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)

Published in: Health & Medicine

Functional Neonatal Echocardiography in Haemodynamic Disturbancies

  1. 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. 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. 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. 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. 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. 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. 7. CHD - TOF The HIP Trial is funded by the European Commission within the 7th Framework Programme
  8. 8. CHD - VSD The HIP Trial is funded by the European Commission within the 7th Framework Programme
  9. 9. PDA – Left to Right The HIP Trial is funded by the European Commission within the 7th Framework Programme
  10. 10. PDA - Bidirectional The HIP Trial is funded by the European Commission within the 7th Framework Programme
  11. 11. PDA – flow pattern, pressure gradient The HIP Trial is funded by the European Commission within the 7th Framework Programme
  12. 12. PDA heart failure The HIP Trial is funded by the European Commission within the 7th Framework Programme
  13. 13. Pulmonary Hypertension The HIP Trial is funded by the European Commission within the 7th Framework Programme
  14. 14. PPHN - TVI The HIP Trial is funded by the European Commission within the 7th Framework Programme
  15. 15. Contractility assessment The HIP Trial is funded by the European Commission within the 7th Framework Programme
  16. 16. Good Contractility The HIP Trial is funded by the European Commission within the 7th Framework Programme
  17. 17. Poor Contractility The HIP Trial is funded by the European Commission within the 7th Framework Programme
  18. 18. Hypertrophy The HIP Trial is funded by the European Commission within the 7th Framework Programme
  19. 19. LVOTO The HIP Trial is funded by the European Commission within the 7th Framework Programme
  20. 20. Filling (preload assessment – extracardiac IVC filling)The HIP Trial is funded by the European Commission within the 7th Framework Programme
  21. 21. Pericardial fluid The HIP Trial is funded by the European Commission within the 7th Framework Programme
  22. 22. Line position The HIP Trial is funded by the European Commission within the 7th Framework Programme
  23. 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. 24. Other findings• Air embolia• Tumor• Thrombus• Etc…. The HIP Trial is funded by the European Commission within the 7th Framework Programme
  25. 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. 26. The HIP Trial is funded by the European Commission within the 7th Framework Programme
  27. 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. 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. 29. Evolution over the time FS 19% FS 36% The HIP Trial is funded by the European Commission within the 7th Framework Programme
  30. 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. 31. TNE GuidelinesThe HIP Trial is funded by the European Commission within the 7th Framework Programme
  32. 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. 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. 34. Special thanks to Dr. Jachym Kucera The HIP Trial is funded by the European Commission within the 7th Framework Programme
  35. 35. Thank you for your attentionThe HIP Trial is funded by the European Commission within the 7th Framework Programme

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