Role of functional echocardiography in neonatal shock: a systematic review and meta-analysis

Point of care functional echocardiography is an emerging tool in neonatology to assess hemodynamic dysfunction and its timely management.

Following PRISMA guidelines, we searched PubMed, EMBASE, CINAHL, Medline, and Web of Sciences databases till December 2024. We selected 2680 text articles of which 21 studies qualified for full-text review and finally, eight studies were included in the systematic review.

Meta-analysis using REM (Random effects model) showed no significant difference in the primary outcome of Inferior Vena Cava Collapsibility Index (IVC-CI) between shock versus controls [SMD = -0.99 (95% CI: -2.89, 0.91), P = 0.31, I² = 96%. Meta-analysis showed significantly lower values of Shortening Fraction(SF) [SMD = -0.84 (95% CI: -1.61, -0.07), P = 0.031, I² = 92%, REM], Left Ventricle Velocity Time Integral(LVVTI) [SMD = 0.22 (95% CI: 0.01, 0.42), P = 0.04, I² = 27%, FEM], Right Ventricle Velocity Time Integral(RVVTI) [SMD = -0.55 (95% CI: -0.77, -0.33), P < 0.00001, I² = 0%, FEM], and Ejection fraction(EF) [SMD = -1.82 (95% CI: -3.09, -0.55), P = 0.005, I² = 89%]. The difference between the remaining outcomes was not statistically significant between the two groups.

This review reinforces the clinical utility of echocardiographic parameters in diagnosing and monitoring neonatal shock and underscores the need for conducting multicentre, prospective studies to validate dynamic changes in echocardiographic parameters before and after treatment of shock.

Our study highlights role of functional echocardiography as an adjunct to clinical and biochemical markers of shock in neonates providing more comprehensive understanding of cardiac function. No significant difference in the Inferior Vena Cava Collapsibility Index values was seen in neonates with shock. However, Shortening Fraction, Left Ventricle Velocity Time Integral, Right Ventricle Velocity Time Integral, and Ejection Fraction were significantly decreased in this group. Impact of this study lies in its potential to increase researchers' awareness of need to conduct multicentre, prospective studies to validate dynamic changes in echocardiographic parameters before and after treatment of shock.