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Functional Neonatal Echocardiography in Haemodynamic Disturbancies

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International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)

International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)

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  • 1. Functional Neonatal Echocardiography in Haemodynamic Disturbancies Jana Semberova Institute for the Care of Mother and Child, Prague, Czech RepublicThe HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 2. What can we see on echo when something goes wrongThe HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. CHD - TOF The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 8. CHD - VSD The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 9. PDA – Left to Right The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 10. PDA - Bidirectional The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 11. PDA – flow pattern, pressure gradient The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 12. PDA heart failure The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 13. Pulmonary Hypertension The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 14. PPHN - TVI The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 15. Contractility assessment The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 16. Good Contractility The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 17. Poor Contractility The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 18. Hypertrophy The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 19. LVOTO The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 20. Filling (preload assessment – extracardiac IVC filling)The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 21. Pericardial fluid The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 22. Line position The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 23. Abdominal Aorta Flow Normal Finding Significant Left to Right Shunt - PDA Coarctation of the Aorta Low LV Output – Heart FailureThe HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 24. Other findings• Air embolia• Tumor• Thrombus• Etc…. The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 25. 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
  • 26. The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 27. Managementaccording 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
  • 28. Evolution over the time Day 1 Day 7 Day 38The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 29. Evolution over the time FS 19% FS 36% The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 30. • 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
  • 31. TNE GuidelinesThe HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 32. 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
  • 33. 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
  • 34. Special thanks to Dr. Jachym Kucera The HIP Trial is funded by the European Commission within the 7th Framework Programme
  • 35. Thank you for your attentionThe HIP Trial is funded by the European Commission within the 7th Framework Programme

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