Abstract
Background
Neonatal sepsis remains a leading cause of mortality in neonatal units. Neonatologist-performed echocardiography (NPE) offers the potential for early detection of sepsis-associated cardiovascular dysfunction. This review examines available echocardiographic findings in septic neonates.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed prospective observational, cross-sectional, case control, and cohort studies on septic newborns with echocardiographic assessments from PubMed, Scopus and Embase. Quality assessment employed the Newcastle–Ottawa Scale, with results analyzed descriptively.
Results
From an initial pool of 1663 papers, 12 studies met inclusion criteria after relevance screening and eliminating duplicates/excluded studies. The review encompassed 438 septic newborns and 232 controls. Septic neonates exhibited either increased risk of pulmonary hypertension or left ventricular diastolic dysfunction, and a warm shock physiology characterized by higher cardiac outputs.
Discussion
The included studies exhibited heterogeneity in sepsis definitions, sepsis severity scores, echocardiographic evaluations, and demographic data of newborns. Limited sample sizes compromised analytical interpretability. Nonetheless, this work establishes a foundation for future high-quality echocardiographic studies.
Conclusion
Our review confirms that septic neonates show significant hemodynamic changes that can be identified using NPE. These findings underscore the need for wider NPE use to tailor hemodynamics-based strategies within this population.
Impact
-
1.
Our study emphasizes the value of neonatologist-performed echocardiography (NPE) as a feasible tool for identifying significant hemodynamic changes in septic neonates.
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2.
Our study underscores the importance of standardized echocardiographic protocols and frequent monitoring of cardiac function in septic neonates.
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3.
The impact of the study lies in its potential to increase researchers’ awareness for the need for more high-quality echocardiographic data in future studies. By promoting wider use of NPE, neonatologists can more accurately assess the hemodynamic status of septic newborns and tailor treatment approaches, potentially improving patient outcomes.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
This work was supported by the Italian Ministry of Health with “Current Research funds”.
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F.P. and C.A. contributed to the study conception and design. Material preparation, data collection, and analysis were performed by F.P. and D.U.D.R. The first draft of the manuscript was written by F.P. and revised by D.U.D.R. N.P., F.K., M.P.R., A.D., P.B., and C.A. critically revised it for important intellectual content. All authors reviewed and approved the final version of the article.
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Pugnaloni, F., De Rose, D.U., Kipfmueller, F. et al. Assessment of hemodynamic dysfunction in septic newborns by functional echocardiography: a systematic review. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03045-2
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DOI: https://doi.org/10.1038/s41390-024-03045-2