Journal article
Use of Targeted Neonatal Echocardiography to Prevent Postoperative Cardiorespiratory Instability after Patent Ductus Arteriosus Ligation
The Journal of pediatrics, Vol.160(4), pp.584-589.e1
04/2012
DOI: 10.1016/j.jpeds.2011.09.027
PMID: 22050874
Abstract
To investigate the value of targeted neonatal echocardiography (TnECHO) in predicting cardiorespiratory instability after patent ductus arteriosus (PDA) ligation, and to evaluate the impact of TnECHO-directed care.
We reviewed serial echocardiography evaluations of 62 preterm infants after PDA ligation to investigate the relationship between indices of myocardial performance and postoperative cardiorespiratory instability. A predictive model was developed based on TnECHO criteria, with targeted initiation of intravenous milrinone. A comparative evaluation was performed between matched infants in the previous era (epoch 1; n=25) and current era (epoch 2; n=27) of TnECHO-guided treatment.
Left ventricular output <200 mL/kg/min at 1 hour after PDA ligation was a sensitive predictor of systemic hypotension and the need for inotropes, and was used for initiation of i.v. milrinone infusion in epoch 2. Infants treated with milrinone had a lower incidence of ventilation failure (15% vs 48%; P=.02) and less need for inotropes (19% vs 56%; P=.01), and showed a trend toward improved oxygenation (P=.08).
TnECHO facilitates early detection of infants at greatest risk for subsequent cardiorespiratory deterioration. Administration of milrinone to neonates with low cardiac output may lead to improved postoperative stability.
Details
- Title: Subtitle
- Use of Targeted Neonatal Echocardiography to Prevent Postoperative Cardiorespiratory Instability after Patent Ductus Arteriosus Ligation
- Creators
- Amish Jain - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, CanadaMohit Sahni - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, CanadaAfif El-Khuffash - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, CanadaEmad Khadawardi - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, CanadaArvind Sehgal - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, CanadaPatrick J McNamara - Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.160(4), pp.584-589.e1
- Publisher
- Mosby, Inc
- DOI
- 10.1016/j.jpeds.2011.09.027
- PMID
- 22050874
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Language
- English
- Date published
- 04/2012
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093326302771
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