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Association between early echocardiography screening of low systemic blood flow and intraventricular hemorrhage in preterm infants: a multicenter cohort study

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To determine whether early echocardiography screening of low systemic blood flow reduces intraventricular hemorrhage in preterm infants.

Study design

Prospective multicenter study in preterm infants below 33 weeks of gestational age at nine neonatal units. Five units performed early echocardiography screening for low systemic blood flow and guided clinical management (exposure group) and 4 units did not (control group). Our main outcome was ≥grade II intraventricular hemorrhage or death within the first 7 days of life. The main analysis used the inverse probability of treatment weighting.

Results

Three hundred and thirty-two preterm infants (131 in the exposure group and 201 in the control group) were included. Exposure to early echocardiography screening was associated with a significant reduction in ≥grade II intraventricular hemorrhage or early death [odds ratio 0.285 (95% CI: 0.133–0.611); p = 0.001].

Conclusions

Early echocardiography screening for low systemic blood flow may reduce the incidence of intraventricular hemorrhage in preterm infants.

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Fig. 1: Flow diagram of the study.
Fig. 2: Systemic blood flow as measured by echocardiography during the first 3 days of life in preterm infants with and without ≥grade II intraventricular hemorrhage or early death.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

To all the staff involved in the participating centers, especially to our neonatal nurses, who always care for our beloved infants with passion.

Funding

The present study is part of a Neo-Flow research project investigating the role of echocardiographic measurements of blood flow in the hemodynamic management of sick neonates. This project has received the following grants: -Biomedicine GRS 2184/A/2020 Research project grants from Gerencia Regional de Salud de Castilla y León, year 2020 (Code:). -Research grant. Fundación Ernesto Sánchez Villares. Sociedad de Pediatría de Asturias, Cantabria y Castilla y León. 2020.

Author information

Author notes

  1. These authors contributed equally: Sandra Terroba-Seara, Ignacio Oulego-Erroz.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain

    Sandra Terroba-Seara

  2. Pediatric Intensive Care Unit and Pediatric Cardiology Unit, Complejo Asistencial Universitario de León, León, Spain

    Sandra Terroba-Seara & Ignacio Oulego-Erroz

  3. Biomedicine Institute of León, University of León, León, Spain

    Ignacio Oulego-Erroz

  4. Pediatric Cardiology Unit, Pediatric Intensive Care Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain

    Daniel Palanca-Arias

  5. Faculty of Medicine, University of Zaragoza, Zaragoza, Spain

    Daniel Palanca-Arias

  6. Neonatal Intensive Care Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain

    Zenaida Galve-Pradel

  7. Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain

    Sara Delgado-Nicolás & Alicia Pérez-Pérez

  8. Neonatal Intensive Care Unit, Hospital Universitario de Navarra, Pamplona, Spain

    Jorge Rodríguez-Ozcoidi, Ana Lavilla-Oíz & Iosune Alegría-Echauri

  9. Department of Neonatology, La Paz University Hospital, Madrid, Spain

    María Carmen Bravo & Leticia La Banda-Montalvo

  10. IdiPaz (Hospital La Paz Institute for Health Research), Madrid, Spain. IdiPaz (Hospital La Paz Institute for Health Research), Madrid, Spain

    María Carmen Bravo & Leticia La Banda-Montalvo

  11. Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain

    Paula Méndez-Abad & Pamela Zafra-Rodríguez

  12. Neonatal Intensive Care Unit, Hospital Universitario de Basurto, Basurto, Spain

    Lorena Rodeño-Fernández & Jon Montero-Gato

  13. Neonatal Intensive Care Unit, Hospital Universitario de Burgos, Burgos, Spain

    Carmen Bustamante-Hervás & Cristina Vega-Del-Val

  14. Pediatric and Neonatal Intensive Care Unit, Hospital Universitario German Trías I Pujol, Badalona, Spain

    Javier Rodríguez-Fanjul

  15. Pediatric Intensive Care Unit, Hospital Central de Asturias, Oviedo, Spain

    Juan Mayordomo-Colunga

  16. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain

    Juan Mayordomo-Colunga

  17. Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain

    Juan Mayordomo-Colunga

  18. Investigation Unit, Complejo Asistencial Universitario de León, León, Spain

    Andrea Pérez-Álvarez

  19. Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Soria, Spain

    Andrea Pérez-Álvarez

Authors
  1. Sandra Terroba-Seara
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  2. Ignacio Oulego-Erroz
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  3. Daniel Palanca-Arias
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  4. Zenaida Galve-Pradel
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Contributions

Sandra Terroba-Seara and Ignacio Oulego-Erroz conceived and designed the study, acquired the data, analyzed the data and drafted the manuscript. Daniel Palanca-Arias, Zenaida Galve-Pradel, Sara Delgado-Nicolás, Alicia Pérez-Pérez, Jorge Rodríguez-Ozcoidi, Ana Lavilla-Oíz, María Carmen Bravo, Paula Mendez-Abad, Lorena Rodeño-Fernández, Jon Montero-Gato, Cristina Vega-Del Val, Javier Rodríguez-Fanjul, Juan Mayordomo-Colunga and Iosune Alegría-Echauri participated in the study design and suggested protocol modifications, acquired the data, and critically reviewed the first and subsequent drafts. Alicia Pérez- Álvarez provided advice on the statistical plan analysis and performed advanced statistics. All the authors approved the final manuscript for submission and agree to be accountable for all the aspects of the work.

Corresponding author

Correspondence to Ignacio Oulego-Erroz.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was reviewed and approved by the IRB (Name: Comité de Ensayos e Investigación con Medicamentos del Área del Salud de León y El Bierzo. ID number: 20101). Parents or legal guardians were approached before study entry and gave their written informed consent for participation.

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Terroba-Seara, S., Oulego-Erroz, I., Palanca-Arias, D. et al. Association between early echocardiography screening of low systemic blood flow and intraventricular hemorrhage in preterm infants: a multicenter cohort study. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01968-6

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