{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:30:38Z","timestamp":1768591838643,"version":"3.49.0"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003Comprehensive assessment of hemodynamic significance of a patent ductus arteriosus (PDA) is a common indication to perform targeted neonatal echocardiography (TNE). Impact of implementation of such an assessment on PDA management decisions remains to be reported. The objective of this study is to compare PDA-related hemodynamic information and PDA treatment decisions before and after introduction of TNE service.<\/jats:p><jats:p>\n            Study Design\u2003This was a retrospective cohort study at a tertiary level neonatal intensive care unit in Southwestern Ontario. We investigated two time periods: Epoch-1 (non-TNE 2013\u20132016) versus Epoch-2 (TNE 2018\u20132021). We included neonates\u2009&lt;\u200932 weeks with PDA. Data on baseline clinical characteristics, PDA-related echocardiographic parameters, PDA treatment details, and relevant long-term outcomes were collected. Primary outcome was defined as PDA treatment rates and need for multiple courses. Secondary outcomes included availability of PDA hemodynamic data and neonatal mortality\/morbidity (PDA-related)<\/jats:p><jats:p>\n            Results\u2003A total of 275 neonates were included. A total of 162 were assessed by conventional echocardiography in Epoch-1, whereas 113 were assessed by TNE in Epoch-2. Baseline clinical characteristics were similar. Epoch-2 had more echocardiographic assessments per patient of 2.7 (\u00b11.8) versus 1.9 (\u00b1\u20091.3), p\u2009&lt;\u20090.001 in Epoch1. The mean postnatal age at first echocardiographic assessment was higher in Epoch-2 (12.7 days [\u2009\u00b1\u200914.6]) than in Epoch-1 (7.9 days [\u2009\u00b1\u200910.4]), p\u2009&lt;\u20090.001. Comprehensive hemodynamic assessment of PDA-related echocardiographic parameters such as PDA size, shunt pattern, effect on systemic circulation, and pulmonary circulation were higher in Epoch-2. Overall, PDA treatment rates were comparable in the two time periods. The use of multiple courses of treatment was higher in Epoch-1 than in Epoch-2 (47.8 vs. 31.7%, p\u2009=\u20090.047). In Epoch-1, neonates received PDA treatment earlier than in Epoch-2.<\/jats:p><jats:p>\n            Conclusion\u2003With the implementation of the TNE service, increased echocardiographic evaluations per patient were completed with availability of more comprehensive hemodynamic information about PDA. PDA treatment rates were similar in the two epochs, but need for multiple courses were less in TNE era.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0043-1774313","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T22:47:05Z","timestamp":1694818025000},"page":"e2703-e2709","source":"Crossref","is-referenced-by-count":7,"special_numbering":"S","title":["Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study"],"prefix":"10.1055","volume":"41","author":[{"given":"Abdulaziz","family":"Homedi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Western University, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"De La Hoz","sequence":"additional","affiliation":[{"name":"Department of Lawson Research \u2013 Medicine, London Health Sciences Centre, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Western University, London, Ontario, Canada"},{"name":"Department of Lawson Research \u2013 Medicine, London Health Sciences Centre, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renjini","family":"Lalitha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Western University, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisha","family":"McClean","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Western University, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soume","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Western University, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.echo.2011.07.014","article-title":"Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC)","volume":"24","author":"L Mertens","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.echo.2012.01.001","article-title":"Targeted echocardiography in the neonatal intensive care unit","volume":"25","author":"B Sinha","year":"2012","journal-title":"J Am Soc Echocardiogr"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.paed.2022.07.005","article-title":"Use of echocardiography in the neonatal intensive care unit","volume":"32","author":"Y Singh","year":"2022","journal-title":"Paediatr Child Health"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/ejechocard\/jer181","article-title":"Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training","volume":"12","author":"L Mertens","year":"2011","journal-title":"Eur J