Browning Carmo Kathryn, Lutz Tracey, Berry Andrew, Kluckow Martin, Evans Nick
Neonatal and Paediatric Emergency Transport Service (NETS), Westmead, NSW, Australia.
Grace Centre for Newborn Intensive Care CHW, Sydney, NSW, Australia.
Acta Paediatr. 2016 Dec;105(12):e549-e554. doi: 10.1111/apa.13589. Epub 2016 Oct 14.
To determine the role of clinician performed ultrasound (CPU) during the retrieval and transport of critically ill term and near term newborns.
A neonatologist with portable ultrasound accompanied a sample of newborn retrievals to perform cardiac and cerebral ultrasound before and after transportation.
A total of fifty-five babies were studied. Median birthweight: 3350 g (2220-5030 g). CPU led to a change in the planned receiving hospital in ten babies. Eleven babies were suspected congenital heart disease (CHD) prior to retrieval: eight confirmed CHD by CPU and three normal structure. One transported to a children's hospital for cardiology review was confirmed as having normal structure; one to a perinatal hospital where normal structure was confirmed and one baby died at the referring hospital and postmortem confirmed normal structure. In five babies with clinical pulmonary hypertension, CPU revealed unsuspected CHD. The destination was changed to a paediatric cardiology centre, avoiding a second retrieval. Eleven babies had evidence of haemodynamic compromise allowing targeting of inotropes.
This is the first study of CPU during retrieval of high-risk infants. Ultrasound in retrieval is feasible, allows accurate triage of babies to cardiac centres and may allow more accurate targeting of fluid and inotrope support.
确定临床医生操作超声（CPU）在危重新生儿和近足月新生儿转运过程中的作用。
一名携带便携式超声的新生儿科医生在一组新生儿转运样本中，于转运前后进行心脏和脑部超声检查。
共研究了55例婴儿。中位出生体重：3350克（2220 - 5030克）。CPU导致10例婴儿的预定接收医院发生改变。转运前11例婴儿疑似患有先天性心脏病（CHD）：8例经CPU确诊为CHD，3例结构正常。1例转运至儿童医院进行心脏检查，结果证实结构正常；1例转运至围产期医院，结构正常得到确认，1例婴儿在转诊医院死亡，尸检证实结构正常。在5例临床诊断为肺动脉高压的婴儿中，CPU显示出未被怀疑的CHD。目的地改为儿科心脏病中心，避免了二次转运。11例婴儿有血流动力学受损的证据，可针对性地使用强心剂。
这是第一项关于高危婴儿转运过程中CPU的研究。转运过程中的超声检查可行，能准确将婴儿分诊至心脏中心，还可能更准确地指导液体和强心剂支持的使用。
