International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)

1. Functional Neonatal Echocardiography in
Haemodynamic Disturbancies
Jana Semberova
Institute for the Care of Mother and Child, Prague,
Czech Republic
The HIP Trial is funded by the European Commission within the 7th Framework Programme

2. What can we see on echo when something goes
wrong
The HIP Trial is funded by the European Commission within the 7th Framework Programme

3. Bedside neonatal echocardiography
• Targeted neonatal echocardiography
• Point of care echocardiography (POCT echo)
• Functional echocardiography
The HIP Trial is funded by the European Commission within the 7th Framework Programme

4. WHY to perform the scan
• Circulatory failure – major cause of neonatal morbidity
and mortality
• Measures currently used to assess circulatory status
often inadequate
• Circulation management varies widely
• Lack of standardized approach
• Echo can help to assess haemodynamic status and
perhaps to guide treatment
The HIP Trial is funded by the European Commission within the 7th Framework Programme

5. WHEN to perform the scan?
• Routine (e.g. PDA assesment)
• Clinical status
• Functional assessment – findings may change over
time, sometimes very quickly
The HIP Trial is funded by the European Commission within the 7th Framework Programme

6. The role of functional Echo
• Structure – exclude CHD
• PDA
• PPHN
• Filling, contractility, flow
• Other: Pericardial fluid, line position etc.
The HIP Trial is funded by the European Commission within the 7th Framework Programme

7. CHD - TOF
The HIP Trial is funded by the European Commission within the 7th Framework Programme

8. CHD - VSD
The HIP Trial is funded by the European Commission within the 7th Framework Programme

9. PDA – Left to Right
The HIP Trial is funded by the European Commission within the 7th Framework Programme

10. PDA - Bidirectional
The HIP Trial is funded by the European Commission within the 7th Framework Programme

11. PDA – flow pattern, pressure gradient
The HIP Trial is funded by the European Commission within the 7th Framework Programme

12. PDA heart failure
The HIP Trial is funded by the European Commission within the 7th Framework Programme

13. Pulmonary Hypertension
The HIP Trial is funded by the European Commission within the 7th Framework Programme

14. PPHN - TVI
The HIP Trial is funded by the European Commission within the 7th Framework Programme

15. Contractility assessment
The HIP Trial is funded by the European Commission within the 7th Framework Programme

16. Good Contractility
The HIP Trial is funded by the European Commission within the 7th Framework Programme

17. Poor Contractility
The HIP Trial is funded by the European Commission within the 7th Framework Programme

18. Hypertrophy
The HIP Trial is funded by the European Commission within the 7th Framework Programme

19. LVOTO
The HIP Trial is funded by the European Commission within the 7th Framework Programme

20. Filling (preload assessment – extracardiac IVC filling)
The HIP Trial is funded by the European Commission within the 7th Framework Programme

21. Pericardial fluid
The HIP Trial is funded by the European Commission within the 7th Framework Programme

22. Line position
The HIP Trial is funded by the European Commission within the 7th Framework Programme

23. Abdominal Aorta Flow
Normal Finding
Significant Left to Right Shunt - PDA
Coarctation of the Aorta
Low LV Output – Heart Failure
The HIP Trial is funded by the European Commission within the 7th Framework Programme

24. Other findings
• Air embolia
• Tumor
• Thrombus
• Etc….
The HIP Trial is funded by the European Commission within the 7th Framework Programme

25. Functional assessment
• Quantification and normative values
• LVO, RVO – influenced by shunts
• SVC flow, SF, EF
• TDI, strain, strain rate, speckle tracking – not used
routinely in neonates, more research tools
• Visual assesment (Eyeballing)
The HIP Trial is funded by the European Commission within the 7th Framework Programme

26. The HIP Trial is funded by the European Commission within the 7th Framework Programme

27. Management
according to Echo findings ???
What to do with what we find
• Fluid administration
• Inotrope administration
• Clinical status!
• So far limited evidence of outcome improvement
The HIP Trial is funded by the European Commission within the 7th Framework Programme

28. Evolution over the time
Day 1 Day 7 Day 38
The HIP Trial is funded by the European Commission within the 7th Framework Programme

29. Evolution over the time
FS 19% FS 36%
The HIP Trial is funded by the European Commission within the 7th Framework Programme

30. • CLOSE COOPERATION WITH PEDIATRIC
CARDIOLOGIST CRUCIAL
• Practice, recognition and availability of functional
neonatal echo varies among countries/centers
The HIP Trial is funded by the European Commission within the 7th Framework Programme

31. TNE Guidelines
The HIP Trial is funded by the European Commission within the 7th Framework Programme

32. Practice in Czech Republic
• Tertiary units have someone who is able to perform
neonatal Echo
• Close cooperation with cardiology and cardiac surgery
(Cardiology center)
• Good prenatal diagnostics (lot of CHD recognized
prenatally-delivery in the hospital with cardiology and
cardiac surgery care)
• Self education, courses available
The HIP Trial is funded by the European Commission within the 7th Framework Programme

33. Summary
• Functional Echo – useful tool in circulatory status
assessment
• Management can’t be based on Echo findings only
• Close cooperation with cardiologist necessary
The HIP Trial is funded by the European Commission within the 7th Framework Programme

34. Special thanks to Dr. Jachym Kucera
The HIP Trial is funded by the European Commission within the 7th Framework Programme

35. Thank you for your attention
The HIP Trial is funded by the European Commission within the 7th Framework Programme