Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training

Mertens, Luc; Seri, István; Marek, Jan; Arlettaz, Romaine; Barker, Piers; McNamara, Patrick J.; Moon-Grady, Anita J.; Coon, Patrick D.; Noori, Shahab; Simpson, John; Lai, Wyman W.

doi:10.1016/j.echo.2011.07.014

Cited by 348 publications

(202 citation statements)

References 122 publications

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“…The left ventricular myocardial performance (Tei) index was calculated from an M-mode view as described (16,17). The patency of, and flow direction across the ductus arteriosus and atrial septum were also assessed, as described (18).…”

Section: Echocardiographymentioning

confidence: 99%

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Hochwald

Jabr

Osiovich

et al. 2014

The Journal of Pediatrics

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Objective-To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow, and brain injury during whole-body therapeutic hypothermia.Study design-Sixteen newborns with moderate or severe hypoxic-ischemic encephalopathy were studied using echocardiography during and immediately after therapeutic hypothermia. Measures were also compared with 12 healthy newborns of similar postnatal age. Newborns undergoing therapeutic hypothermia also had a cerebral magnetic resonance imaging as part of routine clinical care on postnatal day 3-4.Results-LVCO was markedly reduced (mean+/−SD: 126+/−38 mL/kg/min) during therapeutic hypothermia, whereas SVC flow was maintained within expected normal values (88+/− 27 mL/kg/ min) such that it represented 70% of the LVCO. The reduction in LVCO during therapeutic hypothermia was mainly accounted by a reduction in heart rate (99 +/− 13 BPM versus 123 +/− 17 BPM; p<0.001) compared to immediately post-warming, in the context of myocardial dysfunction. Neonates with documented brain injury on MRI showed higher SVC flow pre-rewarming, compared to newborns without brain injury (p=0.013).Conclusion-Newborns with perinatal hypoxic-ischemic encephalopathy showed a preferential systemic-to cerebral redistribution of cardiac blood flow during whole-body therapeutic hypothermia, which may reflect a lack of cerebral vascular adaptation in newborns with more severe brain injury.

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Section: Echocardiographymentioning

confidence: 99%

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Hochwald

Jabr

Osiovich

et al. 2014

The Journal of Pediatrics

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“…The article by Singh et al [6] sets out proposed consensus guidelines for the UK around the use of ultrasound (mainly focused on cardiac ultrasound) in the neonatal unit. The authors closely model these on a comprehensive set of guidelines for training of neonatologists in echocardiography published recently from North America [5]. These guidelines were heavily influenced by paediatric cardiology and highlight the differences between the traditional consultative model of ultrasound and the more recent evolution of ultrasound as an acute point of care diagnostic tool [1].…”

mentioning

confidence: 99%

Point of care ultrasound in the NICU—training, accreditation and ownership

Kluckow

Evans

2015

Eur J Pediatr

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The use of ultrasound by neonatologists to assist in understanding physiology and to help guide management in the NICU is rapidly expanding [4] with research demonstrating an important impact on clinical management [2]. The article by Singh et al. [6] sets out proposed consensus guidelines for the UK around the use of ultrasound (mainly focused on cardiac ultrasound) in the neonatal unit. The authors closely model these on a comprehensive set of guidelines for training of neonatologists in echocardiography published recently from North America [5]. These guidelines were heavily influenced by paediatric cardiology and highlight the differences between the traditional consultative model of ultrasound and the more recent evolution of ultrasound as an acute point of care diagnostic tool [1]. Although an important and needed initiative, this expert consensus statement for training and accreditation in the UK is limited in scope and focuses disproportionately on the exclusion of structural heart disease rather than the use of ultrasound for haemodynamic assessment, which is what most neonatal clinicians are mainly interested in.The consensus guidelines describe best practice for training and accreditation for the use of cardiac ultrasound (termed 'neonatologist performed echocardiography' or NoPE by the authors) in the neonatal intensive care unit. The authors are noted experts/opinion leaders in their field and are representative of a broader group of paediatric cardiologists and neonatologists. Several important principles are outlined including the performance of the ultrasound, care of the infant during the investigation, the aim to screen and establish gross normality on the first ultrasound (though in other statements the aim is higher than this 'to confidently exclude structural lesions at the first scan'), the need for collaboration with a supportive paediatric cardiologist, use of a reporting template, image storage and regular audit/review of images. Training for 6 months in a neonatology placement and 6 months in a paediatric cardiology unit is recommended, even though the authors acknowledge that access to these training positions will be limited.While much of this is to be lauded, there is a difference in training needs between being able to establish gross structural normality and being able to confidently exclude structural abnormality. The latter lifts the training needs close to that of a paediatric cardiologist but with the suggested training pathway well short of that required in the specialty. In our opinion, this enhances the risk of a non-cardiologist performing a cardiac ultrasound in a baby with congenital heart disease and deeming it a normal echocardiogram. Having a high training goal may also deter neonatologists from using cardiac ultrasound for a range of other non-structural heart disease purposes including acute exclusion of pericardial effusions, assessment of volume status in sepsis and on to understanding the pathophysiology of infants with hypoxic respiratory failure and right to lef...

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“…Однако известно, что, например, согласно требова-ниям Американского колледжа кардиологов, Аме-риканской ассоциации сердца, Американского об-щества эхокардиографии, для достижения базового уровня экспертизы в эхокардиографии необходимо провести 150 исследований и проанализировать 150 результатов исследований (при этом соот-ветствующих норме должно быть не более 20 %), обучение длится 4-6 месяцев. Для достижения продвинутого уровня должно быть дополнитель-но проведено 200 исследований и дополнительно проанализировано 200 результатов исследований, срок обучения при этом составляет от 9 до 12 ме-сяцев [41].…”

Section: мониторинг г емодинамики особенности у новорож денныхunclassified

Hemodynamic monitoring on the background of intensive therapy in newborns

et al. 2017

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The article deals with the problem of early neonatal and infant mortality. It is pointed out that recent advances in emergency and intensive care therapy have provided decline in early neonatal and infant mortality. Hemodynamic disorders are reported to be associated with any severe pathology in patients of all age groups including newborns, significantly influence quality of life of patients having experienced a critical condition. Clinical manifestations of hemodynamic disorders in infants are not considered to be specific; they are critically delayed and are not timely recognized. The article describes peculiarities of the cardio-vascular system of newborns that are responsible for the necessity of thorough hemodynamic profile monitoring in order to provide detection of vital function alterations at the early stages, ensure timely onset of intensive therapy and its qualitative performance. Special attention is paid to current methods of determination of central hemodynamic parameters, which are stated to be divided into invasive and non-invasive. The paper also highlights some peculiarities of evaluation of hemodynamic findings using specific monitoring methods and factors influencing the outcome. The article specifies increased interest towards non-invasive monitoring tools of hemodynamic profile in recent years; their relevance is stated to be doubtless in both pediatric and neonatal practice. The main task of any monitoring procedure is reported to be hemodynamic findings analysis, “trend tracking” in the process of monitoring a patient and intensive therapy performance.

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Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training

Cited by 348 publications

References 122 publications

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Point of care ultrasound in the NICU—training, accreditation and ownership

Hemodynamic monitoring on the background of intensive therapy in newborns

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