Monash Newborn

Melbourne, Australia

Monash Newborn

Melbourne, Australia

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Sehgal A.,Monash Newborn | Francis J.V.,Monash Newborn | James A.,Hospital for Sick Children | James A.,University of Toronto | And 3 more authors.
Indian Journal of Pediatrics | Year: 2010

Ligation of a patent ductus arteriosus can lead to severe cardiorespiratory compromise in preterm infants. This report reviews the postoperative course of a patient with significant cardiorespiratory instability following surgical ligation of the patent ductus arteriosus and presents a framework for enhanced cardiovascular care in this population. A preterm infant, born at 24 wk gestation underwent ligation of a large haemodynamically significant ductus arteriosus after failure of 2 courses of indomethacin. He developed systemic hypotension, which was aggressively treated with high doses of multiple cardiotropic agents. After 10 hr of refractory hypotension, the addition of hydrocortisone normalized blood pressure. This article outlines preprocedural categorization of infants according to ductal illness severity which facilitates the risk assignment for postoperative deterioration, development of clinical guidelines specific to the likely haemodynamic changes, enhanced role of functional echocardiography for guiding therapy, and interprofessional education. [Indian J Pediatr 2010; 77 (8): 905-907].


Sehgal A.,Monash Newborn | Sehgal A.,Monash University | Menahem S.,MonashHeart | Menahem S.,Foetal Diagnostic Unit
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Objective: To review the current literature addressing the visualisation and clinical applicability of coronary artery blood flow in various foetal and neonatal settings. Method: We reviewed original research papers, commentaries and review articles which studied the usefulness of coronary flow assessments in the growth restricted foetus, healthy neonates and neonates with clinical conditions such as asphyxia, congenital heart disease and post-surgical duct ligation myocardial failure. Results: Relevant literature showed that visualisation of coronary blood flow in growth restricted foetuses is considered an ominous sign and identifies a subgroup of foetuses with a poorer foetal and neonatal outcome. A direct relationship between coronary blood flow and echocardiographic parameters in healthy term infants was noted. These assessments also provided useful information in infants with heart disease and perinatal asphyxia. Coronary perfusion has been noted as an important haemodynamic marker in the peri-operative evaluation of preterm infants undergoing surgical duct ligation. Conclusions: The available literature suggests that these assessments play an important role in improving the understanding of the underlying clinical physiology of the disease process in both the foetus and the newborn. Future research should focus on the evolution of coronary blood flow in clinical situations such as hypotension and inotropic support. © 2013 Informa UK Ltd.


Sehgal A.,Monash Newborn | Sehgal A.,Monash University
European Journal of Pediatrics | Year: 2011

While extremely low-birthweight infants are at a higher risk of haemodynamic instability, management strategies can be highly variable and may lack scientific validation. The aetiology of cardiovascular compromise can be diverse. Volume replacements, cardiotropes (dobutamine, dopamine, epinephrine and milrinone) and hydrocortisone supplementation are common interventions. Most often, therapy is driven by protocol, is based on poorly validated clinical information or is based on the premise that "one therapy fits all". A physiology-driven approach is most needed during transition from intrauterine to extrauterine life surrounding preterm birth, when rapid changes in cardiovascular adaptation occur. The physiologically important determinants of neonatal haemodynamics include cardiac output and systemic vascular resistance, blood pressure, as well as individual organ vascular resistances and blood flows. Three key variables with impact on neonatal haemodynamics, haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload, as well as related therapeutic dilemmas are addressed. Among the novel technologies and approaches presently available, targeted neonatal echocardiography performed by the clinician, used in conjunction with the clinical context, has the potential to better define pathophysiology. A framework for physiology-driven care is proposed, which has the potential to optimize care. © 2011 Springer-Verlag.


Sehgal A.,Monash Newborn | Sehgal A.,Monash University | Doctor T.,Monash Newborn | Menahem S.,Monash University | Menahem S.,MonashHeart Southern Health
Acta Paediatrica, International Journal of Paediatrics | Year: 2014

Aim To compare strain indices between small for gestational age (SGA) infants and asymptomatic appropriate for gestational age (AGA) infants and to ascertain correlations with arterial biophysical properties. Methods In this prospective observational echocardiographic study, 20 inborn term SGA infants weighing <3rd centile for gestational age were compared with 20 AGA infants. Demographic and echocardiographic data were analysed regarding cardiac strain and strain rate and arterial indices (stiffness, impedance and strain elastic modulus). Correlations between variables were assessed using Pearson's coefficient of correlation. Results Ponderal index was significantly lower in SGA infants (24.6 ± 2.9 vs. 29.5 ± 2.5). Left ventricular global longitudinal strain (GLS) was noted to be significantly impaired in the SGA infants (-15.9% ± 2.1 vs. -21.3% ± 2.8, p < 0.001). A basal to apical gradient was noted in segmental strain. Arterial biophysical measurements were significantly altered in the SGA infants. Significant correlations were noted between GLS and arterial stiffness (r = -0.4, p = 0.03), weight-indexed stiffness (r = -0.45, p = 0.02) and pressure-strain elastic modulus (r = -0.49, p = 0.01). Conclusion Impairment in myocardial deformation was noted in the presence of altered arterial biophysical properties in the SGA infants. © 2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.


