Fields of interest:
Research and clinical interests relate to paediatrics, in particular neonatal and paediatric cardiology and echocardiography
Background:
Consultant at Clinic for Paediatrics and Adolescence at Akershus University Hospital and Associate Professor at the University of Oslo since 2021
School of Health Innovation 2019
EACVI Certification in Congenital Heart Disease Echocardiography since 2017
PhD at UoO 2010
Teaching:
Lectures and seminars for medical students on Paediatric Cardiology in MED5600 - Medical Studies, Module 6, Deputy Chair of the module, and member of the examination committee for the module. Lecture on Congenital Heart Disease in the Master's in Clinical Nutrition ("Klinisk ernæring").
Research:
Principal supervisor in ongoing PhD projects for Marlen Fossan Aas, Nikolai Nordberg Nørgaard, Isabelle Boere Holstad and Erle Sissener, and co-supervisor in PhD projects for Wisam Muhsen, Zarah Eileen Hilde Farrah Farnes and Zanira Ansari
Initiated a cardiovascular study in the ALBINO trial
Study group member in LoTECA - Long-term effects of COVID-19 in adolescents
Finalised projects include post-doc projects in perinatal asphyxia and research-based innovation in adults, innovation projects in tissue Doppler Echocardiography and in Speckle Tracking Echocardiography, strategic Research grants in neonatal and paediatric heart function, principal supervisor for PhD project for Lisa Bjarkø and co-supervising in PhD-project in neonatal heart function.
Current scientific positions:
Within the European Society for Paediatric Research (ESPR), I am member of the ESPR council, Section Secretary for the Circulation, Haematology and Oxygen Transport Section and Chair for the 'Neonatologist Performed Echocardiography (NPE)' Special Interest Group
Advisory Group member of RePHyNe: Registry of Pulmonary Hypertension in Neonates
Faculty member of the Neonatal Hemodynamics Research Centre
FEACVI since 2021
Adjunct editor in Acta Paediatrica and Review Editor for Neonatology in Frontiers in Pediatrics
Previous scientific positions: Memberships in the extended editorial committee for the Journal of the Norwegian Medical Association (2013-2022) and in the Working-group for cardiovascular imaging within the Norwegian Society of Cardiology (2016-2024)
Google Scholar link
Loop profile: 499828
Scopus author ID: 6603325639
ORCID ID 0000-0001-8011-5999
Publications
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Muhsen, Wisam; Hosking, Joanne; Latour, Jos M. & Nestaas, Eirik
(2026).
Tissue Doppler Imaging, Pulmonary Haemodynamics and Conventional Echocardiographic Indices for Early Bronchopulmonary Dysplasia Prediction in Preterm Infants: A Prospective Observational Feasibility Study.
Children.
13(5).
doi:
10.3390/children13050660.
Full text in Research Archive
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Nørgaard, Nikolai Nordberg; Holstad, Isabelle Aria Johanna Boere; Jess, Moritz Schneider; Wyller, Vegard Bruun Bratholm & Nestaas, Eirik
(2026).
Dynamic adaptive changes in heart function first 10 days after birth in healthy term neonates.
Early Human Development.
ISSN 0378-3782.
219,
p. 106553–106553.
doi:
10.1016/j.earlhumdev.2026.106553.
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Muhsen, W. S.; Hosking, J.; Nestaas, Eirik & Latour, J. M.
(2025).
Feasibility of echocardiography and speckle-tracking-derived right ventricular parameters for a prediction model of early bronchopulmonary-dysplasia in preterm infants (REPORT-BPD Study): an observational cohort study.
Pilot and Feasibility Studies.
12(1).
doi:
10.1186/s40814-025-01740-3.
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Show summary
Background
Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants’ underdeveloped lungs, leading to long-term growth and neurodevelopmental issues. Despite its significance, no clinical prediction model exists for neonatologists.
Aim
To assess the feasibility of study procedures and provide descriptive data to guide a large multicentre study for developing a BPD-prediction model.
