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

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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.

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Fig. 2

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Capillary refilling time


Ejection fraction


EF at shock


After resolution of shock

E/A ratio:

Mitral valve E wave to A wave ratio


Heart rate


Inferior vena cava collapsibility index


ICI at shock

ICI2 :

ICI after resolution of shock


Inferior vena cava


Isovolemic ventricular relaxation time


IVRT at shock


IVRT after resolution of shock


Left ventricular stroke volume


LSV at shock

LSV2 :

LSV after resolution of shock


Left ventricular end diastolic volume


LVEDV at shock


LVEDV after resolution of shock


Left ventricular output


Mean arterial pressure


Neonatal intensive care unit


Right ventricular stroke volume


RSV at shock

RSV2 :

RSV after resolution of shock


Right ventricular output


Systemic vascular resistance


  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:

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

    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.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seri I (2001) Neonatal shock: etiology, pathophysiology and management. Prenat Neonatal Med 6.

  10. Saini SS. Hemodynamic changes in preterm neonates with septic shock: a prospective observational study*. - PubMed - NCBI. [cited 2019 Jun 20]. Available from:

  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.

    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.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  22. McLean AS (2016) Echocardiography in shock management. Crit Care 20:275.

    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.

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Authors and Affiliations



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.

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Correspondence to Dinesh Pawale.

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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).

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

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Communicated by Daniele De Luca

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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).

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