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[THE HIP TRIAL] Management of Hypotension In the Preterm Extremely Low Gestational Age Newborn (260777)
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10 Research products, page 1 of 1

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  • Open Access
    Authors: 
    Laere, D. van; Overmeire, B. Van; Gupta, S.; Khuffash, A. El; Savoia, M.; McNamara, P.J.; Schwarz, C.E.; Boode, W.P. de;
    Country: Netherlands
    Project: EC | THE HIP TRIAL (260777)

    In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.

  • Open Access
    Authors: 
    Singh, Yogen; Roehr, Charles Christoph; Tissot, Cecile; Rogerson, Sheryle; Gupta, Samir; Bohlin, Kajsa; Breindahl, Morten; El-Khuffash, Afif; de Boode, Willem; Austin, T.; +20 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.

  • Open Access English
    Authors: 
    Chloe Joynt; Po-Yin Cheung; Po-Yin Cheung; Po-Yin Cheung;
    Publisher: Frontiers Media S.A.
    Project: EC | THE HIP TRIAL (260777)

    Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required. Based on a literature search on published reports, meta-analytic reviews, and selected abstracts, this review discusses the current available information on pharmacologic actions, clinical effects, and side effects of commonly used antihypotensive medications including dopamine, dobutamine, epinephrine, norepinephrine, vasopressin, and milrinone in preterm neonates.

  • Open Access
    Authors: 
    Groves, Alan M.; Singh, Yogen; Dempsey, Eugene; Molnar, Zoltan; Austin, Topun; El-Khuffash, Afif; de Boode, Willem P.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; +18 more
    Publisher: Springer Science and Business Media LLC
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.

  • Open Access
    Authors: 
    de Boode, Willem P.; van der Lee, Robin; Eriksen, Beate Horsberg; Nestaas, Eirik; Dempsey, Eugene; Singh, Yogen; Austin, Topun; El-Khuffash, Afif; Bohlin, K.; Bravo, M. C.; +18 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    Abstract: One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.

  • Open Access
    Authors: 
    de Boode, Willem P.; Singh, Yogen; Molnar, Zoltan; Schubert, Ulf; Savoia, Marilena; Sehgal, Arvind; Levy, Philip; McNamara, Patrick; El-Khuffash, Afif; Austin, T.; +18 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Pulmonary hypertension contributes to morbidity and mortality in both the term newborn infant, referred to as persistent pulmonary hypertension of the newborn (PPHN), and the premature infant, in the setting of abnormal pulmonary vasculature development and arrested growth. In the term infant, PPHN is characterized by the failure of the physiological postnatal decrease in pulmonary vascular resistance that results in impaired oxygenation, right ventricular failure, and pulmonary-to-systemic shunting. The pulmonary vasculature is either maladapted, maldeveloped, or underdeveloped. In the premature infant, the mechanisms are similar in that the early onset pulmonary hypertension (PH) is due to pulmonary vascular immaturity and its underdevelopment, while late onset PH is due to the maladaptation of the pulmonary circulation that is seen with severe bronchopulmonary dysplasia. This may lead to cor-pulmonale if left undiagnosed and untreated. Neonatologist performed echocardiography (NPE) should be considered in any preterm or term neonate that presents with risk factors suggesting PPHN. In this review, we discuss the risk factors for PPHN in term and preterm infants, the etiologies, and the pathophysiological mechanisms as they relate to growth and development of the pulmonary vasculature. We explore the applications of NPE techniques that aid in the correct diagnostic and pathophysiological assessment of the most common neonatal etiologies of PPHN and provide guidelines for using these techniques to optimize the management of the neonate with PPHN.

  • Open Access
    Authors: 
    EL-Khuffash, Afif; Schubert, Ulf; Levy, Philip T.; Nestaas, Eirik; de Boode, Willem P.; Austin, T.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; Breindahl, M.; +18 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.

  • Open Access
    Authors: 
    Nestaas, Eirik; Schubert, Ulf; de Boode, Willem P.; EL-Khuffash, Afif; Austin, T.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; Breindahl, M.; Dempsey, E.; +18 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.

