Original ArticleUse of Targeted Neonatal Echocardiography to Prevent Postoperative Cardiorespiratory Instability after Patent Ductus Arteriosus Ligation
Section snippets
Methods
This study was conducted in 2 parts in the neonatal intensive care unit at The Hospital of Sick Children in Toronto, an outborn quaternary center providing PDA ligation services for all perinatal centers in the region. The study received Institutional Research Ethics Board approval. Study A was a retrospective evaluation of previously analyzed echocardiography markers to determine predictors of PLCS, and study B was a retrospective chart review investigating the impact of TnECHO-guided
Study A
A total of 67 preterm infants underwent PDA ligation and received preoperative and postoperative TnECHO during the study period. Five infants without 8-hour postoperative TnECHO data were excluded. The included infants had a mean gestational age of 25.5 ± 2.0 weeks and a median birth weight of 730 g (650-850 g) and had complete preoperative and 1- and 8-hour postoperative TnECHO data available for review. The median age and weight at the time of surgery were 26.5 days (20-35 days) and 945 g
Discussion
We report on a targeted cardiovascular intervention, based on echocardiography, in neonates after PDA ligation surgery. Our main findings were that (1) an LVO of <200 mL/kg/min within 1 hour of PDA ligation in preterm infants may predict subsequent cardiorespiratory compromise and the need for inotropic agents, and (2) administration of i.v. milrinone to neonates with an LVO <200 mL/kg/min after the 1-hour postligation TnECHO evaluation was associated with improved postoperative stability.
The
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Winner of the Fellow Section at 23rd Annual Canadian Pediatric Resident and Fellow Research National Competition, Winnipeg, MB, Canada, May 12, 2011.
The authors declare no conflicts of interest.