Related Experiment Video
Updated: Jul 29, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Impact of Early Hemodynamic Screening on Extremely Preterm Outcomes in a High-Performance Center
Regan E Giesinger1, Danielle R Rios1, Trassanee Chatmethakul1,2
1Department of Pediatrics.
Insights
Early hemodynamic screening (HS) in extremely preterm infants reduced the risk of death or severe intraventricular hemorrhage. This targeted neonatal echocardiography approach improves survival-free outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Increasing survival rates of extremely preterm infants are associated with a persistent high incidence of severe intraventricular hemorrhage (IVH).
- Severe IVH poses a significant health risk, necessitating strategies to mitigate adverse neonatal outcomes.
- Early identification and management of hemodynamic instability are crucial for improving survival and reducing complications in this population.
Purpose of the Study:
- To assess the impact of early hemodynamic screening (HS) on the composite outcome of death or severe IVH in extremely preterm infants.
- To determine if targeted neonatal echocardiography-based HS can reduce the incidence of major adverse events.
- To evaluate the association between HS and improved survival free of severe IVH.
Main Methods:
- A comparative study design was employed, comparing infants receiving standard neonatal care (control epoch: Jan 2010-Dec 2017) with those undergoing HS (screening epoch: Oct 2018-Apr 2022).
- Eligible infants were born at 22-26 weeks' gestation and admitted within 24 hours of birth.
- HS involved targeted neonatal echocardiography performed at 12-18 hours postnatal age, guiding physiology-based care.
Main Results:
- The screening epoch included 191 infants, while the control epoch comprised 423 infants; infants born at 22-23 weeks were more represented in the screening group (41% vs. 32%).
- A significant reduction was observed in the primary composite outcome (death or severe IVH) in the HS group compared to controls.
- HS was independently associated with improved survival free of severe IVH (OR 2.09, 95% CI [1.19, 3.66]), alongside reductions in necrotizing enterocolitis and severe bronchopulmonary dysplasia.
Conclusions:
- Early hemodynamic screening, coupled with physiology-guided care, demonstrates potential for enhancing neonatal outcomes in extremely preterm infants.
- This approach may offer a valuable strategy to decrease the incidence of severe IVH and mortality.
- Further research is warranted to validate and optimize early HS protocols for widespread clinical application.
Abstract:
Rationale: Increasing survival of extremely preterm infants with a stable rate of severe intraventricular hemorrhage represents a growing health risk for neonates. Objectives: To evaluate the role of early hemodynamic screening (HS) on the risk of death or severe intraventricular hemorrhage. Methods: All eligible patients 22-26+6 weeks' gestation born and/or admitted <24 hours postnatal age were included. As compared with standard neonatal care for control subjects (January 2010-December 2017), patients admitted in the second epoch (October 2018-April 2022) were exposed to HS using targeted neonatal echocardiography at 12-18 hours. Measurements and Main Results: A primary composite outcome of death or severe intraventricular hemorrhage was decided a priori using a 10% reduction in baseline rate to calculate sample size. A total of 423 control subjects and 191 screening patients were recruited with a mean gestation and birth weight of 24.7 ± 1.5 weeks and 699 ± 191 g, respectively. Infants born at 22-23 weeks represented 41% (n = 78) of the HS epoch versus 32% (n = 137) of the control subjects (P = 0.004). An increase in perinatal optimization (e.g., antepartum steroids) but with a decline in maternal health (e.g., increased obesity) was seen in the HS versus control epoch. A reduction in the primary outcome and each of severe intraventricular hemorrhage, death, death in the first postnatal week, necrotizing enterocolitis, and severe bronchopulmonary dysplasia was seen in the screening era. After adjustment for perinatal confounders and time, screening was independently associated with survival free of severe intraventricular hemorrhage (OR 2.09, 95% CI [1.19, 3.66]). Conclusions: Early HS and physiology-guided care may be an avenue to further improve neonatal outcomes; further evaluation is warranted.
