Echocardiography and Management of Sick Neonates in the Intensive Care Unit

Abstract

To evaluate the influence of echocardiographic examination in the clinical management of the sick neonate, 241 patients, admitted to the neonatal intensive care unit of a tertiary referral center that had echocardiograms with data available for review, were enrolled in a retrospective study. Asymptomatic murmurs (45%) followed by extracardiac anomalies/dysmorphic features (24%) were the most common clinical indications for requesting an echocardiogram. Congenital structural abnormalities (33%), hemodynamically significant patent arterial duct (3%), persistent pulmonary hypertension of the newborn (6%), and left ventricular dysfunction (3%) were the echocardiographic findings that subgrouped as structural or functional abnormalities. Patent oval foramen and hemodynamically nonsignificant patent arterial duct (20%) and physiologic pulmonary artery stenosis (1%) were categorized as normal structural group. Thirty-four percent of neonates had normal heart anatomy. This investigation changed the clinical management in at least 66% of newborns scanned, including emergency surgical intervention for 7%, medical treatment for 22%, and routine cardiologic follow-up for 37% of patients. Asymptomatic murmur in our critically ill neonates has been associated with a higher incidence of cardiac disease. Hence, echocardiography is an important tool for diagnosis of cardiac abnormalities that can influence the management and outcome of the sick newborn in the intensive care unit. A preliminary echocardiogram performed by the neonatologist under the supervision of a pediatric cardiologist for interpretation and review is an alternate when there is not a cardiologist "in house."

Use of Targeted Neonatal Echocardiography and Focused Cardiac Sonography in Tertiary Neonatal Intensive Care Units

“…The evidence regarding the impact and safety of echocardiography performed by neonatologists in the NICU setting is largely available in the form of retrospective and prospective descriptive studies (Table 1). 2,5,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] These reports have consistently shown that, when available, targeted neonatal echocardiography is commonly used by neonatal clinicians in a number of cardiorespiratory disorders, often leads to changes in clinical management, Kadivar et al 19 Retrospective study of 241 neonates who underwent echocardiography performed by neonatologists under supervision of pediatric cardiologists at a single tertiary center. Most common clinical indication was murmurs, followed by extracardiac anomalies/dysmorphic features.…”

Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

“…Systolic and diastolic left ventricular functions are critical determinants of sepsis-induced cardiovascular disorders. 6,7 Many cellular pathways of left ventricular systolic function are impeded during sepsis and implicated in the active relaxation of the left ventricle. 8 In our study, preterm neonates with clinical sepsis had temperature instability, respiratory (grunting, retraction, apnea, tachypnea, or cyanosis), gastrointestinal (feeding intolerance or abdominal distention), neurologic (hypotonia, lethargy, seizures), cardiovascular (bradycardia, tachycardia, poor perfusion, or hypotension), or hematology (thrombocytopenia, prolonged coagulation time, bleeding, or anemia) problems.…”

Safety and usefulness of outreach clinic conducted by pediatric echosonographers

“…Neonates with nonurgent problems are assessed in the daily outpatient clinics, while those with moderately severe clinical problems may need transfer for diagnostic clarification or advice on management. [3]…”