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Abstract
Rationale Preterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted neonatal echocardiography consultations (TNE) are increasingly used to guide management, its clinical impact need evaluation.
Objectives To investigate clinical outcomes in relation to TNE utilisation during episodes of ACIs among preterm neonates.
Methods This retrospective cohort study, conducted at two tertiary NICUs over 10 years, included neonates<37 weeks gestational age (GA) who developed ACIs. Patients receiving TNE-guided care (TNE within 24 hours of treatment initiation) were compared with non-TNE management. Outcomes included predischarge mortality, episode-related mortality (<7 days) and a new diagnosis of intraventricular haemorrhage≥grade 3 (IVH-3). Inverse probability of treatment weighting (IPTW) using propensity score was used to account for confounders, including site, birth years and baseline illness severity.
Measurements and main results Of 622 included patients, 297 (48%) had TNE; median (IQR) GA at ACI was 26.4 (25.0–28.4) weeks. TNE group demonstrated higher baseline mean airway pressure, oxygen requirement and heart rate and frequently received both inotrope and iNO during ACI. IPTW analysis revealed TNE was associated with lower mortality (adjusted OR (95% CI) 0.75 (0.59 to 0.95)), episode-related mortality (0.54 (0.40 to 0.72)) and death or IVH-3 (0.78 (0.62 to 0.99)). TNE group received more varied inotropic agents, demonstrated earlier improvements in blood pressures, without increasing overall inotrpoic burden.
Conclusions Among preterm neonates requiring rescue treatments with inotropes/iNO, TNE utilisation to guide clinical management may be associated with improved survival.
- Intensive Care Units, Neonatal
- Neonatology
- Cardiology
Data availability statement
Individual de-identified participant data that underlie the results reported in this manuscript will be available, pending approval by the institutional research ethics board, immediately following publication, for investigators who provide a methodologically sound proposal approved by an independent review committee, to achieve aims cited in the approved proposal. Data request and proposals should be directed to the corresponding author. Requestors will need to sign a data sharing agreement.
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Data availability statement
Individual de-identified participant data that underlie the results reported in this manuscript will be available, pending approval by the institutional research ethics board, immediately following publication, for investigators who provide a methodologically sound proposal approved by an independent review committee, to achieve aims cited in the approved proposal. Data request and proposals should be directed to the corresponding author. Requestors will need to sign a data sharing agreement.
Footnotes
X @danyweisz, @Dr_AmishJain
Contributors AJ conceptualised the study. AJ and SJJ developed the initial study plan and protocol to which all remaining authors (DEW, PJM, LM, PSS, AK, FZ, MB, PD, LS) made significant intellectual contributions. SJJ, AK, FZ, MB, PD undertook study data collection which was supervised by AJ. AK, SJJ, AJ prepared the final data files for analysis. LS performed data analysis under guidance of AJ. All authors reviewed results, participated in the interpretation of findings, reviewed the first draft of the manuscript and provided their critical feedback. SJJ and AJ were responsible for producing the first and final draft of the manuscript for submission. As the study guarantor, AJ is fully responsible for the overall conduct of this study, has full access to the study, takes responsibility for the presented contents and decisions to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and do not have any conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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