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6. Guidelines and Recommendations for Targeted Neonatal Echocardiography and Cardiac Point-of-Care Ultrasound in the Neonatal Intensive Care Unit: An Update from the American Society of Echocardiography

Author

McNamara, Patrick J., Jain, Amish, El-Khuffash, Afif, Giesinger, Regan, Weisz, Dany, Freud, Lindsey, Levy, Philip T., Bhombal, Shazia, de Boode, Willem, Leone, Tina, Richards, Bernadette, Singh, Yogen, Acevedo, Jennifer M., Simpson, John, Noori, Shahab, and Lai, Wyman W.

Published
2024
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26. Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Author

Harrison, Adele, Synnes, Anne, Ting, Joseph, Cieslak, Zenon, Sherlock, Rebecca, Yee, Wendy, Aziz, Khalid, Toye, Jennifer, Fajardo, Carlos, Kalapesi, Zarin, Sankaran, Koravangattu, Daspal, Sibasis, Seshia, Mary, Alvaro, Ruben, Mukerji, Amit, Da Silva, Orlando, Nwaesei, Chuks, Lee, Kyong-Soon, Dunn, Michael, Lemyre, Brigitte, Dow, Kimberly, Pelausa, Ermelinda, Barrington, Keith, Drolet, Christine, Piedboeuf, Bruno, Claveau, Martine, Beltempo, Marc, Bertelle, Valerie, Masse, Edith, Canning, Roderick, Makary, Hala, Ojah, Cecil, Monterrosa, Luis, Deshpandey, Akhil, Afifi, Jehier, Kajetanowicz, Andrzej, Andersson, Sture, Tammela, Outi, Sankilampi, Ulla, Saarela, Timo, Heymann, Eli, Zangen, Shmuel, Smolkin, Tatyana, Mimouni, Francis, Bader, David, Rothschild, Avi, Strauss, Zipora, Felszer, Clari, Omari, Hussam, Tov-Friedman, Smadar Even, Bar-Oz, Benjamin, Feldman, Michael, Saad, Nizar, Flidel-Rimon, Orna, Weisbrod, Meir, Lubin, Daniel, Litmanovitz, Ita, Kugelman, Amir, Shinwell, Eric, Klinger, Gil, Nijim, Yousif, Bin-Nun, Alona, Golan, Agneta, Mandel, Dror, Fleisher-Sheffer, Vered, Kohelet, David, Bakhrakh, Lev, Hattori, Satoshi, Shirai, Masaru, Ishioka, Toru, Mori, Toshihiko, Amizuka, Takasuke, Huchimukai, Toru, Yoshida, Hiroshi, Sasaki, Ayako, Shimizu, Junichi, Nakamura, Toshihiko, Maruyama, Mami, Matsumoto, Hiroshi, Hosokawa, Shinichi, Taki, Atsuko, Nakagawa, Machiko, Ko, Kyone, Uozumi, Azusa, Nakata, Setsuko, Shimazaki, Akira, Yoda, Tatsuya, Numata, Osamu, Imamura, Hiroaki, Kobayashi, Azusa, Tokuriki, Shuko, Uchida, Yasushi, Arai, Takahiro, Ito, Mitsuhiro, Ieda, Kuniko, Ono, Toshiyuki, Hayashi, Masashi, Maki, Kanemasa, Yamakawa, Mie- Toru, Kawai, Masahiko, Fujii, Noriko, Shiomi, Kozue, Nozaki, Koji, Wada, Hiroshi, Kim, Taho, Tokunaga, Yasuyuki, Takatera, Akihiro, Oshima, Toshio, Sumida, Hiroshi, Michinomae, Yae, Kusumoto, Yoshio, Yoshimoto, Seiji, Morisawa, Takeshi, Ohashi, Tamaki, Takahashi, Yukihiro, Sugimoto, Moriharu, Ono, Noriaki, Miyagawa, Shinichiro, Saijo, Takahiko, Yamagami, Takashi, Koyano, Kosuke, Kobayashi, Shoko, Kanda, Takeshi, Sakemi, Yoshihiro, Aoki, Mikio, Iida, Koichi, Goshi, Mitsushi, Maruyama, Yuko, Kofron, Jiri, Brodd, Katarina Strand, Odlind, Andreas, Alberg, Lars, Arwehed, Sofia, Hafström, Ola, Kasemo, Anna, Nederman, Karin, Åhman, Lars, Ingemarsson, Fredrik, Petersson, Henrik, Thurn, Pernilla, Albinsson, Eva, Selander, Bo, Abrahamsson, Thomas, Heimdahl, Ingela, Sveinsdottir, Kristbjorg, Wejryd, Erik, Hedlund, Anna, Söderberg, Maria Katarina, Navér, Lars, Brune, Thomas, Bäckström, Jens, Robinson, Johan, Farooqi, Aijaz, Normann, Erik, Fredriksson, Magnus, Palm, Anders, Rosenqvist, Urban, Walde, Bengt, Hagman, Cecilia, Ohlin, Andreas, Florell, Rein, Löfvenberg, Agneta Smedsaas, Meyer, Philipp, Kusche, Rachel, Schulzke, Sven, Nelle, Mathias, Wagner, Bendicht, Riedel, Thomas, Kaczala, Grégoire, Pfister, Riccardo E., Tolsa, Jean-François, Roth, Matthias, Stocker, Martin, Laubscher, Bernhard, Malzacher, Andreas, Micallef, John P., Hegi, Lukas, Arlettaz, Romaine, Bernet, Vera, Isayama, Tetsuya, Kusuda, Satoshi, Reichman, Brian, Lee, Shoo K., Lehtonen, Liisa, Norman, Mikael, Adams, Mark, Bassler, Dirk, Helenius, Kjell, Hakansson, Stellan, Yang, Junmin, Jain, Amish, and Shah, Prakesh S.

