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Feasibility and utility of portable ultrasound during retrieval of sick preterm infants
Author(s) -
Browning Carmo Kathryn,
Lutz Tracey,
Greenhalgh Mark,
Berry Andrew,
Kluckow Martin,
Evans Nick
Publication year - 2017
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.13881
Subject(s) - medicine , neonatology , ultrasound , gestation , incidence (geometry) , hemodynamics , gestational age , antenatal steroid , pediatrics , blood flow , superior vena cava , obstetrics , anesthesia , surgery , cardiology , pregnancy , radiology , genetics , physics , optics , biology
Aim Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport. Method A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤30 weeks gestation. Results Forty‐four newborns were studied in 2008–2015; of them, 21 were transported by road, 19, by helicopter and four, by fixed wing: median birthweight, 1130 g (680–1960 g) and median gestation, 27 weeks (23–30); 30 of 44 were male babies. Antenatal steroid course was complete in two babies. Ultrasound in the referring hospital was at a mean of two hours: 47 minutes (00:15–7:00) of age. Low systemic blood flow was common: 50% had right ventricular output <150mL/kg/min and 23%, a superior vena cava flow <50mL/kg/min. at stabilisation. Cranial US : 10 Grade I IVH , 2 Grade II IVH , 1 Grade IV IVH and 32 normal scans pretransport. After transport, three further Grade I IVH were reported. Mortality was higher in the babies with low systemic blood flow: 4 of 12 (33%) died vs 1 of 31 (6%) in the normal flow group ( OR = 7.2, 95% CI : 1.1 to 47, p = 0.022). Conclusion Point‐of‐care ultrasound during the retrieval of preterm infants confirms a high incidence of haemodynamic pathology. The use of ultrasound during transport may provide an opportunity for earlier targeted circulatory support.