Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation

J Pediatr. 2012 Apr;160(4):584-589.e1. doi: 10.1016/j.jpeds.2011.09.027. Epub 2011 Nov 3.


Objectives: 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.

Study design: 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).

Conclusion: 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.

MeSH terms

  • Ductus Arteriosus, Patent / surgery*
  • Female
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / prevention & control*
  • Humans
  • Infant, Newborn
  • Male
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / prevention & control*
  • Predictive Value of Tests
  • Respiration Disorders / diagnostic imaging*
  • Respiration Disorders / prevention & control*
  • Retrospective Studies
  • Ultrasonography