Impact of Early Hemodynamic Screening on Extremely Preterm Outcomes in a High-Performance Center

Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

“…[9,10,17] Recently, a large before-after single-center study in extremely preterm infants with a gestational age of <27 weeks showed that the implementation of early targeted neonatal echocardiography-guided hemodynamic management improved the survival rates without high-grade IVH from 66% to 81%. [37] Our results are in line with this study.…”

“…[40] In the study by Giesinger RE et al, the introduction of routine echocardiography screening for extremely preterm infants was associated with an increase in medical treatment for PDA and a reduction in the need for surgical or percutaneous interventions. [37] However, in our study, there were no differences in the proportion of preterm infants who received medical treatment for hemodynamically signi cant PDA or in the timing of treatment between the intervention and the control group. This can be explained by the use of early echocardiography screening of HsPDA in both groups and similar treatment criteria.…”

“…[38] The use of vasopressors, especially dopamine, has been associated with IVH and worse neurological outcomes. [12,37] In fact, in our complementary analysis, dopamine use was an independent predictor of > grade II IVH or ED.…”

“…Second, early ECHO screening may detect other hemodynamic conditions that need to be addressed speci cally, such as hypovolemia, pulmonary hypertension or clinically silent hemodynamically signi cant PDA. [37,39] For instance, in our study, infants in the intervention group were treated more frequently with inhaled nitric oxide for pulmonary hypertension and received a greater cumulative dose of crystalloids compared to the control group. Early treatment of hemodynamically signi cant PDA may attenuate the negative effect of left-to-right shunt on cerebral perfusion.…”

Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study

“…21,22 A recent study showed a systematic evaluation of PDA and physiologybased management improved outcomes in periviable neonates suggesting its safety even in the most fragile neonatal population. 23 However, there are potential negative impacts such as burden on infrastructure, increased cost to maintain such service, increased handling of vulnerable neonates, and increased risk of hindering physiological stability. As TNE implementation increases worldwide, in depth analysis of this balance should be evaluated in future studies.…”