  • Open Access English
    Authors: 
    Levy, Philip; Tissot, Cecile; Eriksen, Beate Horsberg; Nestaas, Eirik; Rogerson, Sheryle; McNamara, Patrick J.; El-Khuffash, Afif; de Boode, Willem P.; Austin, T.; Bohlin, K.; +20 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    AbstractNeonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.

  • Open Access
    Authors: 
    Stranák Z; Jana Semberova; Keith J. Barrington; Colm P F O'Donnell; Neil Marlow; Gunnar Naulaers; Eugene M. Dempsey;
    Publisher: Springer Science and Business Media LLC
    Project: EC | THE HIP TRIAL (260777)

    Hypotension is a commonly diagnosed and treated complication of extremely low gestational age newborns (ELGAN), but enormous variation in diagnosis, management and clinical practice has been documented. We sought to evaluate practice regarding the management of hypotension in ELGANs and developed a web-based questionnaire addressing diagnosis, intervention thresholds and modes of treatment of hypotension in ELGANs. We received 216 completed questionnaires from respondents in 38 countries. Most responses (83 %) were from specialist units where, together, over 26,000 very low birth weight (VLBW) infants are cared for annually. The majority (73 %) defined hypotension as a mean blood pressure (BP) in mmHg less than the gestational age in weeks. Sixty percent assessed the circulation with additional methods; echocardiography was the most commonly used (74 %), with left ventricular output and fractional shortening the two most common measurements made. The majority (85 %) used volume administration as the initial intervention. Dopamine was the inotrope most commonly used initially (80 %). If the initial inotrope therapy failed, dobutamine was the most popular second-line treatment (28 %). Delayed cord clamping was used at 51 % of the centres. Conclusion: The definition of hypotension in ELGANs continues to follow traditional standards. Functional echocardiography is now used to assess the circulation at many centres. Volume expansion and dopamine remain the most frequently used therapies. Electronic supplementary material The online version of this article (doi:10.1007/s00431-013-2251-9) contains supplementary material, which is available to authorized users.

Advanced search in
Research products
arrow_drop_down
Searching FieldsTerms
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arrow_drop_down
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[THE HIP TRIAL] Management of Hypotension In the Preterm Extremely Low Gestational Age Newborn (260777)
Include:
The following results are related to Canada. Are you interested to view more results? Visit OpenAIRE - Explore.
10 Research products, page 1 of 1
  • Open Access
    Authors: 
    Laere, D. van; Overmeire, B. Van; Gupta, S.; Khuffash, A. El; Savoia, M.; McNamara, P.J.; Schwarz, C.E.; Boode, W.P. de;
    Country: Netherlands
    Project: EC | THE HIP TRIAL (260777)

    In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.

  • Open Access
    Authors: 
    Singh, Yogen; Roehr, Charles Christoph; Tissot, Cecile; Rogerson, Sheryle; Gupta, Samir; Bohlin, Kajsa; Breindahl, Morten; El-Khuffash, Afif; de Boode, Willem; Austin, T.; +20 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.

  • Open Access English
    Authors: 
    Chloe Joynt; Po-Yin Cheung; Po-Yin Cheung; Po-Yin Cheung;
    Publisher: Frontiers Media S.A.
    Project: EC | THE HIP TRIAL (260777)

    Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required. Based on a literature search on published reports, meta-analytic reviews, and selected abstracts, this review discusses the current available information on pharmacologic actions, clinical effects, and side effects of commonly used antihypotensive medications including dopamine, dobutamine, epinephrine, norepinephrine, vasopressin, and milrinone in preterm neonates.

  • Open Access
    Authors: 
    Groves, Alan M.; Singh, Yogen; Dempsey, Eugene; Molnar, Zoltan; Austin, Topun; El-Khuffash, Afif; de Boode, Willem P.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; +18 more
    Publisher: Springer Science and Business Media LLC
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.

  • Open Access
    Authors: 
    de Boode, Willem P.; van der Lee, Robin; Eriksen, Beate Horsberg; Nestaas, Eirik; Dempsey, Eugene; Singh, Yogen; Austin, Topun; El-Khuffash, Afif; Bohlin, K.; Bravo, M. C.; +18 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    Abstract: One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.

