title: Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation.
abstract: OBJECTIVE
  To investigate the value of targeted neonatal echocardiography (TnECHO) in predicting cardiorespiratory instability after patent ductus arteriosus (PDA) ligation, and to evaluate the impact of TnECHO-directed care.
  
  
  METHODS
  We reviewed serial echocardiography evaluations of 62 preterm infants after PDA ligation to investigate the relationship between indices of myocardial performance and postoperative cardiorespiratory instability. A predictive model was developed based on TnECHO criteria, with targeted initiation of intravenous milrinone. A comparative evaluation was performed between matched infants in the previous era (epoch 1; n=25) and current era (epoch 2; n=27) of TnECHO-guided treatment.
  
  
  RESULTS
  Left ventricular output <200 mL/kg/min at 1 hour after PDA ligation was a sensitive predictor of systemic hypotension and the need for inotropes, and was used for initiation of i.v. milrinone infusion in epoch 2. Infants treated with milrinone had a lower incidence of ventilation failure (15% vs 48%; P=.02) and less need for inotropes (19% vs 56%; P=.01), and showed a trend toward improved oxygenation (P=.08).
  
  
  CONCLUSIONS
  TnECHO facilitates early detection of infants at greatest risk for subsequent cardiorespiratory deterioration. Administration of milrinone to neonates with low cardiac output may lead to improved postoperative stability.
authors: Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors: Amish
authors: A
authors: Jain
authors: Mohit
authors: M
authors: Sahni
authors: Afif
authors: A
authors: El-Khuffash
authors: Emad
authors: E
authors: Khadawardi
authors: Arvind
authors: A
authors: Sehgal
authors: Patrick J
authors: PJ
authors: McNamara
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012120:Respiration Disorders / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D012189:Retrospective Studies; D014463:Ultrasonography