Skip to main content
SpringerLink
Log in

Echocardiographic assessment of hemodynamic changes in preterm neonates with shock: a prospective pragmatic cohort study

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Shock is a state of circulatory dysfunction and its diagnosis is complex in neonates. Hemodynamic assessment using echocardiography has potential to guide better management regimes in neonates with shock. Objective of this study is to analyze changes in the echocardiographic parameters in preterm neonates with shock at presentation and after resolution. In this prospective pragmatic Cohort study, eligible neonates with shock were monitored for changes in echocardiographic parameters at onset of shock and after resolution of shock. Paired data analysis was done for observed changes in the parameters. Based on initial clinical parameters and echocardiographic parameters, infants were assigned into different types of shock. Data of 37 infants were analyzed for baseline clinical and echocardiographic parameters, and data of 31 infants were analyzed for the changes in the observed parameters after shock resolution. Statistically significant changes were observed in inferior vena cava collapsibility index (ICI), left ventricular end diastolic volume (LVEDV), isovolemic ventricular relaxation time (IVRT), left and right ventricular stroke volume, and ejection fraction (EF). There was no agreement between clinical and echocardiographic definitions of shock.

Conclusion: We noticed shock has overlapping pathophysiologic features. Our study highlights the importance of baseline documentation of echocardiographic parameters of all infants who are at risk of shock and repeat echocardiography at onset of shock to observe the changes in ICI, LVEDV, IVRT, stroke volume, and EF. This would guide pathophysiological management of shock in neonates.

What is Known:

• In neonates pathophysiology of shock is overlapping.

• Echocardiography can help in better understanding and management of shock.

What is New:

• Study gives median changes in major echocardiographic parameters in neonatal shock.

• These changes can guide for selection of volume and inotropes in management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CRT:

Capillary refilling time

EF:

Ejection fraction

EF1:

EF at shock

EF2:

After resolution of shock

E/A ratio:

Mitral valve E wave to A wave ratio

HR:

Heart rate

ICI:

Inferior vena cava collapsibility index

ICI1:

ICI at shock

ICI2 :

ICI after resolution of shock

IVC:

Inferior vena cava

IVRT:

Isovolemic ventricular relaxation time

IVRT1:

IVRT at shock

IVRT2 :

IVRT after resolution of shock

LSV:

Left ventricular stroke volume

LSV1:

LSV at shock

LSV2 :

LSV after resolution of shock

LVEDV:

Left ventricular end diastolic volume

LVEDV1:

LVEDV at shock

LVEDV2:

LVEDV after resolution of shock

LVO:

Left ventricular output

MAP:

Mean arterial pressure

NICU:

Neonatal intensive care unit

RSV:

Right ventricular stroke volume

RSV1:

RSV at shock

RSV2 :

RSV after resolution of shock

RVO:

Right ventricular output

SVR:

Systemic vascular resistance

References

  1. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 6(1):2–8

    Google Scholar 

  2. Giliberti P, Giordano L, Chello G, De Leonibus C, Giliberti P (2010) The scenarios of shock in newborn infants. 23(Suppl 3):27

  3. Sinniah D, Subramaniam T, MyintSoe-Hsiao M (2013) Shock in the neonate. IeJSME 7(2):17–28

  4. de Cássia SR, Clarice G, Soibelmann PR (2010) Sepsis and septic shock in the neonatal period: updating and review of concepts. Rev Bras Tue Intensive. [cited 2020 May 04]; 22(3):280–290. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2010000300011&lng=pt. https://doi.org/10.1590/S0103-507X2010000300011

  5. Sehgal A, McNamara P (2008) Does point-of-care functional echocardiography enhance cardiovascular care in the NICU? J Perinatol 28:729–735. https://doi.org/10.1038/jp.2008.100

    Article  CAS  PubMed  Google Scholar 

  6. Soleymani S, Borzage M, Seri I (2010 Oct) Hemodynamic monitoring in neonates: advances and challenges. J Perinatol Off J Calif Perinat Assoc. 30(Suppl):S38–S45

    Google Scholar 

  7. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, de Luca D (2020) International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 24:65. https://doi.org/10.1186/s13054-020-2787-9

    Article  PubMed  PubMed Central  Google Scholar 

  8. de Boode WP, van der Lee R, Horsberg Eriksen B et al (2018) The role of neonatologist performed echocardiography in the assessment and management of neonatal shock. Pediatr Res 84(Suppl 1):57–67. https://doi.org/10.1038/s41390-018-0081-1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seri I (2001) Neonatal shock: etiology, pathophysiology and management. Prenat Neonatal Med 6. https://doi.org/10.1080/13598630108500263

  10. Saini SS. Hemodynamic changes in preterm neonates with septic shock: a prospective observational study*. - PubMed - NCBI. [cited 2019 Jun 20]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24717905

  11. Baske K, Saini SS, Dutta S, Sundaram V (2018) Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial. Eur J Pediatr 177(9):1335–1342

