functional neonatal echocardiography in haemodynamic disturbancies

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Functional Neonatal Echocardiography in

Haemodynamic Disturbancies

Jana Semberova

Institute for the Care of Mother and Child, Prague, Czech Republic

The HIP Trial is funded by the European Commission within the 7th Framework Programme

What can we see on echo when something goes

wrong

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Bedside neonatal echocardiography

• Targeted neonatal echocardiography

• Point of care echocardiography (POCT echo)

• Functional echocardiography

The HIP Trial is funded by the European Commission within the 7th Framework Programme

WHY to perform the scan

• Circulatory failure – major cause of neonatal morbidity

and mortality

• Measures currently used to assess circulatory status

often inadequate

• Circulation management varies widely

• Lack of standardized approach

• Echo can help to assess haemodynamic status and

perhaps to guide treatment

The HIP Trial is funded by the European Commission within the 7th Framework Programme

WHEN to perform the scan?

• Routine (e.g. PDA assesment)

• Clinical status

• Functional assessment – findings may change over

time, sometimes very quickly

The HIP Trial is funded by the European Commission within the 7th Framework Programme

The role of functional Echo

• Structure – exclude CHD

• PDA

• PPHN

• Filling, contractility, flow

• Other: Pericardial fluid, line position etc.

The HIP Trial is funded by the European Commission within the 7th Framework Programme

CHD - TOF

The HIP Trial is funded by the European Commission within the 7th Framework Programme

CHD - VSD

The HIP Trial is funded by the European Commission within the 7th Framework Programme

PDA – Left to Right

The HIP Trial is funded by the European Commission within the 7th Framework Programme

PDA - Bidirectional

The HIP Trial is funded by the European Commission within the 7th Framework Programme

PDA – flow pattern, pressure gradient

The HIP Trial is funded by the European Commission within the 7th Framework Programme

PDA heart failure

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Pulmonary Hypertension

The HIP Trial is funded by the European Commission within the 7th Framework Programme

PPHN - TVI

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Contractility assessment

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Good Contractility

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Poor Contractility

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Hypertrophy

The HIP Trial is funded by the European Commission within the 7th Framework Programme

LVOTO

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Filling (preload assessment – extracardiac IVC filling)

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Pericardial fluid

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Line position

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Normal Finding

Significant Left to Right Shunt - PDA

Coarctation of the Aorta

Low LV Output – Heart Failure

Abdominal Aorta Flow

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Other findings

• Air embolia

• Tumor

• Thrombus

• Etc….

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Functional assessment

• Quantification and normative values

• LVO, RVO – influenced by shunts

• SVC flow, SF, EF

• TDI, strain, strain rate, speckle tracking – not used

routinely in neonates, more research tools

• Visual assesment (Eyeballing)

The HIP Trial is funded by the European Commission within the 7th Framework Programme

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Management

according to Echo findings ???

What to do with what we find

• Fluid administration

• Inotrope administration

• Clinical status!

• So far limited evidence of outcome improvement

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Evolution over the time

Day 1 Day 7 Day 38

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Evolution over the time

FS 19% FS 36%

The HIP Trial is funded by the European Commission within the 7th Framework Programme

• CLOSE COOPERATION WITH PEDIATRIC

CARDIOLOGIST CRUCIAL

• Practice, recognition and availability of functional

neonatal echo varies among countries/centers

The HIP Trial is funded by the European Commission within the 7th Framework Programme

TNE Guidelines

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Practice in Czech Republic

• Tertiary units have someone who is able to perform

neonatal Echo

• Close cooperation with cardiology and cardiac surgery

(Cardiology center)

• Good prenatal diagnostics (lot of CHD recognized

prenatally-delivery in the hospital with cardiology and

cardiac surgery care)

• Self education, courses available

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Summary

• Functional Echo – useful tool in circulatory status

assessment

• Management can’t be based on Echo findings only

• Close cooperation with cardiologist necessary

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Special thanks to Dr. Jachym Kucera

The HIP Trial is funded by the European Commission within the 7th Framework Programme

Thank you for your attention