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Impact of targeted neonatal echocardiography consultations for critically sick preterm neonates.
Joye, Sébastien; Kharrat, Ashraf; Zhu, Faith; Deshpande, Poorva; Baczynski, Michelle; Jasani, Bonny; Lee, Seungwoo; Mertens, Luc L; McNamara, Patrick J; Shah, Prakesh S; Weisz, Dany E; Jain, Amish.
Afiliación
  • Joye S; Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Kharrat A; Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Zhu F; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
  • Deshpande P; Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Baczynski M; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
  • Jasani B; Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Lee S; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
  • Mertens LL; Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • McNamara PJ; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
  • Shah PS; Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
  • Weisz DE; Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Jain A; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed ; 2024 Sep 03.
Article en En | MEDLINE | ID: mdl-39227145
ABSTRACT
RATIONALE Preterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted neonatal echocardiography consultations (TNE) are increasingly used to guide management, its clinical impact need evaluation.

OBJECTIVES:

To investigate clinical outcomes in relation to TNE utilisation during episodes of ACIs among preterm neonates.

METHODS:

This retrospective cohort study, conducted at two tertiary NICUs over 10 years, included neonates<37 weeks gestational age (GA) who developed ACIs. Patients receiving TNE-guided care (TNE within 24 hours of treatment initiation) were compared with non-TNE management. Outcomes included predischarge mortality, episode-related mortality (<7 days) and a new diagnosis of intraventricular haemorrhage≥grade 3 (IVH-3). Inverse probability of treatment weighting (IPTW) using propensity score was used to account for confounders, including site, birth years and baseline illness severity. MEASUREMENTS AND MAIN

RESULTS:

Of 622 included patients, 297 (48%) had TNE; median (IQR) GA at ACI was 26.4 (25.0-28.4) weeks. TNE group demonstrated higher baseline mean airway pressure, oxygen requirement and heart rate and frequently received both inotrope and iNO during ACI. IPTW analysis revealed TNE was associated with lower mortality (adjusted OR (95% CI) 0.75 (0.59 to 0.95)), episode-related mortality (0.54 (0.40 to 0.72)) and death or IVH-3 (0.78 (0.62 to 0.99)). TNE group received more varied inotropic agents, demonstrated earlier improvements in blood pressures, without increasing overall inotrpoic burden.

CONCLUSIONS:

Among preterm neonates requiring rescue treatments with inotropes/iNO, TNE utilisation to guide clinical management may be associated with improved survival.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Arch Dis Child Fetal Neonatal Ed Asunto de la revista: PEDIATRIA / PERINATOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Arch Dis Child Fetal Neonatal Ed Asunto de la revista: PEDIATRIA / PERINATOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido