Skip to main content

Advertisement

Log in

Functional Echocardiography in the Neonatal Intensive Care Unit

  • Rational Diagnostics
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

The role of functional echocardiography in neonatal intensive care unit is rapidly evolving, and increasingly neonatologists are using it in making clinical decisions in sick infants. Functional echocardiography can provide a direct assessment of hemodynamics on bedside, and may be considered as an extension of the clinical examination to evaluate cardiovascular wellbeing in the critically-ill infant. The physiological information may be used in targeting specific intervention based upon the underlying pathophysiology. Functional echocardiography is being used for diagnosis of pulmonary hypertension, patent ductus arteriosus, hemodynamic evaluation, assessment of cardiac function, and recognition of pericardial effusion and cardiac tamponade in the neonatal intensive care setting. Despite of its increasing popularity, there is a paucity of structured training programs for neonatologists to acquire skills in echocardiography. This review article discusses clinical applications of functional echocardiography in the neonatal intensive care unit.

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

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Beaulieu Y. Bedside echocardiography in the assessment of the critically ill. Crit Care Med. 2007;35:S235–49.

    Article  PubMed  Google Scholar 

  2. Kluckow M, Seri I, Evans N. Functional echocardiography: An emerging clinical tool for the neonatologist. J Pediatr. 2007;150:125–30.

    Article  PubMed  Google Scholar 

  3. Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr. 2017;5:201.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Singh Y. Neonatologist performed echocardiography: Expert consensus statement and current practice in the UK. Eur J Pediatr. 2016;175:1709.

    Article  Google Scholar 

  5. Singh Y, Gupta S, Groves AM, Gandhi A, Thomson J, Qureshi S, et al. ‘Neonatologist-performed Echocardiography (NoPE)'-Training and Accreditation in UK. Eur J Pediatr. 2016;175:281–7.

    Article  PubMed  Google Scholar 

  6. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, et al. Targeted Neonatal Echocardiography in The Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr. 2011;24:1057–78.

    PubMed  Google Scholar 

  7. De Boode W, Singh Y, Gupta S, Austin T, Bohlin K, Dempsey E, et al. Recommendations for Neonatologist Performed Echocardiography in Europe: Consensus Statement Endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res. 2016;80:465–71.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Subhedar NV, Hamdan AH, Ryan SW, Shaw NJ. Pulmonary artery pressure: Early predictor of chronic lung disease in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1998;78:F20–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Nagiub M, Lee S, Guglani L. Echocardiographic assessment of pulmonary hypertension in Infants with bronchopulmonary dysplasia: Systematic review of literature and a proposed algorithm for assessment. Echocardiography. 2015;32:819–33.

    Article  PubMed  Google Scholar 

  10. Jone PN, Ivy PD. Echocardiography in pediatric pulmonary hypertension. Front Pediatr. 2014;2:1–15.

    Article  Google Scholar 

  11. Jain A, Mohamed A, El-Khuffash A, Connelly KA, Dallaire F, Jankov RP, et al. A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: Normative data and z scores. J Am Soc Echocardiogr. 2014;27:1293–304.

    Article  PubMed  Google Scholar 

  12. Czernik C, Rhode S, Metze B, Schmalisch G, Bühreret C. Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia. PLoS One. 2012;7:e38352.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Levy PT, Patel MD, Groh G, Choudhry S, Murphy J, Holland MR, et al. Pulmonary artery acceleration time provides a reliable estimate of invasive pulmonary hemodynamics in children. J Am Soc Echocardiogr. 2016;29:1056–65.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Singh Y, Katheria A, Vora F. Advances in diagnosis and management of hemodynamic instability in neonatal shock. TINEC research paper. Front Pediatr. 2018;6:2.

    Article  Google Scholar 

  15. de Waal K, Kluckow M. Functional echocardiography: From physiology to treatment. Early Hum Dev. 2010;86:149–54.

    Article  PubMed  Google Scholar 

  16. Benitz WE and Committee on fetus and newborn. Patent ductus arteriosus in preterm infants. Pediatrics. 2016;137:e20153730.

    Article  Google Scholar 

  17. Noori S. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol. 2010;30:S31–S37.

    Article  PubMed  Google Scholar 

  18. Romaine A. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Front Pediatr. 2017;5:147.

    Article  Google Scholar 

  19. McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: The need for disease staging. Arch Dis Child Fetal Neonatal Ed. 2007;92:F424–7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics. 2009;123:e138–44.

    Article  PubMed  Google Scholar 

  21. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev. 2015;2:CD003481.

    Google Scholar 

  22. El-Khuffash A, Weisz DE, McNamara PJ. Reflections of the changes in patent ductus arteriosus management during the last 10 years. Arch Dis Child Fetal Neonatal Ed. 2016;101:F474–8.

    Article  PubMed  Google Scholar 

  23. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK, et al. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol. 2001;21:272–8.

    Article  PubMed  CAS  Google Scholar 

  24. Osborn DA, Evans N, Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed. 2004;89:F168–73.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Evans JR, Lou SB, Van MK, Cheryl SH. Cardiovascular support in preterm infants. Clin Ther. 2006;28:1366–84.

    Article  PubMed  CAS  Google Scholar 

  26. Kluckow M, Evans N. Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr. 1996;129:506–12.

    Article  PubMed  CAS  Google Scholar 

  27. Mistry K, Gupta C. Neonatal hypertension. NeoReviews. 2017;18:357–71.

    Article  Google Scholar 

  28. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, et al. Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465–95.

    Article  PubMed  Google Scholar 

  29. Evans N, Kluckow M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996;74:F88–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Kluckow M, Evans N. Superior vena cava flow in newborn infants: A novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed. 2000;82:F182–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics. 2003;112:33–9.

    Article  PubMed  Google Scholar 

  32. Hunt RW, Evans N, Rieger I, Kluckow M. Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatr. 2004;145:588–92.

    Article  PubMed  Google Scholar 

  33. Groves AM, Kuschel CA, Knight DB, Skinner JR. Echocardiographic assessment of blood flow volume in the superior vena cava and descending aorta in the newborn infant. Arch Dis Child Fetal Neonatal Ed. 2008;93:F24–8.

    Article  PubMed  CAS  Google Scholar 

  34. Ficial B, Finnemore AE, Cox DJ, Broadhouse KM, Price AN, Durighel G, et al. Validation study of the accuracy of echocardiographic measurements of systemic blood flow volume in newborn infants. J Am Soc Echocardiogr. 2013;26:1365–71.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sutherland GR, Di Salvo G, Claus P, D'hooge J, Bijnens B. Strain and strain rate imaging: A new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr. 2004;17:788–802.

    Article  PubMed  Google Scholar 

  36. Breatnach CR, James AT, Levy PT, James AT, Franklin O, El-Khuffash A. Novel echocardiography methods in the functional assessment of the newborn heart. Neonatology. 2016;110:248–60.

    Article  PubMed  Google Scholar 

  37. Tham EB, Silverman NH. Measurement of the Tei index: A comparison of M-mode and pulse Doppler methods. J Am Soc Echocardiogr. 2004;17:1259–65.

    Article  PubMed  Google Scholar 

  38. Harada K, Tamura M, Toyono M, Yasuoka K. Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease. Am J Cardiol. 2002;90:566–9.

    Article  PubMed  Google Scholar 

  39. Iyer V, Sharma DM, Charki S, Mohanty PK. Cardiac tamponade in a neonate: A dreadful condition—need for functional echo? BMJ Case Rep. 2014; 2014: bcr2014207040.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics. 2002;110:137–42.

    Article  PubMed  Google Scholar 

  41. Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666–88.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Evans N. Which inotrope for which baby? Arch Dis Child Fetal Neonatal Ed. 2006;91:F213–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. de Carvalho Onofre PS, da Luz Gonçalves Pedreira M, Peterlini MA. Placement of peripherally inserted central catheters in children guided by ultrasound: A prospective randomized, and controlled trial. Pediatr Crit Care Med. 2012;13:e282–7.

    Article  PubMed  Google Scholar 

  44. Telang N, Sharma D, Pratap OT, Kandraju H, Murki S. Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion: A pilot study. Indian J Med Res. 2017;145:373–6.

    PubMed  PubMed Central  Google Scholar 

  45. Chock VY. Therapeutic techniques: Peripherally inserted central catheters in neonates. NeoReviews. 2004;5:e60–2.

    Article  Google Scholar 

  46. Tauzin L, Sigur N, Joubert C, Parra J, Hassid S, Moulies ME. Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants. Acta Paediatr. 2013;102:703–6.

    Article  PubMed  Google Scholar 

  47. Sehgal A, McNamara PJ. Does point-of-care functional echocardiography enhance cardiovascular care in the NICU? J Perinatol. 2008;28:729–35.

    Article  PubMed  CAS  Google Scholar 

  48. O'Rourke DJ, El-Khuffash A, Moody C, Walsh K, Molloy EJ. Patent ductus arteriosus evaluation by serial echocardiography in preterm infants. Acta Paediatr. 2008;97:574–8.

    Article  PubMed  CAS  Google Scholar 

  49. Kadivar M, Kiani A, Kocharian A, Shabanian R, Nasehi L, Ghajarzadeh M. Echocardiography and management of sick neonates in the intensive care unit. Congenit Heart Dis. 2008;3:325–9.

    Article  PubMed  Google Scholar 

  50. Carmo KB, Evans N, Paradisis M. Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography. J Pediatr. 2009;155:819–22.

    Article  PubMed  CAS  Google Scholar 

  51. Sehgal A, Francis JV, James A, McNamara PJ. Patent ductus arteriosus ligation and post-operative hemodynamic instability: case report and framework for enhanced neonatal care. Indian J Pediatr. 2010;77:905–7.

    Article  PubMed  Google Scholar 

  52. Norri S, Friedlich P, Seri I, Wong P. Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm Infants. J Pediatr. 2007;150:597–602.

    Article  Google Scholar 

  53. Moss S, Kitchiner D, Yoxall C, Subhedar NV. Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed. 2003;88:F287–91.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yogen Singh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, Y., Katheria, A. & Tissot, C. Functional Echocardiography in the Neonatal Intensive Care Unit. Indian Pediatr 55, 417–424 (2018). https://doi.org/10.1007/s13312-018-1286-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-018-1286-4

Keywords

Navigation