Possibilities and limitations of the use of echocardiography by an intensive care physician in neonatal intensive care

Abstract

The practical application of echocardiography by clinicians (anesthesiologists and neonatologists) to grasp the pathophysiology of changes in hemodynamic status is increasingly being used in intensive care units under various guidelines. The clinical review focuses on the use of targeted neonatal echocardiography as a tool for an extended assessment of the hemodynamic condition of newborns for the appointment of pathogenetically based treatment. The pathophysiological basis of hemodynamic disorders in newborns in critical condition is given and various methods of echographic assessment of myocardial contractility, preload, and afterload with consideration of their advantages and limitations are highlighted in detail. The development of unified algorithms for evaluating hemodynamics using optimal echocardiographic indicators and the standardization of training is necessary for the integration of targeted neonatal echocardiography in intensive care units and for improving the effectiveness of treatment of newborn children.

Keywords:premature newborn; targeted neonatal echocardiography; neonatal hemodynamics; shock; hypotension; preload; afterload; and myocardial contractility

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Rudakova A.A., Ionov O.V., Filippova E.A., Sugak A.B., Kirtbaya A.R., Balashova E.N., Zubkov V.V. Possibilities and limitations of the use of echocardiography by an intensive care physician in neonatal intensive care. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2022; 10 (4): 54–62. DOI: https://doi.org/10.33029/2308-2402-2022-10-4-54-62 (in Russian)

REFERENCES

1.Claramunt I.M., et al. Functional echocardiography and its clinical applications in neonatology. Andes Pediatr. 2021; 92 (1): 122–30.

2.Tissot C., Singh Y. Neonatal functional echocardiography. Curr Opin Pediatr. 2020; 32 (2): 235–44.

3.Kluckow M., Seri I., Evans N. Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr. 2007; 150 (2): 125–30.

4.Mertens L., et al. Targeted neonatal echocardiography in the neonatal intensive care unit: Practice guidelines and recommendations for training. J Am Soc Echocardiogr. 2011; 24 (10): 1057–78.

5.Soleymani S., Seri I., Seri I. Hemodynamic monitoring in neonates: advances and challenges. J Perinatol. 2010; 30 (S1): S38–45.

6.Singh Y., et al. The evolution of cardiac point of care ultrasound for the neonatologist. Eur J Pediatr. 2021; 180 (12): 3565–75.

7.Corsini I., et al. Neonatologist performed echocardiography (NPE) in Italian neonatal intensive care units: a national survey. Ital J Pediatr. 2019; 45 (1): 1–7.

8.Miller L.E., Stoller J.Z., Fraga M.V. Point-of-care ultrasound in the neonatal ICU. Curr Opin Pediatr. 2020; 32 (2): 216–27.

9.Singh Y., et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020; 24 (1): 65.

10.Raimondi F., et al. Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res. 2021; 90 (3): 524–31.

11.Yousef N., Singh Y., De Luca D. «Playing it SAFE in the NICU» SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU. Eur J Pediatr. 2022; 181 (1): 393–8.

12.Krushelnitsky A.A., Yudenkov D.I., Kondratev M.V., Petrova A.S., Serova O.F. SAFE-R+ ultrasound protocol in the medical practice of intensivist of neonatal intensive care unit. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2022; 10 (1): 34–9. (in Russian)

13.Chiumello D., et al. Lung ultrasound in the critically ill patient. In: Topical Issues in Anesthesia and Intensive Care. Springer, 2016: 55–67.

14.Estoos E., Nakitende D. Diagnostic ultrasound use in undifferentiated hypotension [Electronic resource]. In: StatPearls [Internet]. Treasure Island, FL : StatPearls Publishing, 2022.

15.Nestaas E. Neonatologist performed echocardiography for evaluating the newborn infant. Front Pediatr. 2022; 10: 1–7.

16.Mertens L. Neonatologist performed echocardiography – hype, hope or nope. Eur J Pediatr. 2016; 175 (2): 291–3.

17.Singh Y., Katheria A., Tissot C. Functional echocardiography in the neonatal intensive care unit. Indian Pediatr. 2018; 55 (5): 417–24.

18.Meau-Petit V., Levy Y., Guellec I. Utilisation of neonatologist-performed echocardiography in shock among neonatologists with interest in haemodynamic: international survey. Acta Paediatr. 2022; 111 (5): 971–8.

