Sébastien Joye, Soume Bhattacharya, Ashraf Kharrat, Bonny Jasani, Regan E. Giesinger, Patrick J. McNamara, Amish Jain
Lausanne University Hospital. LHSC Children’s Hospital. Mount Sinai Hospital and University of Toronto. Hospital of Sick Children. University of Iowa.
Switzerland, Canada and United States
Journal of Pediatrics
J Pediatr 2023;
DOI: 10.1016/j.jpeds.2023.113864
Abstract
Objectives: To characterize pulmonary artery Doppler flow profile (PAFP) patterns among infants receiving care in neonatal intensive care units (NICUs) and to examine the association of PAFP patterns with pulmonary and right ventricular (RV) hemodynamics.
Study design: This is a retrospective study at two tertiary NICUs over 4 years that included neonates who demonstrated a complete tricuspid regurgitation envelope on targeted neonatal echocardiography (TNE). Separate personnel reviewed TNEs to characterize PAFP patterns, divide cohort into PAFP groups, and measure quantitative indices of RV hemodynamics (RV systolic pressure [RVSP], pulmonary artery acceleration time [PAAT] and its ratio with RV ejection time [RVET/PAAT], tricuspid annular plane systolic excursion [TAPSE] and RV output [RVO]), for intergroup comparisons.
Results: We evaluated TNEs from 186 neonates with median (IQR) gestational age of 28.5 weeks (25.9-35.9) weeks. Four distinct PAFP patterns were identified: A. near-isosceles triangle (22%), B. right-angled triangle (29%), C. notching (40%), and D. low peak velocity (<0.4 m/s; 9%). Groups A-C demonstrated a stepwise worsening in all indices of PH, while pattern D was associated with lower TAPSE and RVO. Using common definitions of pulmonary hypertension (PH), pattern A performed best to rule out PH [sensitivity range 81-90%] and pattern C for diagnosing PH [specificity range 63-78%].
Conclusions: Inspection of PAFP is a simple bedside echocardiography measure that provides clinically meaningful information on underlying RV hemodynamics and may aid in screening and monitoring of patients for PH in NICUs.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Class III. Pulmonary Hypertension Associated with Lung Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access F
ree PDF File or Full Text Article Available Through PubMed or DOI: Yes