Sehgal A.,Monash Newborn | Sehgal A.,Monash University | Tran H.,Monash Newborn | Carse E.,Monash Newborn | Carse E.,Monash University
European Journal of Pediatrics | Year: 2011

Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities such as necrotizing enterocolitis and intraventricular haemorrhage. Altered systemic blood flow and end-organ hypoperfusion are known associates of a haemodynamically significant ductus arteriosus where descending aorta blood flow profiles may reveal abnormal diastolic retrograde flow. A preterm neonate was noted to have a large symptomatic patent ductus arteriosus with reversal of diastolic flow in the superior mesenteric vessels. Treatment with indomethacin led to ductal closure and concomitant restoration of diastolic flow and resolution of symptoms. Doppler studies of systemic vessels may help improve our understanding of the systemic impact of a haemodynamically significant ductus arteriosus. © 2010 Springer-Verlag.


Sehgal A.,Monash Newborn | Sehgal A.,Monash University
European Journal of Pediatrics | Year: 2012

Neonatal stroke is a diverse clinical entity. Terminology and aetiology described in the literature are very varied. While numerous risk factors are cited, only few case-control studies have investigated them in a systematic fashion. This equipoise extends to the investigational and management profile of perinatal stroke too. Controversy persists about the suitability of detailed haematological thrombophilia workup in the neonatal period. This case-based review details the variable clinical presentation in term and preterm neonates, discusses the current literature, ascertains the respective roles of various imaging modalities, explores relevant new neuroprotective interventions and proposes a systematic approach to clinical and neuroimaging workup. Long-term follow-up is important as many infants suffer neuro-disability, which might need early intervention strategies. © 2011 Springer-Verlag.


PubMed | Monash Newborn
Type: Clinical Trial | Journal: Heart, lung & circulation | Year: 2012

Congenital complete heart block (CCHB) is an uncommon although important and potentially serious condition contributing to neonatal morbidity and mortality.To study the characteristics and outcomes of infants born with CCHB at a single tertiary centre.A retrospective review of all infants with CCHB over the last 20 years was carried out to determine the outcomes, and the indications and timing of pacemaker insertion.Fifteen live born infants (10 male, 5 female) with CCHB were identified. Their mean (and SD) gestation and birth weight were 37 (3.3) weeks and 3100 (448) grams respectively. Maternal systemic lupus erythematosus (SLE) antibodies were present in eight (53%) pregnancies and two infants had congenitally corrected transposition of the great arteries (cCTGA). The median heart rate/minute at birth was 60 (range 40-80). Thirteen (87%) patients to date required a pacemaker. The median age of insertion of a pacemaker device was six months (range 2 days-16 years). All patients were paced epicardially - six initially with a single chamber and five with a dual chamber pacemaker. At the time of generator change, dual chamber pacemakers were used. The median life of an implanted pacemaker was six years (3-10 years). Except for a patient with cCTGA who has undergone a double switch procedure, all the patients had good systemic ventricular function. There was one death in the group unrelated to CCHB.CCHB is a uncommon but potentially serious condition in infancy. While a significant number of infants need a pacemaker, the overall outcome of infants with CCHB in our experience is good.


PubMed | Monash Newborn
Type: Journal Article | Journal: Gene | Year: 2013

Partial terminal duplication of chromosome 9 is a rare anomaly that is known to be associated with specific dysmorphic features. While having common characteristics, these patients also have inconsistent phenotypic features. These inconsistent features may be attributed to the length and the region of the duplicated segment of chromosome 9. We discuss a case of an infant with similar physical features to those previously reported including dysmorphology of the craniofacial region, hands and feet. However we also describe findings of malrotation and renal anomalies. Microarray demonstrated duplication of 9q33.2-q34.3 with normal parental karyotyping. This is the first reported case of duplication of this specific region of chromosome 9q and the phenotypic presentation represents a new constellation of clinical findings.


PubMed | Monash Newborn
Type: Journal Article | Journal: European journal of pediatrics | Year: 2011

While extremely low-birthweight infants are at a higher risk of haemodynamic instability, management strategies can be highly variable and may lack scientific validation. The aetiology of cardiovascular compromise can be diverse. Volume replacements, cardiotropes (dobutamine, dopamine, epinephrine and milrinone) and hydrocortisone supplementation are common interventions. Most often, therapy is driven by protocol, is based on poorly validated clinical information or is based on the premise that one therapy fits all. A physiology-driven approach is most needed during transition from intrauterine to extrauterine life surrounding preterm birth, when rapid changes in cardiovascular adaptation occur. The physiologically important determinants of neonatal haemodynamics include cardiac output and systemic vascular resistance, blood pressure, as well as individual organ vascular resistances and blood flows. Three key variables with impact on neonatal haemodynamics, haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload, as well as related therapeutic dilemmas are addressed. Among the novel technologies and approaches presently available, targeted neonatal echocardiography performed by the clinician, used in conjunction with the clinical context, has the potential to better define pathophysiology. A framework for physiology-driven care is proposed, which has the potential to optimize care.


PubMed | Monash Newborn
Type: Journal Article | Journal: European journal of pediatrics | Year: 2012

Neonatal stroke is a diverse clinical entity. Terminology and aetiology described in the literature are very varied. While numerous risk factors are cited, only few case-control studies have investigated them in a systematic fashion. This equipoise extends to the investigational and management profile of perinatal stroke too. Controversy persists about the suitability of detailed haematological thrombophilia workup in the neonatal period. This case-based review details the variable clinical presentation in term and preterm neonates, discusses the current literature, ascertains the respective roles of various imaging modalities, explores relevant new neuroprotective interventions and proposes a systematic approach to clinical and neuroimaging workup. Long-term follow-up is important as many infants suffer neuro-disability, which might need early intervention strategies.

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