular care in the NICU?

Journal of Perinatology volume 28, pages 729–735 (2008)Cite this article

Abstract

Although the last two decades have seen major advances in the care of sick, extremely premature newborns, the approach to cardiovascular assessment and monitoring remains suboptimal owing to an overreliance on poorly predictive clinical markers such as heart rate or capillary refill time. Point-of-care functional echocardiography (PCFecho) enables real-time evaluation of cardiac performance and systemic hemodynamics to characterize acute physiology, identify the exact nature of cardiovascular compromise and guide therapeutic decisions. In this article, we will review four clinical scenarios where bedside functional cardiac imaging enabled delineation of the real clinical problem and refinement of the therapeutic care plan with direct patient benefits.

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References

  1. Kluckow M, Seri I, Evans N . Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr 2007; 150: 125–130.

    Article  Google Scholar 

  2. Evans N, Kluckow M . Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 74: F88–F94.

    Article  CAS  Google Scholar 

  3. Kluckow M, Evans N . Superior vena cava flow in preterm infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000; 82: 182–187.

    Article  Google Scholar 

  4. Zhang J, Penny DJ, Kim NS, Yu VYH, Smolich J . Mechanisms of blood pressure increase induced by dopamine in hypotensive preterm neonates. Arch Dis Child Fetal Neonatal Ed 1999; 81: 99–104.

    Article  Google Scholar 

  5. Finan E, Shivananda SP, Teixeira L, Mak W, McNamara PJ . Paediatric Academic Societies Annual Meeting 2007; Abstract no. 5896.3.

  6. Skinner JR . Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist? Arch Dis Child 1998; 78: 401–402.

    Article  CAS  Google Scholar 

  7. Evans N . Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 2000; 36: 169–171.

    Article  CAS  Google Scholar 

  8. Teixiera L, Shivananda S, Arsdell GV, James A, McNamara P . PDA ligation causes postoperative myocardial dysfunction in premature infants. Paediatric Academic Societies Annual Meeting 2006. Abstract no. 2863.238.

  9. Sehgal A, McNamara P . Coronary artery perfusion is associated with impaired diastolic dysfunction in preterm infants after PDA ligation. Paediatric Academic Societies Annual Meeting 2007. Abstract no. 5896.15.

  10. Moss S, Kitchener DJ, Yoxall CW, Subhedar NV . Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed 2003; 88: F287–F291.

    Article  CAS  Google Scholar 

  11. Ward CJ, Purdie J . Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J Paediatr Child Health 2001; 37: 3316.

    Article  Google Scholar 

  12. Kuschel CA, Evans N, Askie L, Bredemeyer S, Nash J, Polverino J . A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestation. J Paediatr Child Health 2000; 36: 581–586.

    Article  CAS  Google Scholar 

  13. Manasia AR, Nagaraj HM, Kodali RB, Croft RB, Oropello JM, Kohli-Seth R et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth 2005; 19: 155–159.

    Article  Google Scholar 

  14. Croft LB, Duvall WL, Goldman ME . A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic. Echocardiography 2006; 23: 439–446.

    Article  Google Scholar 

  15. Melamed R, Hanovich S, Shapiro R, Sprenkle M, Ulstad V, Leatherman J . Limited bedside echocardiography performed by intensivists in the medical intensive care unit. Chest 2005; 128 (Suppl): 207–208.

    Article  Google Scholar 

  16. Alexander JH, Peterson ED, Chen AY, Harding TM, Adams DB, Kisslo Jr JA . Feasibility of point-of-care echocardiography by internal medicine house staff. Am Heart J 2004; 147: 476–481.

    Article  Google Scholar 

  17. Thomas JD, Adams DB, DeVries S, Ehler D, Greenberg N, Garcia M et al. Guidelines and recommendations for digital echocardiography: a report from the digital echocardiography committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2005; 18: 287–297.

    Article  Google Scholar 

  18. Jones AE, Craddock PA, Tayal VS, Kline JA . Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock 2005; 24: 513–517.

    Article  Google Scholar 

  19. Breitkreutz R, Walcher F, Seeger FH . Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med 2007; 35 (5 Suppl): S150–S161.

    Article  Google Scholar 

  20. Sehgal A, Cook V, Dunn M . Pericardial effusion in association with an appropriately placed umbilical venous catheter. J Perinatol 2007; 27: 317–318.

    Article  CAS  Google Scholar 

  21. Sehgal A, Skidmore M . Superior vena cava syndrome in a newborn: importance of point of care echocardiography. J Perinatol 2007; 27: 317–319.

    Article  CAS  Google Scholar 

  22. Kluckow M, Evans N . Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82: F188–F194.

    Article  CAS  Google Scholar 

  23. O'Rourke D, Khuffash A, Walsh K, Molloy E . Serial echocardiography in preterm infants may improve outcome. Acta Paediatr 2008; 97: 574–578.

    Article  CAS  Google Scholar 

  24. Wren C . Commentary on Moss et al.'s ‘Evaluation of echocardiography on the neonatal unit’. Arch Dis Child Fetal Neonatal Ed 2003; 88: F290–F291.

    Article  Google Scholar 

  25. Skinner J . Diagnosis of patent ductus arteriosus. Semin Neonatol 2001; 6: 49–61.

    Article  CAS  Google Scholar 

  26. Katumba-Lunyenya JL . Neonatal/infant echocardiography by the non-cardiologist: a personal practice, past, present, and future. Arch Dis Child Fetal Neonatal Ed 2002; 86: F55–F57.

    Article  CAS  Google Scholar 

  27. Samson GR, Kumar S . A study of congenital cardiac disease in a neonatal population; the validity of echocardiography undertaken by a neonatologist. Cardiol Young 2004; 14: 585–593.

    Article  Google Scholar 

  28. Whitehall J . Echocardiography by a neonatologist. Arch Dis Child 1999; 80: 580–581.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Neonatology, University of Toronto, Toronto, Ontario, Canada

    A Sehgal & P J McNamara

  2. Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada

    A Sehgal & P J McNamara

  3. Physiology and Experimental Medicine Program, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada

    P J McNamara

Authors
  1. A Sehgal
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  2. P J McNamara
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Correspondence to P J McNamara.

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Sehgal, A., McNamara, P. Does point-of-care functional echocardiography enhance cardiovascular care in the NICU?. J Perinatol 28, 729–735 (2008). https://doi.org/10.1038/jp.2008.100

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