    Article  CAS  Google Scholar 

  12. Deshpande SA, Platt MP (1997) Association between blood lactate and acid-base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed 76(1):F15–F20. https://doi.org/10.1136/fn.76.1.f15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ma M, Noori S, Maarek J-M, Holschneider DP, Rubinstein EH, Seri I (2015) Prone positioning decreases cardiac output and increases systemic vascular resistance in neonates. J Perinatol Off J Calif Perinat Assoc 35(6):424–427

    CAS  Google Scholar 

  14. Stark MJ, Clifton VL, Wright IMR (2008) Microvascular flow, clinical illness severity and cardiovascular function in the preterm infant. Arch Dis Child Fetal Neonatal Ed 93(4):F271–F274

    Article  CAS  Google Scholar 

  15. Walther FJ, Siassi B, King J, Wu PYK (1986) Echocardiographic measurements in normal preterm and term neonates. Acta Paediatr 75(4):563–568

    Article  CAS  Google Scholar 

  16. Washio Y, Uchiyama A, Nakanishi H, Totsu S, Masumoto K, Kusuda S (2013 Oct) Hemodynamic analysis in infants with late-onset circulatory collapse. Pediatr Int Off J Jpn Pediatr Soc 55(5):582–588

    Article  Google Scholar 

  17. van Laere D, van Overmeire B, Gupta S, El Khuffash A, Savoia M, McNamara PJ et al (2018) Application of NPE in the assessment of a patent ductus arteriosus. Pediatr Res 84(Suppl 1):46–56

    Article  Google Scholar 

  18. Kieliszczyk J, Baranowski W, Kosiak W (2016) Usefulness of ultrasound examination in the evaluation of a neonate’s body fluid status. J Ultrason 16(65):125–134

    Article  Google Scholar 

  19. Meyer S, Todd D, Shadboldt B (2010) Non-invasive cardiac output monitoring in neonates. Arch Dis Child Fetal Neonatal Ed 95(6):F464–F464

    Article  Google Scholar 

  20. Dannevig I, Dale HC, Liestøl K, Lindemann R (2005) Blood pressure in the neonate: three non-invasive oscillometric pressure monitors compared with invasively measured blood pressure. Acta Paediatr 94:191–196. https://doi.org/10.1111/j.1651-2227.2005.tb01889.x

    Article  PubMed  Google Scholar 

  21. Werther T, Aichhorn L, Baumgartner S, Berger A, Klebermass-Schrehof K, Salzer-Muhar U (2018) Discrepancy between invasive and non-invasive blood pressure readings in extremely preterm infants in the first four weeks of life. PLoS One 13(12):e0209831. https://doi.org/10.1371/journal.pone.0209831

    Article  PubMed  PubMed Central  Google Scholar 

  22. McLean AS (2016) Echocardiography in shock management. Crit Care 20:275. https://doi.org/10.1186/s13054-016-1401-7

    Article  PubMed  PubMed Central  Google Scholar 

  23. De Backer D, Giglioli S (2020) Echocardiographic approach to shock. J Emerg Crit Care Med [Online], 3 (2019): n.pag. Web. 10 JUL. 2020. https://jeccm.amegroups.com/article/view/5264

Download references

Author information

Authors and Affiliations

  1. Fernandez Hospital, Hyderabad, India

    Dinesh Pawale, Srinivas Murki, Dattatray Kulkarni, Venkateshwarlu Vardhelli, Deepak Sharma, Tejopratap Oleti & Sai Kiran

  2. Rainbow Children’s Heart Institute, Hyderabad, India

    Shweta Bakhru & Nageswar Rao Koneti

Authors
  1. Dinesh Pawale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srinivas Murki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dattatray Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Venkateshwarlu Vardhelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deepak Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tejopratap Oleti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sai Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shweta Bakhru
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nageswar Rao Koneti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr Dinesh Pawale was a Principal Investigator who collected all data, drafted initial manuscript and revised the manuscript. Dr Srinivas Murki conceptualised and designed study, critically reviewed the manuscript and approved the final version of manuscript. Dr Dattatray Kulkarni helped in data collection and manuscript writing. Dr Venkateshwarlu Vardhelli helped in identifying subjects and managment and anlysis of data. Dr Deepak Sharma helped in developing protocol and drafting initial manuscript. Dr Tejopratap Oleti helped in designing study, drafting initial protocol and reviewed final version of manuscript. Dr Sai Kiran coordinated data collection and data analysis and critically reviewed manucript. Dr Shweta Bakhru analysed all stored echocardiograhic data and reviewed final manuscript. Dr Nageswar Rao Koneti reviewed echocardiographic data, helped in drafting intitial manuscript and analysis of data.

Corresponding author

Correspondence to Dinesh Pawale.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Ethics approval obtained from the Institute’s Ethics Committee (Ec Ref No- 25_2017).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Daniele De Luca

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pawale, D., Murki, S., Kulkarni, D. et al. Echocardiographic assessment of hemodynamic changes in preterm neonates with shock: a prospective pragmatic cohort study. Eur J Pediatr 179, 1893–1899 (2020). https://doi.org/10.1007/s00431-020-03775-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-020-03775-5

Keywords

Search

Navigation