Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals
Abstract Background Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by clinical signs such as heart rate, blood pressure, capillary refill time, and measurem...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-03-01
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| Series: | Egyptian Pediatric Association Gazette |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43054-023-00157-y |
| _version_ | 1797865299841646592 |
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| author | Ahmed Abd-Elaziz Salem Shokr Rania Hosny Tomerak Hala Mounir Agha Rania Mohamad Helmy ElKaffas Samia Bekhtte Ibrahem Ali |
| author_facet | Ahmed Abd-Elaziz Salem Shokr Rania Hosny Tomerak Hala Mounir Agha Rania Mohamad Helmy ElKaffas Samia Bekhtte Ibrahem Ali |
| author_sort | Ahmed Abd-Elaziz Salem Shokr |
| collection | DOAJ |
| description | Abstract Background Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being, and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion. A bedside point-of-care echocardiography can provide real-time hemodynamic information by assessing cardiac function, loading conditions (preload and afterload), and cardiac output, which makes it an ideal tool for monitoring hemodynamic assessment in neonates and children. Methods A prospective cross-section study was carried out on all neonates admitted to the NICU of Cairo University Children’s Hospital (CUCH) during the period from September 2017 through August 2018 in whom manifestations of hemodynamic instability were elected regardless of gestational age, weight, gender, or type of disease. Results There is a positive correlation between EF, FS, LVOT, RVOT, LVTI, RVTI, MAPSE, and TAPSE with birth weight. There is a negative correlation between birth weight and either LVO or RVO. In neonates weighted > 1500 g, there is a significant correlation between decreases in longitudinal systolic function of the heart (TAPSE and MAPSE) and either hemodynamic instability or need for echo-directed management, but there is no significant correlation between both in neonates weighted ≤ 1500 g. There is a significant relationship between birth weight and survival “the more the births weight the better survival chance and between complete compliance with ECDM protocol and achieving normal hemodynamic state.” Conclusions Decreases in EF, FS, TAPSE, and MAPSE in low birth weight neonates’ ≤ 1500 g are late signs of hemodynamic instability. TAPSE and MAPSE are the earliest parameters noticed to be decreased in hemodynamically unstable neonates > 1500 g even before EF and FS but return to normal values latterly. There is a significant relationship between complete compliance with ECDM protocol and achieving normal hemodynamics. Birth weight of ≤ 1500 g was an independent predictor of mortality regardless of the degree of compliance with the protocol. |
| first_indexed | 2024-04-09T23:06:50Z |
| format | Article |
| id | doaj.art-de97c094383d4d23ade4f33bed50522b |
| institution | Directory Open Access Journal |
| issn | 2090-9942 |
| language | English |
| last_indexed | 2024-04-09T23:06:50Z |
| publishDate | 2023-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Pediatric Association Gazette |
| spelling | doaj.art-de97c094383d4d23ade4f33bed50522b2023-03-22T10:41:54ZengSpringerOpenEgyptian Pediatric Association Gazette2090-99422023-03-0171111110.1186/s43054-023-00157-yEchocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitalsAhmed Abd-Elaziz Salem Shokr0Rania Hosny Tomerak1Hala Mounir Agha2Rania Mohamad Helmy ElKaffas3Samia Bekhtte Ibrahem Ali4Faculty of Medicine, Alexandria UniversityFaculty of Medicine, Cairo UniversityFaculty of Medicine, Alexandria UniversityFaculty of Medicine, Alexandria UniversityFaculty of Medicine, Alexandria UniversityAbstract Background Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being, and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion. A bedside point-of-care echocardiography can provide real-time hemodynamic information by assessing cardiac function, loading conditions (preload and afterload), and cardiac output, which makes it an ideal tool for monitoring hemodynamic assessment in neonates and children. Methods A prospective cross-section study was carried out on all neonates admitted to the NICU of Cairo University Children’s Hospital (CUCH) during the period from September 2017 through August 2018 in whom manifestations of hemodynamic instability were elected regardless of gestational age, weight, gender, or type of disease. Results There is a positive correlation between EF, FS, LVOT, RVOT, LVTI, RVTI, MAPSE, and TAPSE with birth weight. There is a negative correlation between birth weight and either LVO or RVO. In neonates weighted > 1500 g, there is a significant correlation between decreases in longitudinal systolic function of the heart (TAPSE and MAPSE) and either hemodynamic instability or need for echo-directed management, but there is no significant correlation between both in neonates weighted ≤ 1500 g. There is a significant relationship between birth weight and survival “the more the births weight the better survival chance and between complete compliance with ECDM protocol and achieving normal hemodynamic state.” Conclusions Decreases in EF, FS, TAPSE, and MAPSE in low birth weight neonates’ ≤ 1500 g are late signs of hemodynamic instability. TAPSE and MAPSE are the earliest parameters noticed to be decreased in hemodynamically unstable neonates > 1500 g even before EF and FS but return to normal values latterly. There is a significant relationship between complete compliance with ECDM protocol and achieving normal hemodynamics. Birth weight of ≤ 1500 g was an independent predictor of mortality regardless of the degree of compliance with the protocol.https://doi.org/10.1186/s43054-023-00157-yEchocardiographyHemodynamic assessmentHemodynamically unstable neonates |
| spellingShingle | Ahmed Abd-Elaziz Salem Shokr Rania Hosny Tomerak Hala Mounir Agha Rania Mohamad Helmy ElKaffas Samia Bekhtte Ibrahem Ali Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals Egyptian Pediatric Association Gazette Echocardiography Hemodynamic assessment Hemodynamically unstable neonates |
| title | Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals |
| title_full | Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals |
| title_fullStr | Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals |
| title_full_unstemmed | Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals |
| title_short | Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals |
| title_sort | echocardiography directed management of hemodynamically unstable neonates in tertiary care hospitals |
| topic | Echocardiography Hemodynamic assessment Hemodynamically unstable neonates |
| url | https://doi.org/10.1186/s43054-023-00157-y |
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