Published
2020
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30. Hypotension following Patent Ductus Arteriosus Ligation: The Role of Adrenal Hormones

Author

Clyman, Ronald I, Wickremasinghe, Andrea, Merritt, T Allen, Solomon, Tabitha, McNamara, Patrick, Jain, Amish, Singh, Jaideep, Chu, Alison, Noori, Shahab, Sekar, Krishnamurthy, Lavoie, Pascal M, Attridge, Joshua T, Swanson, Jonathan R, Gillam-Krakauer, Maria, Reese, Jeff, DeMauro, Sara, Poindexter, Brenda, Aucott, Sue, Satpute, Monique, Fernandez, Erika, Auchus, Richard J, and Investigators, Patent Ductus Arteriosus Ligation Hypotension Trial

Subjects
Paediatrics, Biomedical and Clinical Sciences, Pediatric, Neurosciences, Cardiovascular, Rare Diseases, Clinical Research, 2.1 Biological and endogenous factors, Aetiology, Adrenocorticotropic Hormone, Cardiac Surgical Procedures, Catecholamines, Cohort Studies, Drug Resistance, Ductus Arteriosus, Patent, Female, Follow-Up Studies, Humans, Hydrocortisone, Hypotension, Infant, Newborn, Infant, Premature, Ligation, Male, Postoperative Care, Postoperative Complications, Preoperative Care, Retrospective Studies, Risk Assessment, Survival Rate, Patent Ductus Arteriosus Ligation/Hypotension Trial Investigators, Human Movement and Sports Sciences, Paediatrics and Reproductive Medicine, Pediatrics
Abstract

