069 - Impact of TNE on Physiologic Stability in Extremely Preterm Infants during the First Postnatal Week

Publication Number: 69.5444

Sarah R. Westbrook, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Daniel Dagle, University of Iowa, Iowa City, IA, United States; Patrick J. McNamara, University of Iowa Stead Family Children's Hospital, IOWA CITY, IA, United States; Danielle R. Rios, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States

Background: Avoidance of echocardiography, in extremely low birth weight (ELBW) infants during the first postnatal week, is recommended in some centers due to concern for physiologic instability. Recent evidence demonstrates that phenotype-based, hemodynamic care, based on screening targeted neonatal echocardiography (TNE) in the 1st 24 hours, leads to lower rates of adverse neonatal outcomes such as intraventricular hemorrhage and necrotizing enterocolitis.

Objective: We hypothesized that day 1 and 7 screening TNE, by trained expert neonatologists, may be performed safely without negative physiologic impact. We retrospectively analyzed a cohort of patients, then validated our findings in a prospective cohort.

Design/Methods: We analyzed a database of continuously collected vital signs from SickBay (Medical Informatics) for patients in the NICU from 3/20-6/23 (cohort 1-retrospective) and 4/24-9/24 (cohort 2-prospective). Comprehensive TNE (days 1 and 7) and head ultrasound (HUS, day 7) were routinely performed on all babies born < 27 w gestational age (GA). Each TNE evaluation was conducted according to a standardized protocol and included 80-100 images. Continuous heart rate (HR), pulse oximetry (SpO2), and systolic blood pressure (SBP) data were abstracted one-hour prior (baseline) and for the duration of each procedure. Mean values for all variables during each time-period were calculated. Comparative evaluation was performed at each time-period and between groups (TNE vs HUS).

Results: Cohort 1 (retrospective) contained 175 patients born at mean GA and weight of 24 ± 1.5 weeks and 683 ± 193 g respectively, of whom 30 were born at < 23 weeks GA. A statistically significant, but not clinically relevant, increase in HR was noted during the TNE on day 1 (150 ± 11 vs 153 ± 15, p< 0.05) only; other vital signs were unchanged. No differences were seen during either day 7 TNE or compared to day 7 HUS. Cohort 2 (prospective) contained 29 patients born at mean GA and weight of 24 ± 1.7 weeks and 687 ± 193 g, respectively, of whom 5 were born < 23 weeks GA. No differences were seen in any vital signs during any time-period, or between groups in this cohort. There was no change in mode of ventilation, need for inhaled nitric oxide, or vasopressors during either procedure in either cohort.

Conclusion(s): Comprehensive TNE, when performed by neonatologists with advanced hemodynamic expertise, has negligible impact on cardiopulmonary physiology and patient safety in ELBW infants during the transitional period.

Table 1: Demographics for Cohort 1 and 2
Data presented as mean ± SD or frequency (%). Abbreviations: HUS - head ultrasound; TNE - targeted neonatal echocardiogram

Figure 1. Vital sign changes before and during TNE on day 1 in (A) retrospective and (B) prospective cohorts