The Pathophysiology of Low Systemic Blood Flow in the Preterm Infant

Kluckow, Martin

doi:10.3389/fped.2018.00029

Cited by 30 publications

(19 citation statements)

References 66 publications

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“…In a critically sick preterm neonate, circulatory compromise could occur due to reduced preload, impaired LV pump function or changes in afterload secondary to excessive vasoconstriction or vasodilatation 26,27 . A persistent discrepancy between oxygen demand and supply can lead to derangement of metabolism, organ dysfunction, and poor outcomes 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Currently, left ventricle output (LVO) determined using the velocity time integral (VTI) method is the most commonly used echocardiographic parameter in preterm neonates for assessment of LV systolic performance 30,31 . However, LVO is not an accurate indicator of systemic blood flow and organ perfusion in the presence of a hemodynamically significant PDA 26 . Moreover, as LVO is derived from heart rate, aortic diameter, and VTI, it only describes forward blood flow through the LV outflow tract and provides a limited insight into LV preload, and the interplay between preload, stroke volume, and LV pump efficiency 31 …”

Section: Discussionmentioning

confidence: 99%

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Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Phad

Waal

2020

Echocardiography

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Background Biplane left ventricular ejection fraction (LVEF) is a valuable echocardiographic parameter for assessment of LV systolic pump efficiency in adults and children, but not often reported in preterm infants. The primary aim of this study was to longitudinally measure biplane LVEF in very preterm infants during the neonatal intensive care period. Secondary aim was to compare manual and semi‐automatic determination of LVEF for agreement and variability. Methods Stable preterm infants less than 30 weeks gestation were scanned on day 3, day 28, and at 36 weeks postmenstrual age. The LV endocardium was traced manually and semi‐automatically using integrated speckle tracking software in apical 4‐chamber and apical 3‐chamber images to obtain end‐diastolic volume and end‐systolic volume, and calculate LVEF. Agreement between methods and variability within and between observers was determined using an interclass correlation coefficient (ICC) and Bland‐Altman analysis. Results Sixty‐six preterm infants with a mean birth weight of 1100 (239) g were analyzed. The average manual biplane LVEF was 58 (3)%, 59 (3)%, and 55 (4)% at the three respective time points. Manual LVEF showed good agreement with semi‐automatic LVEF (ICC 0.76) with a small bias of −1.5 (3.0)%. Interobserver variability of LVEF improved with semi‐automatic tracing of the LV endocardial border (ICC manual 0.68 vs semi‐automatic 0.80). Conclusion Left ventricular systolic pump efficiency in preterm infants remains stable during the neonatal intensive care period. Semi‐automatic biplane LVEF has less interobserver variability and can be used interchangeably with manual biplane LVEF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Phad

Waal

2020

Echocardiography

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“…When blood flow and breathing pattern change, body volume-how bodily fluids distribute in the various body segments and tissues-changes accordingly. Body volume and composition can be measured to assess the infant's health, development, and growth (40), thus giving useful information as the monitoring of neonatal hemodynamics (e.g., systemic and pulmonary blood flow and vascular resistance) (41,42). Hemodynamics is indeed continuously monitored because abnormal cardiovascular function during the neonatal period correlates with a higher risk of morbidity and mortality (41,42).…”

Section: Changes In Body Tissuesmentioning

confidence: 99%

Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit?

Manzotti

Cerritelli²,

Chiera³

et al. 2020

Front. Pediatr.

