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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Point-of-care echocardiographic assessment of right ventricle systolic function in infants with severe bronchiolitis:
Julien Gotchac1, Alix Rousseau2, Agathe Arcourt2
1Pediatric Intensive Care Unit, Children's Hospital, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. julien.gotchac@chu-bordeaux.fr.
Insights
Tricuspid annular plane systolic excursion (TAPSE) in infants with severe bronchiolitis is typically normal, suggesting right ventricle systolic dysfunction is uncommon. Lower TAPSE may correlate with longer hospital stays and respiratory support duration, warranting further study.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Neonatology
Background:
- Severe bronchiolitis in infants can impact cardiac function.
- Right ventricle (RV) systolic function is crucial but often unassessed in severe pediatric respiratory illness.
- Tricuspid annular plane systolic excursion (TAPSE) is a key echocardiographic marker for RV systolic function.
Purpose of the Study:
- To evaluate RV systolic function in infants with severe bronchiolitis using TAPSE.
- To determine the prognostic value of TAPSE for length of stay (LOS) and respiratory support duration.
- To test the hypothesis that lower TAPSE at pediatric intensive care unit (PICU) admission predicts worse outcomes.
Main Methods:
- Prospective, single-center observational pilot study during the 2022-2023 bronchiolitis season.
- Included infants under 12 months admitted to the PICU for severe bronchiolitis.
- Transthoracic echocardiography measured TAPSE at PICU admission; patients followed until discharge.
Main Results:
- Forty-six infants were included; 78% had normal TAPSE Z-scores (-2 to +2).
- TAPSE Z-score showed a weak inverse association with PICU LOS (ρ=-0.38, p=0.009).
- TAPSE Z-score had a moderate inverse association with respiratory support duration (ρ=-0.45, p=0.002) and was independently associated with shorter support (<3 days).
Conclusions:
- RV systolic function, assessed by TAPSE, is generally preserved in infants with severe bronchiolitis.
- While TAPSE Z-scores show associations with clinical course, RV systolic dysfunction appears uncommon.
- Further research is needed to clarify the pathophysiological basis and clinical relevance of TAPSE associations in this population.
Abstract:
The aim of this study was to assess right ventricle (RV) systolic function in infants with severe bronchiolitis using tricuspid annular plane systolic excursion (TAPSE) and to explore its prognostic value. We hypothesized that lower TAPSE at pediatric intensive care unit (PICU) admission could be associated with prolonged length of stay (LOS) and duration of respiratory support. We conducted a prospective single-center observational pilot study in a tertiary general PICU during the 2022-2023 bronchiolitis season. All children < 12 months admitted to PICU for bronchiolitis were eligible. TAPSE was measured by transthoracic echocardiography at PICU admission. Patients were followed up until discharge. Forty-six patients were included, aged from 16 days to 9.5 months. TAPSE Z-score was within normal range (- 2 to + 2) in 36/46 (78%) patients and > + 2 in 10/46 (22%) patients. TAPSE Z-score was weakly associated with PICU LOS (Spearman ρ = - 0.38, p = 0.009) and moderately associated with the duration of respiratory support (Spearman ρ = - 0.45, p = 0.002). No significant association was found between other echocardiographic parameters and PICU LOS or duration of respiratory support. In post hoc exploratory multivariable analysis, TAPSE Z-score was independently associated with a duration of respiratory support < 3 days (OR = 2.29, 95% CI [1.25; 4.17], p = 0.007). Conclusion: TAPSE was within or above normal range in children with severe bronchiolitis, suggesting that RV systolic dysfunction is uncommon. Although its value may be associated with patients' clinical course, the pathophysiological basis and the clinical relevance of this association warrants further investigations.Trial registration: NCT07209956, date of registration October 7, 2025, retrospectively registered.
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