19.Osborn D.A., Evans N., Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed. 2004; 89 (2): F168–73.

20.Camfferman F.A., et al. Systematic review. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res. 2020; 87 (suppl 1): 50–8.

21.Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr. 2017; 5: 1–14.

22.Evans J.R., et al. Cardiovascular support in preterm infants. Clin Ther. 2006; 28 (9): 1366–84.

23.Kluckow M., Evans N. Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr. 1996; 129 (4): 506–12.

24.Singh Y., Katheria A.C., Vora F. Advances in diagnosis and management of hemodynamic instability in neonatal shock. Front Pediatr. 2018; 6: 1–12.

25.Siassi B., Noori S., Wong P., Acherman R.M. Practical Neonatal Echocardiography. 1st ed. McGraw Hill Education, 2019.

26.Elsayed Y., Abdul Wahab M.G. A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability. Eur J Pediatr. 2022; 181 (3): 1277–91.

27.Elsayed Y.N., Fraser D. Integrated evaluation of neonatal hemodynamics program optimizing organ perfusion and performance in critically ill neonates, part 1: understanding physiology of neonatal hemodynamics. Neonatal Netw. 2016; 35 (3): 143–50.

28.Gupta S., Donn S.M. Hemodynamic management of the micropreemie: when inotropes are not enough. Semin Fetal Neonatal Med. 2022; 27 (3): 101329.

29.Wu T.W., Noori S. Recognition and management of neonatal hemodynamic compromise. Pediatr Neonatol. 2021; 62: S22–9.

30.Kleideiter U., Dalla Pozza R., Haas N.A. Клайдайтер У., Далла Поцца Р., Хаас Н.А. Pädiatrische Echokardiografie: Ultraschall des Herzens im Kindesalter und bei angeborenen Herzfehlern. 2019: 392 p.

31.El-Khuffash A.F. Neonatologist Performed Echocardiography. 2019.

32.Siassi B., Noori S., Wong P., Acherman R.M. Practical Neonatal Echocardiography. McGraw-Hill Education, 2019–2020; 8: 1–11.

33.Stranak Z., et al. International survey on diagnosis and management of hypotension in extremely preterm babies. Eur J Pediatr. 2014; 173 (6): 793–8.

34.de Waal K., Kluckow M. Functional echocardiography; from physiology to treatment. Early Hum Dev. 2010; 86 (3): 149–54.

35.Feissel M., et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004; 30 (9): 1834–7.

36.Via G., Tavazzi G., Price S. Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Med. 2016; 42 (7): 1164–7.

37.Barbier C., et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004; 30 (9): 1740–6.

38.Ficial B., et al. Validation study of the accuracy of echocardiographic measurements of systemic blood flow volume in newborn infants. J Am Soc Echocardiogr. 2013; 26 (12): 1365–71.

39.Abushaban L., et al. Normal reference ranges for left ventricular dimensions in preterm infants. Ann Pediatr Cardiol. 2014; 7 (3): 180–6.

40.Poon W.B., Wong K.Y. Neonatologist-performed point-of-care functional echocardiography in the neonatal intensive care unit. Singapore Med J. 2017; 58 (5): 230–3.

41.de Boode W.P., et al. The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock. Pediatr Res. 2018; 84 (1): 57–67.

42.Lingwood B.E., et al. Supporting preterm cardiovascular function. Clin Exp Pharmacol Physiol. 2019; 46 (3): 274–9.

43. Groves A.M., Kuschel C.A., Knight D.B., Skinner J.R. Does retrograde diastolic flow in the descending aorta signify impaired systemic perfusion in preterm infants? Pediatr Res. 2008; 63 (1): 89–94.

44. de Boode WP. Individualized Hemodynamic Management in Newborns. Front Pediatr. 2020; 8: 580470.

45. Sehgal A., McNamara P.J. Does point-of-care functional echocardiography enhance cardiovascular care in the NICU? J Perinatol. 2008; 28 (11): 729–35.

46. El-Khuffash A., Herbozo C., Jain A., Lapointe A., McNamara P.J. Targeted neonatal echocardiography (TnECHO) service in a Canadian neonatal intensive care unit: a 4-year experience. J Perinatol. 2013; 33 (9): 687–90.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

Journals of «GEOTAR-Media»