Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Department of Internal Medicine, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Pediatr Res. 2023 Aug;94(2):724-729. doi: 10.1038/s41390-023-02526-0. Epub 2023 Feb 18.
The aim of this study was to assess whether neonatologist-performed echocardiography (NPE) changed the previously planned hemodynamic approach in critically ill newborn infants.
This prospective cross-sectional study included the first NPE of 199 neonates. Before the exam, the clinical team was asked about the planned hemodynamic approach and the answer was classified as an intention to change or not to change the therapy. After being informed about the NPE results, the clinical management was grouped as performed as previously planned (maintained) or modified.
NPE modified the planned pre-exam approach in 80 cases (40.2%; 95% CI: 33.3-47.4%), and variables associated with an increased chance of this modification were exams to assess pulmonary hemodynamics (prevalent ratio (PR): 1.75; 95% CI: 1.02-3.00) and to assess systemic flow (PR: 1.68; 95% CI: 1.06-2.68) in relation to those requested for patent ductus arteriosus, pre-exam intention of changing the prescribed management (PR: 2.16; 95% CI: 1.50-3.11), use of catecholamines (PR: 1.68; 95% CI: 1.24-2.28) and birthweight (per kg) (PR: 0.81; 95% CI: 0.68-0.98).
The NPE was an important tool to direct hemodynamic management in a different approach from the previous intention of the clinical team, mainly for critically ill neonates.
This study shows that neonatologist-performed echocardiography guides the therapeutic planning in the NICU, mainly in the more unstable newborns, with lower birthweight and receiving catecholamines. Exams requested with the intention of modifying the current approach were more likely to change the management in a different way than planned pre-exam.
本研究旨在评估新生儿科医师进行的超声心动图（NPE）是否改变了危重新生儿先前计划的血流动力学方法。
这是一项前瞻性的横断面研究，纳入了 199 例新生儿的首次 NPE。在检查前，临床团队被问及计划的血流动力学方法，答案分为改变或不改变治疗的意向。在了解 NPE 结果后，临床管理被分为按原计划进行（维持）或修改。
NPE 改变了 80 例（40.2%；95%CI：33.3-47.4%）计划检查前方法，与增加这种改变可能性相关的变量是评估肺血流动力学（普遍比数比（PR）：1.75；95%CI：1.02-3.00）和评估体循环（PR：1.68；95%CI：1.06-2.68）的检查，与为动脉导管未闭而要求的检查相比，检查前改变规定治疗的意向（PR：2.16；95%CI：1.50-3.11），使用儿茶酚胺（PR：1.68；95%CI：1.24-2.28）和出生体重（每公斤）（PR：0.81；95%CI：0.68-0.98）。
NPE 是指导血流动力学管理的重要工具，与临床团队的先前意图不同，主要适用于危重新生儿。
本研究表明，新生儿科医师进行的超声心动图指导新生儿重症监护病房的治疗计划，主要是在更不稳定的新生儿中，出生体重较低，接受儿茶酚胺治疗。出于改变当前方法的意图而要求的检查更有可能以不同于计划前的方式改变管理。
