Journal article
Impact of targeted neonatal echocardiography consultations for critically sick preterm neonates
Archives of disease in childhood. Fetal and neonatal edition, Vol.110(2), pp.200-206
03/2025
DOI: 10.1136/archdischild-2024-327347
PMID: 39227145
Abstract
Rationale Preterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted neonatal echocardiography consultations (TNE) are increasingly used to guide management, its clinical impact need evaluation. Objectives To investigate clinical outcomes in relation to TNE utilisation during episodes of ACIs among preterm neonates. Methods This retrospective cohort study, conducted at two tertiary NICUs over 10 years, included neonates<37 weeks gestational age (GA) who developed ACIs. Patients receiving TNE-guided care (TNE within 24 hours of treatment initiation) were compared with non-TNE management. Outcomes included predischarge mortality, episode-related mortality (<7 days) and a new diagnosis of intraventricular haemorrhage≥grade 3 (IVH-3). Inverse probability of treatment weighting (IPTW) using propensity score was used to account for confounders, including site, birth years and baseline illness severity. Measurements and main results Of 622 included patients, 297 (48%) had TNE; median (IQR) GA at ACI was 26.4 (25.0–28.4) weeks. TNE group demonstrated higher baseline mean airway pressure, oxygen requirement and heart rate and frequently received both inotrope and iNO during ACI. IPTW analysis revealed TNE was associated with lower mortality (adjusted OR (95% CI) 0.75 (0.59 to 0.95)), episode-related mortality (0.54 (0.40 to 0.72)) and death or IVH-3 (0.78 (0.62 to 0.99)). TNE group received more varied inotropic agents, demonstrated earlier improvements in blood pressures, without increasing overall inotrpoic burden. Conclusions Among preterm neonates requiring rescue treatments with inotropes/iNO, TNE utilisation to guide clinical management may be associated with improved survival.
Details
- Title: Subtitle
- Impact of targeted neonatal echocardiography consultations for critically sick preterm neonates
- Creators
- Sébastien Joye - University of LausanneAshraf Kharrat - University of TorontoFaith Zhu - Mount Sinai HospitalPoorva Deshpande - University of TorontoMichelle Baczynski - Mount Sinai HospitalBonny Jasani - Hospital for Sick ChildrenSeungwoo Lee - Mount Sinai HospitalLuc L Mertens - University of TorontoPatrick J McNamara - University of IowaPrakesh S Shah - University of TorontoDany E Weisz - Sunnybrook Health Science CentreAmish Jain - Mount Sinai Hospital
- Resource Type
- Journal article
- Publication Details
- Archives of disease in childhood. Fetal and neonatal edition, Vol.110(2), pp.200-206
- Publisher
- BMJ PUBLISHING GROUP
- DOI
- 10.1136/archdischild-2024-327347
- PMID
- 39227145
- ISSN
- 1359-2998
- eISSN
- 1468-2052
- Language
- English
- Electronic publication date
- 09/03/2024
- Date published
- 03/2025
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984701559702771
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