ObjectiveTo test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation.Study designWe performed a multicenter study of infants born at 15.ResultsOf 95 infants enrolled, 43 (45%) developed hypotension and 14 (15%) developed catecholamine-resistant hypotension. Low postoperative cortisol levels were not associated with the overall incidence of hypotension after ligation. However, low cortisol levels were associated with the refractoriness of the hypotension to catecholamine treatment. In a multivariate analysis: the OR for developing catecholamine-resistant hypotension was OR 36.6, 95% CI 2.8-476, P = .006. Low cortisol levels (in infants with catecholamine-resistant hypotension) were not attributable to adrenal immaturity or impairment; their cortisol precursor concentrations were either low or unchanged, and their response to cosyntropin was similar to infants without catecholamine-resistant hypotension.ConclusionInfants with low cortisol concentrations after PDA ligation are likely to develop postoperative catecholamine-resistant hypotension. We speculate that decreased adrenal stimulation, rather than an impaired adrenal response to stimulation, may account for the decreased production.

Published
2014

35. Merits and perils of targeted neonatal echocardiography-based hemodynamic research: a position statement

Author

Kharrat, Ashraf, McNamara, Patrick J., Weisz, Dany, and Jain, Amish

Subjects
Echocardiography -- Technology application -- Analysis, Neonatal intensive care -- Methods -- Technology application, Newborn infants, Infants, Curriculum, Pediatrics, Heart, Doors, Technology application, Biological sciences
Abstract

In the neonatal setting, point-of-care ultrasound is increasingly being used to help clinicians with the evaluation of heart function. Practices in neonatology, particularly with regard to acute and chronic hemodynamic managements, were traditionally more driven on dogma and predefined thresholds and not always supported by demonstrable physiology. For the first time, targeted neonatal echocardiography (TNE) provided neonatal intensivists with a bedside tool that made real- time assessment of neonatal hemodynamics status feasible in even the tiniest of babies. This opened the door towards more targeted physiological driven practices, allowing us to test historical approaches to clinical problems in a more precise way. Despite the standardization of TNE training and the creation of a formalized curriculum, little attention has been paid to the establishment of an empirical framework to adjudicate scientific investigation. In this position statement, we reflect on the evolution of TNE in Canadian neonatal intensive care units, appraise its strengths and limitations, and suggest guiding principles for clinicians and researchers to consider as they take this field forward. Key words: neonate, echocardiography, hemodynamics, research. L'echographie au point de service est de plus en plus utilisee en neonatalogie pour aider les cliniciens a evaluer la fonction cardiaque. La pratique en neonatalogie, en particulier quant a la prise en charge de l'hemodynamie dans des contextes aigus ou prolonges, est classiquement guidee davantage par des dogmes ou des seuils predetermines sans etre toujours appuyee par des faits physiologiques averes. Pour la premiere fois, l'echocardiographie neonatale ciblee (ENC) a permis aux intensivistes en neonatalogie d'obtenir un outil rendant realisable l'evaluation de l'hemodynamie neonatale en temps reel au chevet, meme chez les nouveau-nes les plus petits. Cela a ouvert la voie a une pratique mieux ciblee sur la physiologie, ce qui nous a permis d'evaluer de maniere plus precise les approches historiques en rapport avec des problemes cliniques. En depit de la standardisation de la formation en ENC et de la creation d'un programme d'enseignement formel, on a porte peu d'attention a la creation d'un cadre empirique en vue de statuer sur l'evaluation guidee par des donnees scientifiques. Dans la presente declaration de principes, nous reflechissons sur l'evolution de l'ENC dans le contexte canadien de l'unite des soins intensifs en neonatalogie, nous evaluons ses forces et ses limites, et nous proposons des principes directeurs pour que les cliniciens et les chercheurs les prennent en compte dans leurs actions futures dans ce domaine de la medecine. [Traduit par la Redaction] Mots-cles : neonatalogie, echocardiographie, hemodynamie, recherche., Introduction In the neonatal setting, point-of-care ultrasound is increasingly being used to help clinicians with the evaluation of heart function. Practices in neonatology, particularly with regard to acute and chronic [...]

