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

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

Author information

1
Neonatal and Paediatric Emergency Transport Service (NETS), Sydney, NSW, Australia.
2
Grace Centre for Newborn Intensive Care, CHW, Sydney, NSW, Australia.
3
University of Sydney, Sydney, NSW, Australia.
4
Royal Prince Alfred Department of Newborn Care, Sydney, NSW, Australia.
5
Department of Neonatology, Royal North Shore Hospital, Sydney, NSW, Australia.

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

PMID:
28419552
DOI:
10.1111/apa.13881
[Indexed for MEDLINE]

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