Methods
This was a single-centre feasibility observational cohort study conducted at a neonatal intensive care unit. Forty preterm infants born before 32 weeks of gestation were recruited within 18 months. Two echocardiographic scans on days 5 and 9 after birth were planned for each infant. Feasibility targets included achieving adequate recruitment and retention, ensuring at least 80% of recruited infants underwent two scans, and maintaining high-quality imaging, with at least 80% of scans analysable, particularly Tissue Doppler Imaging (TDI) and speckle tracking imaging (STI). Descriptive statistics for feasibility, demographic, clinical, and cardiac parameters of preterm infants with and without BPD are reported.
Results
Seventy-seven preterm infants were screened for eligibility between June 2022 and May 2023. The target of 40 preterm infants was achieved within 11 months. All infants had the first echo scan performed, whereas 39 (97%) had a second one performed. Majority had their echo scans performed within 24 h of the prespecified timeframe, i.e. days 5 and 9 after birth (34 (85%) of the first and 28 (69%) of the second echo scans). All the first and 39 (97%) of the second echo scans, excluding STI, were suitable for analysing the cardiac parameters. Regarding STI, 38 (95%) of the first and 34 (85%) of the second echo scans were analysable. Compared with the 27 infants without BPD, the 13 BPD-affected preterm infants had a lower gestational age (median 26 vs 30 weeks) and lower birth weight (median 1370 vs 763 g). Clinically, respiratory support was greater in the BPD group than in the non-BPD group (median 8.3 vs 3.0 for the first scan; 7.9 vs 0.0 (cmH2O or L/min) for the second echo scan).
Conclusion
Our findings demonstrate that a large multicentre study is feasible and will inform the construction of a BPD-prediction model.
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Engel, Corinna; Rüdiger, Mario; Benders, Manon J. N. L.; Bel, Frank van; Allegaert, Karel & Naulaers, Gunnar
[Show all 23 contributors for this article]
(2024).
Detailed statistical analysis plan for ALBINO: effect of Allopurinol in addition to hypothermia for hypoxic-ischemic Brain Injury on Neurocognitive Outcome — a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III).
Trials.
25(1),
p. 1–13.
doi:
10.1186/s13063-023-07828-6.
Full text in Research Archive
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Wyk, Lizelle van; Austin, Topun; Barzilay, Bernard; Bravo, Maria Carmen; Breindahl, Morten & Czernik, Christoph
[Show all 27 contributors for this article]
(2024).
A recommendation for the use of electrical biosensing technology in neonatology.
Pediatric Research.
ISSN 0031-3998.
p. 1–14.
doi:
10.1038/s41390-024-03369-z.
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Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice.
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Nestaas, Eirik; BJARKØ, LISA; Kiserud, Torvid; Haugen, Guttorm Nils & Fugelseth, Drude
(2023).
Heart function by M-mode and tissue Doppler in the early neonatal period in neonates with fetal growth restriction.
Early Human Development.
ISSN 0378-3782.
183.
doi:
10.1016/j.earlhumdev.2023.105809.
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Background: Fetal growth restricted (FGR) neonates have increased risk of circulatory compromise due to failure of normal transition of circulation after birth. Aim: Echocardiographic assessment of heart function in FGR neonates first three days after birth. Study design: Prospective observational study. Subjects: FGR- and non-FGR neonates. Outcome measures: M-mode excursions and pulsed-wave tissue Doppler velocities normalised for heart size and E/e′ of the atrioventricular plane day one, two and three after birth. Results: Compared with controls (non-FGR of comparable gestational age, n = 41), late-FGR (gestational age ≥ 32 weeks, n = 21) exhibited higher septal excursion (15.9 (0.6) vs. 14.0 (0.4) %, p = 0.021) (mean (SEM)) and left E/e′ (17.3 (1.9) vs.11.5 (1.3), p = 0.019). Relative to day three, indexes on day one were higher for left excursion (21 (6) % higher on day one, p = 0.002), right excursion (12 (5) %, p = 0.025), left e′ (15 (7) %, p = 0.049), right a′ (18 (6) %, p = 0.001), left E/e′ (25 (10) %, p = 0.015) and right E/e′ (17 (7) %, p = 0.013), whereas no index changed from day two to day three. Late-FGR had no impact on changes from day one and two to day three. No measurements differed between early-FGR (n = 7) and late-FGR. Conclusions: FGR impacted neonatal heart function the early transitional days after birth. Late-FGR hearts had increased septal contraction and reduced left diastolic function compared with controls. The dynamic changes in heart function between first three days were most evident in lateral walls, with similar pattern in late-FGR and non-FGR. Early-FGR and late-FGR exhibited similar heart function.
