232 - Impact of Targeted Neonatal Echocardiography Service on Assessment and Management of Patent Ductus Arteriosus

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 232
Publication Number: 232.33

Abdulaziz Homedi, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Michael R. Miller, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Renjini Lalitha, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Marisha McClean, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Soume Bhattacharya, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada

Presenting Author(s)

RL

Renjini Lalitha, MBChB, M.Med

Assistant Professor
The University of Western Ontario - Schulich School of Medicine & Dentistry
London, Ontario, Canada

Background: Targeted Neonatal Echocardiography (TNE) is a goal-oriented cardiac assessment using bedside echocardiography by trained neonatologists. Comprehensive assessment for the hemodynamic significance of Patent Ductus Arteriosus (PDA) is a common indication to perform TNE. The clinical impact of the implementation of such assessment on management decisions and patient outcomes remains to be reported.

Objective: Analyze differences in the assessment of PDA hemodynamics using echocardiography before and after the introduction of TNE services and compare PDA treatment rates and related long-term outcomes between these two cohorts.

Design/Methods: This was a retrospective cohort study at a tertiary care neonatal intensive care unit in Southwestern Ontario. We investigated two time periods: Epoch-1 (Non-TNE 2013-2016) vs Epoch-2 (TNE 2018 – 2021). We included neonates < 32 weeks who had a diagnosis of PDA during the study period. Data on baseline clinical characteristics, PDA-related echocardiographic parameters and treatment details, and relevant long-term outcomes (Bronchopulmonary Dysplasia (BPD), Necrotizing Enterocolitis (NEC), days on respiratory support, days to full feeds, days on mechanical ventilation, survival to discharge, etc.) were collected. Univariate and multivariate analysis compared the two Epochs.

Results: 278 neonates were included. 162 were assessed by conventional echocardiography in Epoch-1 whereas 116 were assessed by TNE in Epoch-2. Baseline clinical characteristics were similar Table 1). Epoch-2 had significantly more echocardiographic assessment per patient per year (M=0.77, SD=0.52) compared to Epoch-1 (M=0.49, SD=0.32), p< 0.001. Postnatal age at first echocardiographic assessment was higher in Epoch-2 (M=12.65, SD=14.62) than in Epoch-1 (M=7.91, SD=10.42), p< 0.001. Comprehensive hemodynamic assessment of PDA-related echocardiographic parameters was significantly higher in EPOCH 2 (Table 2). Overall, PDA treatment rates were comparable in the two time periods but neonates received PDA treatment earlier in Epoch-1. Use of multiple courses of treatment was higher in Epoch-1 than in Epoch-2 (47.8% vs 31.7%, P =0.047, Table 3). Outcomes such as pulmonary hemorrhage, BPD, NEC, survival to discharge, days to full feeds, and days on oxygen were similar in the two Epochs (Table 3).

Conclusion(s): With the implementation of TNE service, more comprehensive hemodynamic information about PDA was available with increased echocardiographic surveillance per patient, and reduced need for repeated treatment courses.