Published
2019
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42. Neurodevelopmental outcomes of preterm neonates receiving rescue inhaled nitric oxide in the first week of age: a cohort study

Author

Gurram Venkata, Sujith Kumar Reddy, Lodha, Abhay, Hicks, Matthew, Jain, Amish, Lapointe, Anie, Makary, Hala, Kanungo, Jaideep, Lee, Kyong-Soon, Ye, Xiang, Shah, Prakesh S, and Soraisham, Amuchou S

Abstract

ObjectiveTo assess the neurodevelopmental outcomes of preterm neonates who received inhaled nitric oxide (iNO) in the first week of age for hypoxaemic respiratory failure (HRF).MethodsIn this retrospective cohort study, we included neonates born at <29 weeks gestational age (GA) between January 2010 and December 2018 who had a neurodevelopmental assessment at 18–24 months corrected age (CA) at one of the Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment (NDI). We performed propensity score-matched analysis to compare the outcomes of those who received and did not receive iNO.ResultsOf the 5612 eligible neonates, 460 (8.2%) received iNO in the first week of age. Maternal age, receipt of antenatal corticosteroids, GA and birth weight were lower in the iNO group compared with the no-iNO group. Neonates in the iNO group had higher illness severity scores and higher rates of preterm prolonged rupture of membranes and were small for GA. Severe brain injury, bronchopulmonary dysplasia and mortality were higher in the iNO group. Of the 4889 survivors, 3754 (77%) neonates had follow-up data at 18–24 months CA. After propensity score matching, surviving infants who received rescue iNO were not associated with higher odds of NDI (adjusted OR 1.34; 95% CI 0.85 to 2.12).ConclusionsIn preterm neonates <29 weeks GA with HRF, rescue iNO use was not associated with worse neurodevelopmental outcomes among survivors who were assessed at 18–24 months CA.

Published
2024
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44. Rectal Acetaminophen Improves Shunt Volume and Reduces Patent Ductus Arteriosus Ligation in Extremely Preterm Infants.

Author

Castaldo, Michael P., Neary, Elaine, Bischoff, Adrianne R., Weisz, Dany E., Jain, Amish, Giesinger, Regan E., and McNamara, Patrick J.

Subjects
RECTAL medication, ECHOCARDIOGRAPHY, STATISTICS, CYCLOOXYGENASE 2, PATENT ductus arteriosus, ACETAMINOPHEN, NONSTEROIDAL anti-inflammatory agents, RETROSPECTIVE studies, CASE-control method, FISHER exact test, MANN Whitney U Test, TREATMENT effectiveness, T-test (Statistics), COMPARATIVE studies, DESCRIPTIVE statistics, BRONCHOPULMONARY dysplasia, DEATH, LIGATURE (Surgery), EVALUATION
Abstract

