Eirik Nestaas

Background/Objectives: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity, yet no prediction model incorporating echocardiographic assessment of right ventricle (RV) function and pulmonary haemodynamics exists. This study aimed to identify clinical and echocardiographic candidate variables of BPD to inform the design of a future multicentre study for BPD prediction model construction. Methods: This prospective observational feasibility study recruited preterm infants born before 32 weeks of gestation. Echocardiographic scans were performed at Day 5 and Day 9 postnatally. Candidate variables across six domains, clinical, RV systolic, diastolic, and global function, pulmonary-haemodynamics, and patent ductus arteriosus (PDA) variables, were evaluated using Mann–Whitney U tests and univariable logistic regression. Results: Of 40 preterm infants enrolled, 27 (68%) developed BPD. The BPD group had lower gestational age (median 26 vs. 30 weeks, OR 0.50, p < 0.001), lower current weight (median 763 vs. 1200 g, OR 0.54, p = 0.002), and higher mean airway pressure (OR 1.86, p = 0.002). By Day 5, significant differences included higher normalised RV s’ (OR 2.26, p = 0.042), shorter RVET (OR 0.49, p = 0.018), elevated RV-MPI-PW (OR 2.28, p = 0.019), shorter PAAT (OR 0.72, p = 0.047), and larger normalised PDA diameter (OR 1.70, p = 0.002). By Day 9, normalised RV a’ (OR 1.93, p = 0.015), RV E/e’ ratio (OR 2.03, p = 0.033), and RV e’/a’ ratio (OR 0.54, p = 0.019) additionally emerged. All infants with reversed anterior–cerebral–artery diastolic flow subsequently developed BPD. Conclusions: Clinical and echocardiographic variables across multiple RV-function, PDA and pulmonary vascular domains were identified as candidate variables for BPD, providing a conceptual framework for a future multicentre prediction model study.

Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants’ underdeveloped lungs, leading to long-term growth and neurodevelopm

Objective Assess effects of fetal growth restriction (FGR) on cardiac modelling in premature and term neonates. Study design Prospective echocardiographic study of a cohort of FGR neonates (n = 21) and controls (n = 41) with normal prenatal growth and circulation. Results Unadjusted for gestational age, birth weight, sex, and twin/singleton, Late-FGR neonates had smaller hearts than controls, with globular left ventricles and symmetrical right ventricles. Adjusted estimates showed smaller left ventricles and similarly sized right ventricles, with symmetrical left and right ventricles. Early-FGR (compared with Late-FGR) had smaller hearts and globular left ventricles in unadjusted estimates, but after adjustment, sizes and shapes were similar. Conclusion FGR had significant impact on cardiac modelling, seen in both statistical models unadjusted and adjusted for gestational age, birth weight, sex, and twin/singleton. The adjustments, however, refined the results and revealed more specific effects of FGR, thus underscoring the importance of statistical adjustments in such studies.

Objective: Assess effects of fetal growth restriction (FGR) on cardiac modelling in premature and term neonates. Study design: Prospective echocardiographic cohort study comparing FGR neonates (n=21) and controls (n=41) with normal prenatal growth and circulation. Results: Unadjusted for gestational age, birth weight, sex and twin/singleton, Late-FGR neonates had smaller hearts than controls, with globular left ventricles and symmetrical right ventricles. Adjusted estimates showed smaller left ventricles and similarly sized right ventricles, with symmetrical left and right ventricles. Early-FGR (compared with Late-FGR) had smaller hearts and globular left ventricles in unadjusted estimates, but after adjustment, sizes and shapes were similar. Conclusion: FGR had significant impact on cardiac modelling, both unadjusted and when adjusted for gestational age, birth weight, sex and twin/singleton. The adjustments, however, refined the results notably and represents more specific the effects of FGR, thus underscoring the importance of adjustments in such studies.

The interest in the use of cardiac ultrasound for hemodynamic evaluation in neonates has increased in the last decades. Several overlapping terms exists, and a non-comprehensive list includes point-of-care ultrasound, clinician-performed ultrasound, focused cardiac ultrasound, targeted neonatal echocardiography, and neonatologist performed echocardiography. This review will use the term neonatologist performed echocardiography. Neonatologist performed echocardiography is primarily echocardiography to obtain snapshots of hemodynamics and heart function, usually as repeated exams during intensive care. It provides the neonatologist with in-depth information on the hemodynamics not available by blood pressure, pulse oximetry, capillary refill time, and various blood tests. The review provides a brief overview of some relevant methods for assessment of hemodynamics and heart function. It does not discuss training, implementation, accreditation, and certification nor in-depth technical aspects and detailed use of neonatologist performed echocardiography. If the information obtainable by neonatologist performed echocardiography had been accessible easily (e.g., via a sensor put on the neonate similarly to a pulse oximeter), neonatologist performed echocardiography would have been more widely used. Acquiring skills for neonatologist performed echocardiography take time and resources. Future developments probably include a stronger focus on education, training, and certification. It is likely that echocardiographic methods will evolve further, probably involving establishing new indexes and methods and implementing artificial intelligence in the analyses procedure to improve accuracy and workflow. It is important to acknowledge that neonatologist performed echocardiography is not a therapeutic intervention; it is a diagnostic tool providing additional information.