Feasibility and utility of portable ultrasound during retrieval of sick preterm infants

Acta Paediatr. 2017 Aug;106(8):1296-1301. doi: 10.1111/apa.13881. Epub 2017 May 29.

Abstract

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.

Keywords: Neonate; Newborn; Preterm; Transport; Ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Cerebral Intraventricular Hemorrhage / diagnostic imaging
  • Cerebral Intraventricular Hemorrhage / epidemiology*
  • Cerebral Intraventricular Hemorrhage / etiology
  • Feasibility Studies
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • New South Wales / epidemiology
  • Point-of-Care Systems*
  • Prospective Studies
  • Transportation of Patients*
  • Ultrasonography / statistics & numerical data*