Objective An alternative therapy for preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA) is needed when cyclooxygenase inhibitors fail or where treatment is contraindicated due to coexisting renal failure, necrotizing enterocolitis, and/or intestinal perforation. No studies have evaluated the efficacy of per rectum (PR) acetaminophen. The study aimed to evaluate the efficacy of PR acetaminophen in modulating the risk of PDA ligation. Study Design A retrospective matched case–control study was conducted to compare neonates born <29 weeks' gestation with evidence of hsDA, in an era when rescue rectal acetaminophen was used (January 2014–March 2018) as a treatment strategy, versus historical controls (July 2006–August 2012). All patients underwent comprehensive echocardiography assessment of ductal shunt volume according to a standardized protocol. Acetaminophen treated neonates were matched according to demographics, gestation, preintervention echocardiography features, and comorbidities. Control patients were selected when an echocardiography was performed at an equivalent postnatal age. Infants with a genetic syndrome, severe congenital malformation, or major forms of congenital heart disease excluding small atrial septal defect or ventricular septal defect, PDA, or patent formale ovale were excluded. The primary outcome was surgical ligation of the PDA. Secondary outcomes included echocardiography indices of hemodynamic significance, the composite of death, or severe BPD (defined by ventilator dependence at 36 weeks postmenstrual age). Descriptive statistics and univariate (t -tests, Fisher's exact test, and Mann–Whitney U test) analyses were used to evaluate clinical and echocardiography characteristics of the groups and compare outcomes. Results Forty infants (20 cases and 20 controls), with similar demographic and echocardiography features, were compared. Cases received 6.8 ± 0.7 days (60 mg/kg/day) of PR acetaminophen. Responders (n = 12, 60%) had echocardiography evidence of reduced ductal diameter (2.2 mm [1.9–2.6] to 1.1 mm [0–1.7], p = 0.002), left ventricular output (363 ± 108–249 ± 61 mL/min/kg; p = 0.002) and left atrium to aortic root ratio (1.7 ± 0.3–1.3 ± 0.2; p = 0.002) following treatment. The rate of PDA ligation was 50% lower (p = 0.02) and composite outcome of death or severe bronchopulmonary dysplasia was reduced (p = 0.04) in the acetaminophen group. Conclusion Rectal acetaminophen was associated with improvement in echocardiography indices of PDA shunt volume, a 50% reduction in PDA ligation rates and a reduction in the composite outcome of death or severe BPD. Pharmacologic and further prospective clinical studies are needed. Key Points Many preterm infants encounter the clinical consequences of a hemodynamically significant PDA. The merits and optimal timing of PDA ligation remains an area of controversy amongst neonatologists. Cyclooxygenase inhibitors are associated with adverse events or are often contraindicated. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Contributors

Author

Azhibekov, Timur, primary, Blank, Douglas, additional, Breatnach, Colm Riobard, additional, Cox, David J., additional, Boode, Willem-Pieter de, additional, de Waal, Koert, additional, Dempsey, Eugene, additional, Diab, Karim Assaad, additional, Dix, Laura, additional, du Plessis, Adré J., additional, Dyson, R.M., additional, El-Khuffash, Afif Faisal, additional, Eriksen, Beate Horsberg, additional, Evans, Nicholas, additional, Fairchild, Karen D., additional, Fernandez, Erika F., additional, Fugelseth, Drude, additional, Greisen, Gorm, additional, Groves, Alan M., additional, Gupta, Samir, additional, Hijazi, Ziyad M., additional, Hooper, Stuart B., additional, Jain, Amish, additional, Katheria, Anup C., additional, Kluckow, Martin, additional, Lakshminrusimha, Satyan, additional, Lemmers, Petra, additional, Mathew, Bobby, additional, McNamara, Patrick Joseph, additional, Mulkey, Sarah B., additional, Naulaers, Gunnar, additional, Nestaas, Eirik, additional, Nijres, Bassel Mohammad, additional, Noori, Shahab, additional, Osypka, Markus, additional, Phad, Nilkant, additional, Price, Anthony N., additional, Pruetz, Jay D., additional, Rath, Chandra, additional, Seri, Istvan, additional, Shah, Prakesh S., additional, Singh, Yogen, additional, Soleymani, Sadaf, additional, Stark, M.J., additional, Sullivan, Brynne A., additional, Tesoriero, Linda, additional, Ting, Joseph, additional, van Bel, Frank, additional, Victor, Suresh, additional, Votava-Smith, Jodie K., additional, Weindling, Michael, additional, Weisz, Dany, additional, Wright, Ian M.R., additional, and Wu, Tai-Wei, additional

Published
2019
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48. Dopamine or norepinephrine for sepsis-related hypotension in preterm infants: a retrospective cohort study

Author

Nissimov, Sagee, primary, Joye, Sébastien, additional, Kharrat, Ashraf, additional, Zhu, Faith, additional, Ripstein, Gabriella, additional, Baczynski, Michelle, additional, Choudhury, Julie, additional, Jasani, Bonny, additional, Deshpande, Poorva, additional, Ye, Xiang Y., additional, Weisz, Dany E., additional, and Jain, Amish, additional

Published
2022
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