Ismina Papadhima1, Deepak Louis1, Jyotsna Purna2, Poorva Deshpande1,2, Yenge Diambomba1,2, Shoo Lee1,2,3, Prakesh Shah1,2,3, Dany Weisz4, Afif El-Khuffash5, Patrick J McNamara2,6, Luc Mertens2,7, Amish Jain8,9,10. 1. Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada. 2. Department of Pediatrics, University of Toronto, Toronto, ON, Canada. 3. Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. 4. Department of Newborn and Developmental Pediatrics, Sunnybrook Hospital, Toronto, ON, Canada. 5. Department of Pediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland. 6. Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada. 7. Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada. 8. Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca. 9. Department of Pediatrics, University of Toronto, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca. 10. Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca.
Abstract
OBJECTIVE: To describe the utilization and study the factors associated with the impact on clinical management of a new TNE consultation service in a perinatal center. METHODS: This retrospective cohort study included all neonates who underwent TNE consultation at the neonatal unit of Mount Sinai Hospital in Toronto, Canada (November 2011 and July 2015). The consults that had "impact" were defined as those that led to a TNE suggested change in the clinical management within 6 h of its recommendation. Logistic regression analysis was performed to identify factors associated with a change in clinical management following the consultation. RESULTS: A total of 553 consults were performed for 268 infants (gestational age: 27 ± 4 weeks and age at initial consult: 16 (5, 34) days). Patent ductus arteriosus (PDA, 61%), suspected pulmonary hypertension (PH, 27%), and systemic hypotension (SH, 9%) were the common indications. The average consultations increased from 9 in 2012-2013 to 20 per month in 2014-2015. Forty eight percent of consults had an impact on clinical management (PDA scans: 38%, PH: 58%, and SH: 81%, p < 0.01 between all). Male gender (adjusted odds ratio (95% confidence interval): 1.9 (1.0, 3.5); p = 0.04), mechanical ventilation (2.43 (1.2, 4.9); p = 0.01), and scans for PH (7.1 (2.2, 23.2); p < 0.01) and SH (2.6 (1.1, 6.5); p = 0.03) were independently associated with the impact on clinical management. TNE consults identified all incidental cases of major structural defects (n = 4), and six out of ten minor diagnoses. CONCLUSIONS: TNE consult service demonstrated an increasing utilization and a significant impact on clinical management over time especially for non-PDA indications and in situations of high-illness severity. Although, all major cardiac defects were identified, some minor congenital defects were missed by TNEs.
OBJECTIVE: To describe the utilization and study the factors associated with the impact on clinical management of a new TNE consultation service in a perinatal center. METHODS: This retrospective cohort study included all neonates who underwent TNE consultation at the neonatal unit of Mount Sinai Hospital in Toronto, Canada (November 2011 and July 2015). The consults that had "impact" were defined as those that led to a TNE suggested change in the clinical management within 6 h of its recommendation. Logistic regression analysis was performed to identify factors associated with a change in clinical management following the consultation. RESULTS: A total of 553 consults were performed for 268 infants (gestational age: 27 ± 4 weeks and age at initial consult: 16 (5, 34) days). Patent ductus arteriosus (PDA, 61%), suspected pulmonary hypertension (PH, 27%), and systemic hypotension (SH, 9%) were the common indications. The average consultations increased from 9 in 2012-2013 to 20 per month in 2014-2015. Forty eight percent of consults had an impact on clinical management (PDA scans: 38%, PH: 58%, and SH: 81%, p < 0.01 between all). Male gender (adjusted odds ratio (95% confidence interval): 1.9 (1.0, 3.5); p = 0.04), mechanical ventilation (2.43 (1.2, 4.9); p = 0.01), and scans for PH (7.1 (2.2, 23.2); p < 0.01) and SH (2.6 (1.1, 6.5); p = 0.03) were independently associated with the impact on clinical management. TNE consults identified all incidental cases of major structural defects (n = 4), and six out of ten minor diagnoses. CONCLUSIONS: TNE consult service demonstrated an increasing utilization and a significant impact on clinical management over time especially for non-PDA indications and in situations of high-illness severity. Although, all major cardiac defects were identified, some minor congenital defects were missed by TNEs.
Authors: Regan E Giesinger; Philip T Levy; J Lauren Ruoss; Mohamed El Dib; Khorshid Mohammad; Pia Wintermark; Patrick J McNamara Journal: Pediatr Res Date: 2020-10-18 Impact factor: 3.756