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Muhsen, Wisam; Nestaas, Eirik; Hosking, Joanne & Latour, Jos M.
(2023).
Echocardiography parameters used in identifying right ventricle dysfunction in preterm infants with early bronchopulmonary dysplasia: A scoping review.
Frontiers in Pediatrics.
11.
doi:
10.3389/fped.2023.1114587.
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Background Bronchopulmonary Dysplasia (BPD) is a chronic condition that affects preterm infants and is associated with long-term complications. Haemodynamic effects of BPD can lead to right ventricular (RV) dysfunction. Objective To synthesise and map the evidence of echo parameters used in identifying RV dysfunction in the first two weeks-after-birth (WAB) of preterm infants with early BPD. Information Sources This scoping review included the databases: Medline, CINAHL, PubMed, EMBASE, Scopus, ProQuest, Web of Science, Cochrane Library, JBI Evidence-Based Practise and Gray Literature. Search Strategy The search utilised Boolean operators and descriptors registered in Medical Subject Headings. Inclusion and exclusion criteria Included were studies utilising echo parameters to examine RV function in preterm infants with early BPD in the first two WAB. Synthesis of results The results are presented as a map of the extracted findings in a tabular format with a narrative summary. Results Eight studies were included. Differences were observed in the number and timing of echo scans performed in the first two WAB and the variations in the echo parameters used to compare preterm infants with and without early BPD. Only echo scans performed at the end of the first WAB, demonstrated significant differences in the echo parameters measurements between preterm infants with and without BPD. Studies using RV Myocardial Performance Index (MPI) to identify RV-dysfunction associated with early BPD demonstrated similar findings. The Pulsed-Wave Doppler technique identified differences in RV-MPI between preterm infants with and without BPD, while Tissue-Doppler-Imaging did not demonstrate similar results. Speckle tracking can measure strain (S) and strain rate (SR) and diagnose RV-dysfunction. However, the findings of studies that utilised speckle tracking varied. Finally, two of the included studies added blood tests to their diagnostic model of early BPD, which was able to demonstrate significant differences in blood test results between BPD-affected and control preterm infants. Conclusion BPD could adversely affect the myocardium function of the RV; these negative influences can be captured in the first two WAB. However, there are still knowledge gaps regarding the appropriate number, timing and the most suitable echo parameters to assess RV function.
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Bjarkø, Lisa; Fugelseth, Drude; Harsem, Nina Kittelsen; Kiserud, Torvid; Haugen, Guttorm Nils & Nestaas, Eirik
(2022).
Cardiac morphology in neonates with fetal growth restriction.
Journal of Perinatology.
ISSN 0743-8346.
43.
doi:
10.1038/s41372-022-01538-8.
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Objective: Assess effects of fetal growth restriction (FGR) on cardiac modelling in premature and term neonates. Study design: Prospective echocardiographic study of a cohort of FGR neonates (n = 21) and controls (n = 41) with normal prenatal growth and circulation. Results: Unadjusted for gestational age, birth weight, sex, and twin/singleton, Late-FGR neonates had smaller hearts than controls, with globular left ventricles and symmetrical right ventricles. Adjusted estimates showed smaller left ventricles and similarly sized right ventricles, with symmetrical left and right ventricles. Early-FGR (compared with Late-FGR) had smaller hearts and globular left ventricles in unadjusted estimates, but after adjustment, sizes and shapes were similar. Conclusion: FGR had significant impact on cardiac modelling, seen in both statistical models unadjusted and adjusted for gestational age, birth weight, sex, and twin/singleton. The adjustments, however, refined the results and revealed more specific effects of FGR, thus underscoring the importance of statistical adjustments in such studies.
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Nestaas, Eirik
(2022).
Neonatologist performed echocardiography for evaluating the newborn infant.
Frontiers in Pediatrics.
10,
p. 1–7.
doi:
10.3389/fped.2022.853205.