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Despite the technological improvements in monitoring preterm infants in the neonatal intensive care unit, routine care in the neonatal ward is primarily based on manual procedures. Although manual clinical procedures play a critical role in neonatology, little attention has been paid to palpation as a clinical assessment tool. Palpation is a clinical evaluation tool that relies mostly on the senses of touch and proprioception. Based on recent studies investigating the role and clinical effectiveness of touch in full-term and preterm babies, this paper proposes an evaluative touch-based procedure-the Neonatal Assessment Manual Score (NAME) model-that could be useful in the neonatal ward and describes its rationale. The operator applies gentle light pressures to the infant's body. In essence, the touch stimulates low-threshold afferent fibers that could influence the interoceptive cerebral network and the autonomic nervous system, thus altering the blood flow and breathing rhythm. These events could change how bodily fluids distribute among body segments and hence the body volume. The volume modification could be felt manually through haptic perception owing to the high sensitivity of the fingers. On the basis of their clinical conditions and stage of development, infants will respond differently to the applied pressures. Evaluating the infant's response, the operator produces a score of "bad," "marginal," or "good" for communicating quickly and clearly the infant's conditions to other professionals. Because the NAME model is intended for every professional who is used to touch-based procedures, if future studies confirmed its validity and reliability in clinical practice, the NAME model could become a part of the neonatal ward routine care for better assessing and managing the infant's conditions, even during emergencies.

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“…Newborns adapt to extra-uterine life during the rst minutes, hours, and days of life (35). Filling of the lungs with air, establishing respiration and pulmonary blood ow, closing of the foramen ovale and the ductus arteriosus all constitute components of this transition (6). In preterm neonates, this challenge is compounded by immature lungs, inadequate surfactant production and myocardial immaturity with limited diastolic as well as systolic function (6).…”

mentioning

confidence: 99%

“…Filling of the lungs with air, establishing respiration and pulmonary blood ow, closing of the foramen ovale and the ductus arteriosus all constitute components of this transition (6). In preterm neonates, this challenge is compounded by immature lungs, inadequate surfactant production and myocardial immaturity with limited diastolic as well as systolic function (6). In extremely preterm infants, this process often requires cardiorespiratory support, and in spite of this, neurodevelopmental impairment is common (36).…”

mentioning

confidence: 99%

The Clinical Effects of Cerebral Near-Infrared Spectroscopy Monitoring (NIRS) Versus No Monitoring in Children and Adults: A Protocol for a Systematic Review With Meta-Analysis and Trial Sequential Analysis

Hansen¹,

Hyttel-Sørensen²,

Jakobsen³

et al. 2020

Preprint

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BackgroundMultiple clinical conditions are associated with cerebral hypoxia/ischaemia and thereby an increased risk of hypoxic-ischaemic brain injury. Cerebral near-infrared spectroscopy monitoring (NIRS) is a tool to monitor brain oxygenation and perfusion, and the clinical uptake of NIRS has expanded over recent years. Specifically, NIRS is used in the perioperative and neonatal, paediatric, and adult intensive care settings. However, the available literature suggests that clinical benefits and harms of cerebral NIRS monitoring are uncertain. As rates of clinically significant hypoxic-ischaemic brain injuries are typically low, it is difficult for randomised clinical trials to capture a sufficiently large number of events to evaluate the clinical effect of cerebral NIRS monitoring, when focusing on specific clinical settings. MethodsWe will conduct a systematic review with meta-analysis and Trial Sequential Analysis to evaluate the benefits and harms of clinical care with cerebral NIRS monitoring versus clinical care without cerebral NIRS monitoring in children and adults across all clinical settings. We will only include randomised clinical trials and the primary outcomes are all-cause mortality, moderate or severe persistent cognitive or neurological deficit, and proportion of participants with one or more serious adverse events. The review will be conducted according to the methodology described in The Cochrane Handbook for Systematic Reviews of Interventions, including GRADE. An eight-step procedure by Jakobsen et al. will be used to assess if thresholds for statistical and clinical significance are crossed.DiscussionAs we include trials across multiple clinical settings, there is an increased probability of reaching a sufficient information size. However, heterogeneity between the included trials may impair our ability to interpret results to specific clinical settings. In this situation, we may have to depend on subgroup analyses with inherent increased risks of type I and II errors. Systematic review registrationThis systematic review protocol has been submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) (http://www.crd.york.ac.uk/prospero) (1,2) on 12th of October 2020.

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The Pathophysiology of Low Systemic Blood Flow in the Preterm Infant

Cited by 30 publications

References 66 publications

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit?

The Clinical Effects of Cerebral Near-Infrared Spectroscopy Monitoring (NIRS) Versus No Monitoring in Children and Adults: A Protocol for a Systematic Review With Meta-Analysis and Trial Sequential Analysis

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