Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study

Abdulaziz Homedi; Andrea De La Hoz; Michael R. Miller; Renjini Lalitha; Marisha McClean; Soume Bhattacharya

doi:10.1055/s-0043-1774313

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e2703-e2709
DOI: 10.1055/s-0043-1774313

Original Article

Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study

Authors

Abdulaziz Homedi

¹Department of Pediatrics, Western University, London, Ontario, Canada
Andrea De La Hoz

²Department of Lawson Research – Medicine, London Health Sciences Centre, London, Ontario, Canada
Michael R. Miller

¹Department of Pediatrics, Western University, London, Ontario, Canada

²Department of Lawson Research – Medicine, London Health Sciences Centre, London, Ontario, Canada
Renjini Lalitha

¹Department of Pediatrics, Western University, London, Ontario, Canada
Marisha McClean

¹Department of Pediatrics, Western University, London, Ontario, Canada
Soume Bhattacharya

¹Department of Pediatrics, Western University, London, Ontario, Canada

Abstract

Objective Comprehensive assessment of hemodynamic significance of a patent ductus arteriosus (PDA) is a common indication to perform targeted neonatal echocardiography (TNE). Impact of implementation of such an assessment on PDA management decisions remains to be reported. The objective of this study is to compare PDA-related hemodynamic information and PDA treatment decisions before and after introduction of TNE service.

Study Design This was a retrospective cohort study at a tertiary level neonatal intensive care unit in Southwestern Ontario. We investigated two time periods: Epoch-1 (non-TNE 2013–2016) versus Epoch-2 (TNE 2018–2021). We included neonates < 32 weeks with PDA. Data on baseline clinical characteristics, PDA-related echocardiographic parameters, PDA treatment details, and relevant long-term outcomes were collected. Primary outcome was defined as PDA treatment rates and need for multiple courses. Secondary outcomes included availability of PDA hemodynamic data and neonatal mortality/morbidity (PDA-related)

Results A total of 275 neonates were included. A total of 162 were assessed by conventional echocardiography in Epoch-1, whereas 113 were assessed by TNE in Epoch-2. Baseline clinical characteristics were similar. Epoch-2 had more echocardiographic assessments per patient of 2.7 (±1.8) versus 1.9 (± 1.3), p < 0.001 in Epoch1. The mean postnatal age at first echocardiographic assessment was higher in Epoch-2 (12.7 days [ ± 14.6]) than in Epoch-1 (7.9 days [ ± 10.4]), p < 0.001. Comprehensive hemodynamic assessment of PDA-related echocardiographic parameters such as PDA size, shunt pattern, effect on systemic circulation, and pulmonary circulation were higher in Epoch-2. Overall, PDA treatment rates were comparable in the two time periods. The use of multiple courses of treatment was higher in Epoch-1 than in Epoch-2 (47.8 vs. 31.7%, p = 0.047). In Epoch-1, neonates received PDA treatment earlier than in Epoch-2.

Conclusion With the implementation of the TNE service, increased echocardiographic evaluations per patient were completed with availability of more comprehensive hemodynamic information about PDA. PDA treatment rates were similar in the two epochs, but need for multiple courses were less in TNE era.

Key Points

TNE allows comprehensive hemodynamic assessment of PDA.
Implementation of dedicated TNE service led to increased use of echocardiography to assess PDA.
Standardized hemodynamic assessment of PDA may allow improved individualization of treatment need.

Keywords

targeted neonatal echocardiography - patent ductus arteriosus - premature - neonates

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Referenzen

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