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The interest in the use of cardiac ultrasound for hemodynamic evaluation in neonates has increased in the last decades. Several overlapping terms exists, and a non-comprehensive list includes point-of-care ultrasound, clinician-performed ultrasound, focused cardiac ultrasound, targeted neonatal echocardiography, and neonatologist performed echocardiography. This review will use the term neonatologist performed echocardiography. Neonatologist performed echocardiography is primarily echocardiography to obtain snapshots of hemodynamics and heart function, usually as repeated exams during intensive care. It provides the neonatologist with in-depth information on the hemodynamics not available by blood pressure, pulse oximetry, capillary refill time, and various blood tests. The review provides a brief overview of some relevant methods for assessment of hemodynamics and heart function. It does not discuss training, implementation, accreditation, and certification nor in-depth technical aspects and detailed use of neonatologist performed echocardiography. If the information obtainable by neonatologist performed echocardiography had been accessible easily (e.g., via a sensor put on the neonate similarly to a pulse oximeter), neonatologist performed echocardiography would have been more widely used. Acquiring skills for neonatologist performed echocardiography take time and resources. Future developments probably include a stronger focus on education, training, and certification. It is likely that echocardiographic methods will evolve further, probably involving establishing new indexes and methods and implementing artificial intelligence in the analyses procedure to improve accuracy and workflow. It is important to acknowledge that neonatologist performed echocardiography is not a therapeutic intervention; it is a diagnostic tool providing additional information.
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Wendel, Kristina; Pfeiffer, Helle Cecilie; Fugelseth, Drude; Nestaas, Eirik; Domellöf, Magnus & Skålhegg, Bjørn Steen
[Show all 42 contributors for this article]
(2021).
Effects of nutrition therapy on growth, inflammation and metabolism in immature infants: a study protocol of a double-blind randomized controlled trial (ImNuT).
BMC Pediatrics.
21.
doi:
10.1186/s12887-020-02425-x.
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Background: Current nutritional management of infants born very preterm results in significant deficiency of the essential fatty acids (FAs) arachidonic acid (ARA) and docosahexaenoic acid (DHA). The impact of this deficit on brain maturation and inflammation mediated neonatal morbidities are unknown. The aim of this study is to determine whether early supply of ARA and DHA improves brain maturation and neonatal outcomes in infants born before 29 weeks of gestation.
Methods: Infants born at Oslo University Hospital are eligible to participate in this double-blind randomized controlled trial. Study participants are randomized to receive an enteral FA supplement of either 0.4 ml/kg MCT-oil™ (medium chain triglycerides) or 0.4 ml/kg Formulaid™ (100 mg/kg of ARA and 50 mg/kg of DHA). The FA supplement is given from the second day of life to 36 weeks' postmenstrual age (PMA). The primary outcome is brain maturation assessed by Magnetic Resonance Imaging (MRI) at term equivalent age. Secondary outcomes include quality of growth, incidence of neonatal morbidities, cardiovascular health and neuro-development. Target sample size is 120 infants (60 per group), this will provide 80% power to detect a 0.04 difference in mean diffusivity (MD, mm2/sec) in major white matter tracts on MRI.
Discussion: Supplementation of ARA and DHA has the potential to improve brain maturation and reduce inflammation related diseases. This study is expected to provide valuable information for future nutritional guidelines for preterm infants.
Trial registration: Clinicaltrials.gov ID: NCT03555019 . Registered 4 October 2018- Retrospectively registered.
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Quattrone, Alessia; Lie, Øyvind Haugen; Nestaas, Eirik; Lange, Charlotte de; Try, Kirsti & Lindberg, Harald L
[Show all 11 contributors for this article]
(2021).
Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot.
Open heart.
8(1).
doi:
10.1136/openhrt-2020-001400.
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Objective: Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF.
Methods: We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide).
Results: 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007).
Conclusion: Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.
Keywords: Fallots tetralogy; arrhythmias; echocardiography
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Quattrone, Alessia; Lie, Øyvind Haugen; Nestaas, Eirik; Lange, Charlotte de; Try, Kirsti & Lindberg, Harald L
[Show all 11 contributors for this article]
(2021).
Long-term follow-up and sex differences in adults operated for tetralogy of Fallot.
