Division of Neonatology, Department of Paediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6815-6822. doi: 10.1080/14767058.2021.1926447. Epub 2021 May 13.
There are no established clinical or laboratory markers of preload adequacy and fluid responsiveness in management of neonatal shock. Functional echocardiographic preload markers are evaluated in children and adults, but there is no data in neonatal septic shock. We evaluated five functional echocardiographic preload markers during intravenous volume resuscitation in neonatal septic shock.
(1) To compare baseline functional echocardiographic preload markers between neonates with septic shock and their "matched" healthy controls. (2) To compare echocardiographic preload markers before and after intravenous volume resuscitation.
In this cohort study, we enrolled neonates with septic shock (cases) and recorded five preload markers - inferior vena cava collapsibility index (IVC-CI), left ventricular end-diastolic (LVEDV) & end-systolic volume (LVESV) and their indices (LVEDVI, LVESVI) - before initiation of intravenous fluid resuscitation (baseline evaluation). An equal number of "matched hemodynamically stable" controls were recruited, who underwent functional echocardiographic assessment once. In neonates with shock, we recorded these markers again after volume resuscitation.
We analyzed 46 neonates (23 cases and 23 controls). Neonates with shock had significantly elevated baseline IVC-CI as compared to controls [53% (21, 100) vs. 20% (15, 24) respectively, -value = .01). Rest 4 echocardiographic markers (LVEDV, LVESV, LVEDVI, and LVESVI) were comparable between cases and controls. Sixteen neonates (70% of 23) received intravenous fluid resuscitation and rest 7 (30%) were started directly on vasoactive drugs. None of the preload markers changed significantly after volume resuscitation as compared to the baseline values including IVC-CI, which was almost significant [74% (33, 100) at baseline to 48% (13, 93) after 10 mL/kg and 50% (40, 69) after 20 mL/kg, ( = .05). All preload markers were comparable between survivors and non-survivors.
Neonates with septic shock had significantly elevated IVC-CI at baseline as compared to hemodynamically stable neonates. None of the preload markers changed significantly after volume resuscitation as compared to the baseline values including IVC-CI, which was almost significant.
在新生儿休克的管理中，尚无明确的临床或实验室指标来评估前负荷充足性和液体反应性。功能性超声心动图前负荷标志物已在儿童和成人中进行了评估，但在新生儿感染性休克中尚无数据。我们评估了在新生儿感染性休克的静脉输液复苏过程中五个功能性超声心动图前负荷标志物。
（1）比较感染性休克新生儿与“匹配”健康对照组之间的基线功能性超声心动图前负荷标志物。（2）比较静脉输液复苏前后的超声心动图前负荷标志物。
在这项队列研究中，我们纳入了感染性休克的新生儿（病例组），并在开始静脉补液复苏前（基线评估）记录了五个前负荷标志物：下腔静脉塌陷指数（IVC-CI）、左心室舒张末期（LVEDV）和收缩末期容积（LVESV）及其指数（LVEDVI、LVESVI）。还招募了相同数量的“血流动力学稳定”的匹配对照组，这些对照组仅接受一次功能性超声心动图评估。在休克新生儿中，我们在容量复苏后再次记录这些标志物。
我们分析了 46 名新生儿（23 例病例和 23 例对照组）。与对照组相比，休克新生儿的基线 IVC-CI 显著升高[分别为 53%（21，100）和 20%（15，24），-值=0.01]。其余 4 个超声心动图标志物（LVEDV、LVESV、LVEDVI 和 LVESVI）在病例组和对照组之间无差异。16 名新生儿（23 名中的 70%）接受了静脉补液复苏，其余 7 名（30%）直接开始使用血管活性药物。与基线值相比，包括 IVC-CI 在内的所有前负荷标志物在容量复苏后均无显著变化，IVC-CI 几乎有统计学意义[分别为基线时的 74%（33，100）至 10 mL/kg 后 48%（13，93）和 20 mL/kg 后 50%（40，69），=0.05]。幸存者和非幸存者之间的所有前负荷标志物均无差异。
与血流动力学稳定的新生儿相比，感染性休克的新生儿在基线时 IVC-CI 显著升高。与基线值相比，包括 IVC-CI 在内的所有前负荷标志物在容量复苏后均无显著变化，IVC-CI 几乎有统计学意义。
