Faculty Bibliography

Prenatal prediction of critical coarctation of the aorta remains challenging. Fetal echocardiography in isolated persistent left-sided superior vena cava (IP L-SVC), a benign variant, can mimic suspected coarctation with shared right-to-left ventricular size discrepancy. We sought to describe cardiac deformation in fetuses with IP L-SVC and compare to those with suspected coarctation. We hypothesized that cardiac deformation as measured by global longitudinal strain (GLS) could differentiate fetuses with coarctation from IP L-SVC. This is a single-center, retrospective study of fetuses with IP L-SVC and suspected coarctation. Fetal cardiac deformation analysis was performed using a vendor non-specific software. The primary variable was GLS. Secondary variables were left ventricular ejection fraction, left ventricular end-systolic volume, and left ventricular end-diastolic volume (LVEDV). Mean LVEDV z-score was determined. Interrater reliability was performed. Baseline measures of GLS were performed using a cohort of normal fetuses. Ninety fetuses were analyzed (IP L-SVC n=28, suspected coarctation n=30, normal n=32). Seventeen required surgical repair for coarctation. Fetuses with IP L-SVC and suspected coarctation had lower GLS (p <0.001) and smaller left ventricular size compared to normal (p<0.001). Fetuses who required surgical repair for coarctation of the aorta had the lowest LVEDV. Interrater reliability was poor to moderate. Our study is the first to date that examines strain in fetuses with IP L-SVC compared to suspected coarctation of the aorta. Cardiac deformation in fetuses with IP L-SVC was indistinguishable from fetuses with suspected coarctation of the aorta. GLS proved a poor predictor of postnatal surgical repair in isolation.

OBJECTIVES/UNASSIGNED:The study aimed to assess the reliability of the Fenton curve superimposed with fetal weight percentile in predicting the birth weight of infants born ≤36 weeks gestational age. STUDY DESIGN/UNASSIGNED:-test and Bland-Altman test. RESULTS/UNASSIGNED: = 0.17), with a median difference of 32.2 grams between the predicted and actual weight. CONCLUSION/UNASSIGNED:The study found that the Fenton curve method reliably predicted the birth weight of infants born ≤36 weeks of gestational age. The results indicate that in normally grown fetuses, healthcare providers in the delivery room could potentially use Fenton curve predicted birth weight for drug dosage and equipment sizing in scenarios where obtaining actual birth weight is not possible. Nonetheless, additional analysis in larger cohorts is needed before this method can be universally adopted.

Judicious balance of fluids is needed for optimal management of acute respiratory distress syndrome (ARDS). Achieving optimal fluid balance is difficult in patients with disorders of fluid homeostasis such as diabetes insipidus (DI). There is little data on the use of Furosemide to aid in balancing fluid and electrolytes in patients with DI. Here, we present a critically ill 11-year-old female with developmental delay, septo-optic dysplasia, central DI, and respiratory failure secondary to COVID-19 ARDS. She required careful titration of a Vasopressin infusion in addition to IV Furosemide for successful management of fluid and electrolyte derangements. On admission, she demonstrated high-volume urine output with mild hypernatremia (serum sodium 156 mmol/L). Despite her maximum Vasopressin infusion rate of 8 mU/kg/hr, by day two of admission, she voided a total of 4 L resulting in severe hypernatremia (serum sodium 171 mmol/L). With continually high Vasopressin infusion rates, her overall fluid balance became increasingly net positive, although her hypernatremia persisted. Her ARDS continued to worsen. After 48 hours of the addition of intermittent Furosemide, successful diuresis along with resolution of hypernatremia was achieved. The combination of IV Furosemide with Vasopressin infusion resulted in tailored diuresis and more controlled titration of serum sodium levels than adjustment in Vasopressin and fluids alone. These results are in contradistinction to the published literature, which focuses on the use of thiazide diuretics in managing DI. This experience highlights the potential for loop diuretics to aid in establishing a desired fluid and electrolyte status in managing patients with both DI and ARDS.