Open heart.
8(2).
doi:
10.1136/openhrt-2021-001738.
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Objective Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up.
Methods We included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator.
Results We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06).
Conclusions Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.
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Ross, Stian Balnagown; Nestaas, Eirik; Kongsgård, Erik; Odland, Hans Henrik; Håland, Trine Synnøve Fink & Hopp, Einar
[Show all 8 contributors for this article]
(2020).
Septal contraction predicts acute haemodynamic improvement and paced QRS width reduction in cardiac resynchronization therapy.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
21(8),
p. 845–852.
doi:
10.1093/ehjci/jez315.
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Three distinct septal contraction patterns typical for left bundle branch block may be assessed using echocardiography in heart failure patients scheduled for cardiac resynchronization therapy (CRT). The aim of this study was to explore the association between these septal contraction patterns and the acute haemodynamic and electrical response to biventricular pacing (BIVP) in patients undergoing CRT implantation.
Thirty-eight CRT candidates underwent speckle tracking echocardiography prior to device implantation. The patients were divided into two groups based on whether their septal contraction pattern was indicative of dyssynchrony (premature septal contraction followed by various amount of stretch) or not (normally timed septal contraction with minimal stretch). CRT implantation was performed under invasive left ventricular (LV) pressure monitoring and we defined acute CRT response as ≥10% increase in LV dP/dtmax. End-diastolic pressure (EDP) and QRS width served as a diastolic and electrical parameter, respectively. LV dP/dtmax improved under BIVP (737 ± 177 mmHg/s vs. 838 ± 199 mmHg/s, P < 0.001) and 26 patients (68%) were defined as acute CRT responders. Patients with premature septal contraction (n = 27) experienced acute improvement in systolic (ΔdP/dtmax: 18.3 ± 8.9%, P < 0.001), diastolic (ΔEDP: −30.6 ± 29.9%, P < 0.001) and electrical (ΔQRS width: −23.3 ± 13.2%, P < 0.001) parameters. No improvement under BIVP was observed in patients (n = 11) with normally timed septal contraction (ΔdP/dtmax: 4.0 ± 7.8%, P = 0.12; ΔEDP: −8.8 ± 38.4%, P = 0.47 and ΔQRS width: −0.9 ± 11.4%, P = 0.79).
Septal contraction patterns are an excellent predictor of acute CRT response. Only patients with premature septal contraction experienced acute systolic, diastolic, and electrical improvement under BIVP.
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Nestaas, Eirik & Walsh, Brian H.
(2020).
Hypothermia and Cardiovascular Instability.
Clinics in Perinatology.
ISSN 0095-5108.
47(3),
p. 575–592.
doi:
10.1016/j.clp.2020.05.012.
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Severely asphyxiated neonates have acute heart failure as part of their
multiorgan dysfunction syndrome during the first days of life. Supporting
the cardiovascular system during this phase is part of contemporary
treatment and regarded as vital for limiting the neurodevelopmental
injury. The decision to treat cardiovascular instability should be based
on evaluation of end-organ function. Neonatologist-performed
echocardiography in combination with other diagnostic modalities enables
comprehensive real-time assessment. This review discusses associations
between hemodynamics and adverse outcome, modalities for evaluating the
hemodynamic state of the infant, and therapeutic approaches during
intensive care.
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Nestaas, Eirik & Brun, Henrik
(2019).
Funksjonell ekkokardiografi hos barn og nyfødte.
Hjerteforum.
ISSN 0802-1465.
32(2),
p. 73–82.
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Boode, Willem P. de; Lee, Robin van der; Eriksen, Beate Horsberg; Nestaas, Eirik; Dempsey, Eugene & Singh, Yogen
[Show all 28 contributors for this article]
(2018).
The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock.
Pediatric Research.
ISSN 0031-3998.
84,
p. 57–67.
doi:
10.1038/s41390-018-0081-1.
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One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinicalassessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objectivemonitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assesscardiovascular compromise and guide hemodynamic management. Different techniques of central bloodflow measurement, suchas left and right ventricular output, superior vena cavaflow, and descending aorticflow are reviewed focusing on methodology,validation, and available reference values. Recommendations are provided for individualized hemodynamic management guidedby NPE.