Echocardiogr"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"151721","DOI":"10.1016\/j.semperi.2023.151721","article-title":"Impact of early screening echocardiography and targeted PDA treatment on neonatal outcomes in \u201c22-23\u201d week and \u201c24-26\u201d infants","volume":"47","author":"R E Giesinger","year":"2023","journal-title":"Semin Perinatol"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1067\/mpd.2001.110528","article-title":"Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome","volume":"138","author":"B Van Overmeire","year":"2001","journal-title":"J Pediatr"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"147.e1","DOI":"10.1016\/j.ajog.2006.09.014","article-title":"Trends in neonatal morbidity and mortality for very low birthweight infants","volume":"196","author":"A A Fanaroff","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1159\/000092870","article-title":"Mechanisms regulating the ductus arteriosus","volume":"89","author":"R I Clyman","year":"2006","journal-title":"Biol Neonate"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.siny.2010.05.001","article-title":"Neonatologist-performed functional echocardiography in the neonatal intensive care unit","volume":"16","author":"A F El-Khuffash","year":"2011","journal-title":"Semin Fetal Neonatal Med"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1159\/000515415","article-title":"Early PARacetamol (EPAR) trial: a randomized controlled trial of early paracetamol to promote closure of the ductus arteriosus in preterm infants","volume":"118","author":"T Schindler","year":"2021","journal-title":"Neonatology"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00431-015-2633-2","article-title":"Expert consensus statement \u2018neonatologist-performed echocardiography (NoPE)\u2019-training and accreditation in UK","volume":"175","author":"Y Singh","year":"2016","journal-title":"Eur J Pediatr"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s13312-018-1286-4","article-title":"Functional echocardiography in the neonatal intensive care unit","volume":"55","author":"Y Singh","year":"2018","journal-title":"Indian Pediatr"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/chd.12703","article-title":"Echocardiography of the patent ductus arteriosus in 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Soc Echocardiogr"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1046\/j.1440-1754.2000.00469.x","article-title":"Echocardiography on neonatal intensive care units in Australia and New Zealand","volume":"36","author":"N Evans","year":"2000","journal-title":"J Paediatr Child Health"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00246-008-9275-3","article-title":"Echocardiography and the neonatologist","volume":"29","author":"M Kluckow","year":"2008","journal-title":"Pediatr Cardiol"},{"key":"ref19","first-page":"1","article-title":"Neonatal performed echocardiography course: can we face it?","author":"N C Cabral","year":"2023","journal-title":"J Perinatol"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s13052-019-0721-z","article-title":"Neonatologist performed echocardiography (NPE) in Italian neonatal intensive care units: a national survey","volume":"45","author":"I Corsini","year":"2019","journal-title":"Ital J Pediatr"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1038\/s41372-018-0130-y","article-title":"Targeted neonatal echocardiography (TNE) consult service in a large tertiary perinatal center in Canada","volume":"38","author":"I Papadhima","year":"2018","journal-title":"J Perinatol"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.anpedi.2013.11.026","volume":"81","author":"A Corredera","year":"2014","journal-title":"Ann Pediatr (Paris)"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1164\/rccm.202212-2291OC","article-title":"Impact of early hemodynamic screening on extremely preterm outcomes in a high-performance center","volume":"208","author":"R E Giesinger","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"137","DOI":"10.3233\/NPM-221042","article-title":"Comparison of PDA diameter measurements using color and 2D echocardiography in newborn infants","volume":"16","author":"S S Pereira","year":"2023","journal-title":"J Neonatal Perinatal Med"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1038\/s41390-023-02526-0","article-title":"Echocardiography performed by the neonatologist: the impact on the clinical management","volume":"94","author":"S A Negreiros Figueira","year":"2023","journal-title":"Pediatr Res"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1139\/cjpp-2018-0458","article-title":"Merits and perils of targeted neonatal echocardiography-based hemodynamic research: a position statement","volume":"97","author":"A Kharrat","year":"2019","journal-title":"Can J Physiol Pharmacol"},{"issue":"S 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