Evidence map›Paper›PMID 35485231›Full record

ReviewCirculation. Cardiovascular interventions2022

Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management.

Hannah El-Sabrout, Srujan Ganta, Peter Guyon, Kanishka Ratnayaka, Gabrielle Vaughn, James Perry, Amy Kimball, Justin Ryan, Courtney D Thornburg, Suzanne Tucker and 4 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Circulation. Cardiovascular interventions, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Hannah El-SabroutDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.
Srujan GantaDivision of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego.ORCID 0000-0002-5675-0834
Peter GuyonDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.
Kanishka RatnayakaDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.ORCID 0000-0003-4502-6645
Gabrielle VaughnDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.
James PerryDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.ORCID 0000-0001-9520-4660
Amy KimballDivision of Neonatology (A.K.), Rady Children's Hospital/University of California, San Diego.
Justin Ryan3D Innovation Lab (J.R.), Rady Children's Hospital/University of California, San Diego.
Courtney D ThornburgDivision of Hematology (C.D.T.), Rady Children's Hospital/University of California, San Diego.
Suzanne TuckerDivision of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego.
Jun MoDivision of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego.
Sanjeet HegdeDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.
John NigroDivision of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego.
Howaida El-SaidDivision of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego.ORCID 0000-0002-3447-7398

Funding

The Cardiac Atlas ProjectR01HL121754 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MCCULLOCH, ANDREW D., OMENS, JEFFREY H. · 2014 to 2023
$5.0M
NHLBI NIH HHS R01 HL121754
6 · The paper itself

Abstract

backgroundNeonatal myocardial infarction is rare and is associated with a high mortality of 40% to 50%. We report our experience with neonatal myocardial infarction, including presentation, management, outcomes, and our current patient management algorithm.

methodsWe reviewed all infants admitted with a diagnosis of coronary artery thrombosis, coronary ischemia, or myocardial infarction between January 2015 and May 2021.

resultsWe identified 21 patients (median age, 1 [interquartile range (IQR), 0.25-9.00] day; weight, 3.2 [IQR, 2.9-3.7] kg). Presentation included respiratory distress (16), shock (3), and murmur (2). Regional wall motion abnormalities by echocardiogram were a key criterion for diagnosis and were present in all 21 with varying degrees of depressed left ventricular function (severe [8], moderate [6], mild [2], and low normal [5]). Ejection fraction ranged from 20% to 54% (median, 43% [IQR, 34%-51%]). Mitral regurgitation was present in 19 (90%), left atrial dilation in 15 (71%), and pulmonary hypertension in 18 (86%). ECG was abnormal in 19 (90%). Median troponin I was 0.18 (IQR, 0.12-0.56) ng/mL. Median BNP (B-type natriuretic peptide) was 2100 (IQR, 924-2325) pg/mL. Seventeen had documented coronary thrombosis by cardiac catheterization. Seventeen (81%) were treated with intracoronary tPA (tissue-type plasminogen activator) followed by systemic heparin, AT (antithrombin), and intravenous nitroglycerin, and 4 (19%) were treated with systemic heparin, AT, and intravenous nitroglycerin alone. Nineteen of 21 recovered. One died (also had infradiaphragmatic total anomalous pulmonary venous return). One patient required a ventricular assist device and later underwent heart transplant; this patient was diagnosed late at 5 weeks of age and did not respond to tPA. Nineteen of 21 (90%) regained normal left ventricular function (ejection fraction, 60%-74%; mean, 65% [IQR, 61%-67%]) at latest follow-up (median, 6.8 [IQR, 3.58-14.72] months). Two of 21 (10%) had residual trivial mitral regurgitation. After analysis of these results, we present our current algorithm, which developed and matured over time, to manage neonatal myocardial infarction.

conclusionsWe experienced a lower mortality rate for infants with neonatal infarction than that reported in the literature. We propose a post hoc algorithm that may lead to improvement in patient outcomes following coronary artery thrombus.

Indexed as

Coronary ThrombosisMitral Valve InsufficiencyMyocardial InfarctionAlgorithmsCoronary VesselsHeparinHumansInfantInfant, NewbornNitroglycerinTreatment OutcomeHeparinNitroglycerindilatationinfantstroke volumetroponin Iumbilical cord

Identifiers

PMID35485231
PMCPMC11225359

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.