  • Open Access
    Authors: 
    de Boode, Willem P.; Singh, Yogen; Molnar, Zoltan; Schubert, Ulf; Savoia, Marilena; Sehgal, Arvind; Levy, Philip; McNamara, Patrick; El-Khuffash, Afif; Austin, T.; +18 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Pulmonary hypertension contributes to morbidity and mortality in both the term newborn infant, referred to as persistent pulmonary hypertension of the newborn (PPHN), and the premature infant, in the setting of abnormal pulmonary vasculature development and arrested growth. In the term infant, PPHN is characterized by the failure of the physiological postnatal decrease in pulmonary vascular resistance that results in impaired oxygenation, right ventricular failure, and pulmonary-to-systemic shunting. The pulmonary vasculature is either maladapted, maldeveloped, or underdeveloped. In the premature infant, the mechanisms are similar in that the early onset pulmonary hypertension (PH) is due to pulmonary vascular immaturity and its underdevelopment, while late onset PH is due to the maladaptation of the pulmonary circulation that is seen with severe bronchopulmonary dysplasia. This may lead to cor-pulmonale if left undiagnosed and untreated. Neonatologist performed echocardiography (NPE) should be considered in any preterm or term neonate that presents with risk factors suggesting PPHN. In this review, we discuss the risk factors for PPHN in term and preterm infants, the etiologies, and the pathophysiological mechanisms as they relate to growth and development of the pulmonary vasculature. We explore the applications of NPE techniques that aid in the correct diagnostic and pathophysiological assessment of the most common neonatal etiologies of PPHN and provide guidelines for using these techniques to optimize the management of the neonate with PPHN.

  • Open Access
    Authors: 
    EL-Khuffash, Afif; Schubert, Ulf; Levy, Philip T.; Nestaas, Eirik; de Boode, Willem P.; Austin, T.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; Breindahl, M.; +18 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.

  • Open Access
    Authors: 
    Nestaas, Eirik; Schubert, Ulf; de Boode, Willem P.; EL-Khuffash, Afif; Austin, T.; Bohlin, K.; Bravo, M. C.; Breatnach, C. R.; Breindahl, M.; Dempsey, E.; +18 more
    Countries: Belgium, Netherlands
    Project: EC | THE HIP TRIAL (260777)

    Abstract: Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.

  • Open Access English
    Authors: 
    Levy, Philip; Tissot, Cecile; Eriksen, Beate Horsberg; Nestaas, Eirik; Rogerson, Sheryle; McNamara, Patrick J.; El-Khuffash, Afif; de Boode, Willem P.; Austin, T.; Bohlin, K.; +20 more
    Countries: Netherlands, Belgium
    Project: EC | THE HIP TRIAL (260777)

    AbstractNeonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.

  • Open Access
    Authors: 
    Stranák Z; Jana Semberova; Keith J. Barrington; Colm P F O'Donnell; Neil Marlow; Gunnar Naulaers; Eugene M. Dempsey;
    Publisher: Springer Science and Business Media LLC
    Project: EC | THE HIP TRIAL (260777)

    Hypotension is a commonly diagnosed and treated complication of extremely low gestational age newborns (ELGAN), but enormous variation in diagnosis, management and clinical practice has been documented. We sought to evaluate practice regarding the management of hypotension in ELGANs and developed a web-based questionnaire addressing diagnosis, intervention thresholds and modes of treatment of hypotension in ELGANs. We received 216 completed questionnaires from respondents in 38 countries. Most responses (83 %) were from specialist units where, together, over 26,000 very low birth weight (VLBW) infants are cared for annually. The majority (73 %) defined hypotension as a mean blood pressure (BP) in mmHg less than the gestational age in weeks. Sixty percent assessed the circulation with additional methods; echocardiography was the most commonly used (74 %), with left ventricular output and fractional shortening the two most common measurements made. The majority (85 %) used volume administration as the initial intervention. Dopamine was the inotrope most commonly used initially (80 %). If the initial inotrope therapy failed, dobutamine was the most popular second-line treatment (28 %). Delayed cord clamping was used at 51 % of the centres. Conclusion: The definition of hypotension in ELGANs continues to follow traditional standards. Functional echocardiography is now used to assess the circulation at many centres. Volume expansion and dopamine remain the most frequently used therapies. Electronic supplementary material The online version of this article (doi:10.1007/s00431-013-2251-9) contains supplementary material, which is available to authorized users.