Bandyopadhyay T, Saili A, Yadav D K, Kumar A
Department of Neonatology, PGIMER and Dr. RML Hospital, New Delhi, India.
Department of Neonatology, Lady Hardinge Medical College, New Delhi, India.
J Neonatal Perinatal Med. 2020;13(2):167-173. doi: 10.3233/NPM-180179.
To evaluate the correlation between functional echocardiography and clinical parameters in term neonates with shock.
Cross sectional study of 30 full term newborns who were clinically detected to have shock compared to 30 full term hemodynamically stable neonates. For statistical analysis, cases were further sub classified into cardiogenic and septic shock.
Functional echocardiography revealed inferior vena cava collapsibility index (cIVC), fractional shortening (FS), ejection fraction (EF), cardiac output and superior vena cava (SVC) flow were significantly lower whereas myocardial performance index (MPI) was significantly higher in babies with cardiogenic and septic shock as compared to the controls. Left ventricular end diastolic area (LVEDA) was significantly higher in cardiogenic shock whereas it was significantly lower in septic shock as compared to the controls. Also, cIVC was significantly lower and LVEDA was significantly higher in cardiogenic as compared to the septic shock. In cardiogenic shock SVC flow correlated significantly with capillary filling time and systolic blood pressure. The correlation between functional echocardiographic parameters of cardiogenic and septic shock showed that EF, FS and MPI were positively and significantly correlated (r 0.742, p 0.022 for EF, r 0.766, p 0.016 for FS and r 0.478, p 0.05 for MPI) whereas SVC flow and cIVC were negatively and significantly correlated between cardiogenic and septic shock (r - 0.655, p 0.045 for SVC flow and - 0.578, p 0.05 for cIVC).
In the complex environment of neonatal intensive care unit detection of shock continues to be a major challenge. Functional echocardiography provides an adjunct information to the clinical assessment of shock and helps in monitoring the response to treatment.
评估足月儿休克时心脏功能超声检查与临床参数之间的相关性。
对30例临床诊断为休克的足月儿与30例血流动力学稳定的足月儿进行横断面研究。为进行统计分析，病例进一步分为心源性休克和脓毒性休克。
心脏功能超声检查显示，与对照组相比，心源性休克和脓毒性休克患儿的下腔静脉塌陷指数（cIVC）、缩短分数（FS）、射血分数（EF）、心输出量和上腔静脉（SVC）血流显著降低，而心肌做功指数（MPI）显著升高。与对照组相比，心源性休克患儿的左心室舒张末期面积（LVEDA）显著增大，而脓毒性休克患儿的LVEDA显著减小。此外，与脓毒性休克相比，心源性休克患儿的cIVC显著降低，LVEDA显著升高。在心源性休克中，SVC血流与毛细血管充盈时间和收缩压显著相关。心源性休克和脓毒性休克的心脏功能超声参数之间的相关性表明，EF、FS和MPI呈正相关且显著相关（EF的r = 0.742，p = 0.022；FS的r = 0.766，p = 0.016；MPI的r = 0.478，p = 0.05），而心源性休克和脓毒性休克之间SVC血流和cIVC呈负相关且显著相关（SVC血流的r = -0.655，p = 0.045；cIVC的r = -0.578，p = 0.05）。
在新生儿重症监护病房的复杂环境中，休克的检测仍然是一项重大挑战。心脏功能超声检查为休克的临床评估提供了辅助信息，并有助于监测治疗反应。
