Article Text

SURVEY OF CARDIOVASCULAR ASSESSMENT AND MANAGEMENT OF HYPOTENSION AND PATENT DUCTUS ARTERIOSUS (PDA) IN NEONATAL INTENSIVE CARE UNITS ACROSS THE UNITED KINGDOM
  1. S Janakiraman1,
  2. P Mallya1,
  3. J P Wyllie2,
  4. M Abu-Harb3,
  5. C K Harikumar1,
  6. S Gupta1
  1. 1Department of Neonatology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
  2. 2Department of Neonatology, The James Cook University Hospital, Middlesbrough, Cleveland, UK
  3. 3Department of Neonatology, City Hospital of Sunderland, Sunderland, UK

Abstract

Aim To evaluate the current practices of cardiovascular assessment and management in tertiary neonatal intensive care units (NICU) in the United Kingdom.

Methods A consultant neonatologist or senior registrar in each NICU in the UK was contacted with a structured questionnaire survey. This included questions to evaluate practices of cardiac assessment, use of ECHO, and management policies for hypotension and PDA. The data is presented as the percentage from the respondent units.

Results 90% of NICUs responded. Intra arterial blood pressure monitoring was the preferred method for blood pressure (BP) measurement when feasible, followed by oscillometry (65.3%) and Doppler measurements (28.8%). Basic echocardiographic assessment was performed by a neonatologist in 75% units. Hypotension was defined using mean (94.2%) or systolic BP (5.8%). Two thirds units (67.3%) administered a routine fluid bolus before commencing inotropes. Only 23% units performed routine echocardiographic assessment prior to management of hypotension.

Significant PDA was defined using clinical signs (19.2%), Echo (7.6%) or both (73%), with initial management pharmacological in 57.6% of units compared with conservative management in 42.3%. None of the NICUs considered surgery as initial management of choice. Indomethacin was the preferred drug of choice (76.9%) followed by Ibuprofen (21.1%). PDA was treated prophylactically in 9.6% units. Only 8% units would assess Superior Vena Cava flow.

Conclusions

  • The majority of units use mean BP values to define hypotension and most units give at least one fluid bolus before commencing inotropes.

  • Most units have at least one neonatologist with echocardiographic skills.

  • There is no consensus for initial management of PDA to be conservative or pharmacologic treatment.

Conclusions

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