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Intravenous administration of ultrasound contrast to critically ill pediatric patients

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Abstract

Background

The off-label use of contrast-enhanced ultrasound has been increasingly used for pediatric patients.

Objective

The purpose of this retrospective study is to report any observed clinical changes associated with the intravenous (IV) administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents.

Materials and methods

All critically ill patients who had 1 or more contrast-enhanced ultrasound scans while being closely monitored in the neonatal, pediatric, or pediatric cardiac intensive care units were identified. Subjective and objective data concerning cardiopulmonary, neurological, and hemodynamic monitoring were extracted from the patient’s electronic medical records. Vital signs and laboratory values before, during, and after administration of ultrasound contrast were obtained. Statistical analyses were performed using JMP Pro, version 15. Results were accepted as statistically significant for P-value<0.05.

Results

Forty-seven contrast-enhanced ultrasound scans were performed on 38 critically ill patients, 2 days to 17 years old, 19 of which were female (50%), and 19 had history of prematurity (50%). At the time of the contrast-enhanced ultrasound scans, 15 patients had cardiac shunts or a patent ductus arteriosus, 25 had respiratory failure requiring invasive mechanical oxygenation and ventilation, 19 were hemodynamically unstable requiring continual vasoactive infusions, and 8 were receiving inhaled nitric oxide. In all cases, no significant respiratory, neurologic, cardiac, perfusion, or vital sign changes associated with IV ultrasound contrast were identified.

Conclusion

This study did not retrospectively identify any adverse clinical effects associated with the IV administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Lydia Sheldon, M.S. Ed., medical writer at Children’s Hospital of Philadelphia, Department of Radiology, for editing this manuscript.

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Authors and Affiliations

  1. Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Becky J. Riggs

  2. Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, 3NW24, Philadelphia, PA, 19104, USA

    Santiago Martinez-Correa, Joseph Stern, Luis Octavio Tierradentro-Garcia, Sophie Haddad, Sudha Anupindi, Susan J. Back, Kassa Darge & Misun Hwang

  3. Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA

    Luis Octavio Tierradentro-Garcia, Sudha Anupindi, Susan J. Back, Kassa Darge & Misun Hwang

Authors
  1. Becky J. Riggs
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  2. Santiago Martinez-Correa
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  3. Joseph Stern
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  4. Luis Octavio Tierradentro-Garcia
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  5. Sophie Haddad
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  6. Sudha Anupindi
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  7. Susan J. Back
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  8. Kassa Darge
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  9. Misun Hwang
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Contributions

Riggs, Hwang, Back, and Darge conceived, supervised, and supported the study. Riggs, Hwang, Martinez-Correa, Stern, Tierradentro-Garcia, Haddad, and Anupindi collated and analyzed the data, performed the statistical analysis, and drafted the initial manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Misun Hwang.

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Conflicts of interest

Dr. Back has an educational grant and investigator-initiated study with Bracco Diagnostics, Inc. Dr. Hwang has an investigator-initiated study with Bracco Diagnostics, Inc and two NIH R01 grants on contrast-enhanced ultrasound applications (R01 NS126469 and R01 NS119473). No other authors have any financial relationships relevant to this article to disclose.

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Supplementary information

ESM 1:

Supplementary Material 1. Number of patients included in the Analysis of Variance to analyze vital sign changes before and after contrast-enhanced ultrasound scans. (DOCX 19 kb)

ESM 2:

Supplementary Material 2. Vital signs of 38 critically ill neonates, infants, children, and adolescents who underwent a total of 47 contrast-enhanced ultrasound examinations. (DOCX 57.8 kb)

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Riggs, B.J., Martinez-Correa, S., Stern, J. et al. Intravenous administration of ultrasound contrast to critically ill pediatric patients. Pediatr Radiol 54, 820–830 (2024). https://doi.org/10.1007/s00247-024-05898-5

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  • DOI: https://doi.org/10.1007/s00247-024-05898-5

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