Related Experiment Video
Updated: Aug 3, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without
Janneth Cristina Sánchez-Becerra1, Rogelio Guillén-Torres1, Rosario Becerra-Becerra2
1Neonatology Department, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
Insights
Chronic pulmonary hypertension (cPH) in preterm infants with chronic lung disease (CLD) is linked to worse outcomes. Diuretic treatment in cPH-CLD infants improved respiratory support and ultrasound markers of pulmonary vascular resistance.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Pulmonology
Background:
- Chronic pulmonary hypertension (cPH) is increasingly recognized in preterm infants with chronic lung disease (CLD).
- Enhanced monitoring is crucial for identifying different phenotypes of cPH in CLD patients.
- Understanding cPH phenotypes aids in targeted interventions and improved outcomes.
Purpose of the Study:
- To identify all cases of cPH (cPH-CLD/IPBF) in CLD patients screened.
- To compare outcomes between different cPH phenotypes.
- To evaluate the effectiveness of diuretic therapy in cPH-CLD infants.
Main Methods:
- Screening for cPH-CLD and cPH-IPBF using echocardiography (TnECHO) and lung ultrasound (LUS) at 36 weeks postmenstrual age.
- Standardized algorithm for cPH-CLD treatment with diuretics.
- Analysis of ultrasound findings before and after diuretic therapy, including respiratory rate (RR), right ventricular output (RVO), and pulmonary vascular resistance (PVR) markers.
Main Results:
- Twenty-two (30%) of 72 CLD infants had cPH-CLD, and nine (12%) had cPH-IPBF.
- cPH infants experienced more mechanical ventilation days, higher rates of retinopathy of prematurity, and increased mortality.
- Diuretic therapy in cPH-CLD infants led to a 59% step-down in respiratory support, decreased RR, RVO, PVR markers, and improved LUS patterns.
Conclusions:
- CLD infants with cPH exhibit significantly increased morbidity and mortality.
- Diuretic treatment in cPH-CLD patients effectively reduces respiratory support needs and improves hemodynamic and ultrasound markers.
- Ultrasound parameters, including RVO, PVR, and B-line patterns, are valuable for monitoring treatment response.
Introduction:
Increased recognition of the development of chronic pulmonary hypertension (cPH) in preterm infants with chronic lung disease (CLD) has prompted enhanced monitoring for the identification of different phenotypes.
Methods:
All newborns consulted for oxygen/respiratory support dependency (CLD assessment) from January 2018 to December 2021 were included. TnECHO and LUS screening for cPH-CLD were performed at 36 weeks postmenstrual age. Cases of cPH related to increased pulmonary blood flow (cPH-IPBF) were referred to Pediatric Cardiology. The objective of the study was to identify all cases of cPH (cPH-CLD/IPBF) in the CLD patients screened and to compare outcomes. Following a standardized algorithm, cPH-CLD patients were treated with diuretics; ultrasounds taken before and after treatment were analyzed.
Results:
Seventy-two patients with CLD were screened. Twenty-two (30%) had cPH-CLD, and nine (12%) had cPH-IPBF. cPH infants underwent more days of mechanical ventilation, were more likely to have retinopathy of prematurity, and showed increased mortality. The LUS pattern observed in the 72 CLD patients consisted of a thickened pleural line and a B-line interstitial heterogeneous pattern; 29% of patients were found to have lung consolidations. After diuretic therapy, step-down in respiratory support occurred in 59% of neonates with cPH-CLD. A decrease in respiratory rate (RR), right ventricular output (RVO), markers of pulmonary vascular resistance (PVR), and B-line pattern was observed. In tissue Doppler imaging, biventricular diastolic function was found to be modified after diuretics.
Conclusions:
CLD infants with cPH showed increased morbidity and mortality. In cPH-CLD patients, a decrease in RR and step-down in respiratory support was observed after diuretic treatment. Follow-up ultrasound showed a decrease in RVO, markers of PVR, and B-lines.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
06:15Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
