Functional echocardiographic preload markers in neonatal septic shock

Abstract Background There are no established clinical or laboratory markers of preload adequacy and fluid responsiveness in management of neonatal shock. Functional echocardiographic preload markers are evaluated in children and adults, but there is no data in neonatal septic shock. We evaluated five functional echocardiographic preload markers during intravenous volume resuscitation in neonatal septic shock. Objective (1) To compare baseline functional echocardiographic preload markers between neonates with septic shock and their “matched” healthy controls. (2) To compare echocardiographic preload markers before and after intravenous volume resuscitation. Methods In this cohort study, we enrolled neonates with septic shock (cases) and recorded five preload markers – inferior vena cava collapsibility index (IVC-CI), left ventricular end-diastolic (LVEDV) & end-systolic volume (LVESV) and their indices (LVEDVI, LVESVI) – before initiation of intravenous fluid resuscitation (baseline evaluation). An equal number of “matched hemodynamically stable” controls were recruited, who underwent functional echocardiographic assessment once. In neonates with shock, we recorded these markers again after volume resuscitation. Results We analyzed 46 neonates (23 cases and 23 controls). Neonates with shock had significantly elevated baseline IVC-CI as compared to controls [53% (21, 100) vs. 20% (15, 24) respectively, p-value = .01). Rest 4 echocardiographic markers (LVEDV, LVESV, LVEDVI, and LVESVI) were comparable between cases and controls. Sixteen neonates (70% of 23) received intravenous fluid resuscitation and rest 7 (30%) were started directly on vasoactive drugs. None of the preload markers changed significantly after volume resuscitation as compared to the baseline values including IVC-CI, which was almost significant [74% (33, 100) at baseline to 48% (13, 93) after 10 mL/kg and 50% (40, 69) after 20 mL/kg, (p = .05). All preload markers were comparable between survivors and non-survivors. Conclusion Neonates with septic shock had significantly elevated IVC-CI at baseline as compared to hemodynamically stable neonates. None of the preload markers changed significantly after volume resuscitation as compared to the baseline values including IVC-CI, which was almost significant.

[1]  A. Saili,et al.  Correlation of functional echocardiography and clinical parameters in term neonates with shock. , 2019, Journal of neonatal-perinatal medicine.

[2]  P. McNamara,et al.  The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock , 2018, Pediatric Research.

[3]  S. Dutta,et al.  Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial , 2018, European Journal of Pediatrics.

[4]  F. Babl,et al.  Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis , 2018, Emergency medicine Australasia : EMA.

[5]  Y. Singh,et al.  Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock , 2018, Front. Pediatr..

[6]  Samir M Hassan,et al.  Non-invasive Assessment of Significant Dehydration in Infants Using the Inferior Vena Cava to Aortic Ratio: Is it Useful? , 2017, Journal of pediatric gastroenterology and nutrition.

[7]  John C. Lin,et al.  American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock , 2017, Critical care medicine.

[8]  E. Dempsey.  What Should We Do about Low Blood Pressure in Preterm Infants , 2017, Neonatology.

[9]  F. Saulnier,et al.  Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure , 2017, Critical care medicine.

[10]  W. Kosiak,et al.  Usefulness of ultrasound examination in the evaluation of a neonate's body fluid status , 2016, Journal of ultrasonography.

[11]  Praveen Kumar,et al.  Hemodynamic Changes in Preterm Neonates With Septic Shock: A Prospective Observational Study* , 2014, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[12]  M. Cannesson,et al.  Predicting Fluid Responsiveness in Children: A Systematic Review , 2013, Anesthesia and analgesia.

[13]  P. McNamara,et al.  Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training:. , 2011, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[14]  K. Maitland,et al.  Mortality after fluid bolus in African children with severe infection. , 2011, The New England journal of medicine.

[15]  T. Wolfson,et al.  The effect of breathing manner on inferior vena caval diameter. , 2011, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[16]  K. Walley,et al.  Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality* , 2011 .

[17]  Ji Yeon Lee,et al.  Respiratory Variation in Aortic Blood Flow Velocity as a Predictor of Fluid Responsiveness in Children After Repair of Ventricular Septal Defect , 2010, Pediatric Cardiology.

[18]  H. Wong,et al.  Pathophysiology and treatment of septic shock in neonates. , 2010, Clinics in perinatology.

[19]  S. Colan,et al.  Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. , 2010, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[20]  P. McNamara,et al.  Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? , 2009, European Journal of Pediatrics.

[21]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  A. Randolph,et al.  International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[23]  A. Hyslop.  Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. , 2004, Pediatrics.

[24]  W. Fetter,et al.  Echocardiographic assessment of preload conditions does not help at the neonatal intensive care unit. , 2003, American journal of perinatology.

[25]  N. Evans,et al.  Early determinants of right and left ventricular output in ventilated preterm infants. , 1996, Archives of disease in childhood. Fetal and neonatal edition.

[26]  B. Falkner,et al.  Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. , 1995, Journal of perinatology : official journal of the California Perinatal Association.

[27]  P. Sánchez,et al.  Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates. , 1994, Pediatrics.

[28]  N. Schiller,et al.  Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. , 1990, The American journal of cardiology.

[29]  C. Rosenfeld,et al.  The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. , 1979, The Journal of pediatrics.