functional neonatal echocardiography in haemodynamic disturbancies
Post on 11-May-2015
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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
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