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Nestaas, Eirik; Schubert, Ulf; Boode, Willem P. de; El-Khuffash, Afif; Austin, T & Bohlin, K
[Show all 28 contributors for this article]
(2018).
Tissue Doppler velocity imaging and event timings in neonates: a guide to image acquisition, measurement, interpretation, and reference values.
Pediatric Research.
ISSN 0031-3998.
84,
p. 18–29.
doi:
10.1038/s41390-018-0079-8.
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Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.
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El-Khuffash, Afif; Schubert, Ulf; Levy, Philip T; Nestaas, Eirik; Boode, Willem P. de & Austin, T
[Show all 28 contributors for this article]
(2018).
Deformation imaging and rotational mechanics in neonates: a
guide to image acquisition, measurement, interpretation, and
reference values.
Pediatric Research.
ISSN 0031-3998.
84,
p. 30–45.
doi:
10.1038/s41390-018-0080-2.
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Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.
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Levy, Philip T; Tissot, Cécile; Eriksen, Beate Horsberg; Nestaas, Eirik; Rogerson, Sheryle & McNamara, Patrick J.
[Show all 28 contributors for this article]
(2018).
Application of Neonatologist Performed Echocardiography in
the Assessment and Management of Neonatal Heart Failure
unrelated to Congenital Heart Disease.
Pediatric Research.
ISSN 0031-3998.
84,
p. 78–88.
doi:
10.1038/s41390-018-0075-z.
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Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.
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Nestaas, Eirik; Fugelseth, Drude & Eriksen, Beate Horsberg
(2018).
Assessment of Systemic Blood Flow and Myocardial Function in the Neonatal Period Using Ultrasound.
In Polin, Richard A. (Eds.),
Hemodynamics and Cardiology.
Elsevier.
ISSN 9780323533669.
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Nestaas, Eirik; Shih, Jhih-Yuan; Smedsrud, Marit Kristine; Gjesdal, Ola; Hopp, Einar & Haugaa, Kristina
[Show all 7 contributors for this article]
(2017).
Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients With Previous Myocardial Infarction.
American Journal of Cardiology.
ISSN 0002-9149.
119(9),
p. 1307–1312.
doi:
10.1016/j.amjcard.2017.01.020.
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Myocardial scar burden is an important prognostic factor after myocardial infarction. This cohort study compared assessment of left ventricle scar burden between pathological Q waves on electrocardiography (ECG), Selvester multiparametric ECG scoring system for scar burden, and global longitudinal strain (GLS) by speckle-tracking echocardiography 6 months after myocardial infarction. The scar burden was defined by late gadolinium enhancement cardiac magnetic resonance as fraction of total left ventricle tissue. ECG measures were presence of pathologic Q waves and Selvester scores. GLS was the average of peak strain from 16 left ventricle segments. In 34 patients aged 58 ± 10 years (mean ± SD), the scar burden was 19% (9, 26) (median [quartiles]) and 79% had scar burden >5%. Patients with scar burden >5% more frequently had pathologic Q waves (63% vs 14%) and had worse Selvester scores (5 [3, 7] vs 0 [0, 1]) and worse GLS (−16.6 ± 2.4% vs −19.9 ± 1.1%). Pathologic Q waves, Selvester scores, ejection fraction, and GLS related to scar burden in univariable analyses. Sensitivity and specificity for detecting scar burden >5% was 63% and 86% (pathologic Q waves), 89% and 86% (Selvester score), 81% and 86% (ejection fraction), 89% and 86% (GLS), and 96% and 71% (combination of Q waves, Selvester score, and GLS). In conclusion, Selvester score and GLS related to scars 6 months after myocardial infarction, and pathologic Q waves were only weakly associated with scar and GLS was associated with scar independently of ECG markers.
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Nestaas, Eirik; Støylen, Asbjørn & Fugelseth, Drude
(2016).
Speckle tracking using gray-scale information from tissue Doppler recordings versus regular gray-scale recordings in term neonates.
Ultrasound in Medicine and Biology.
ISSN 0301-5629.
42(11),
p. 2599–2605.
doi:
10.1016/j.ultrasmedbio.2016.06.003.
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Koestenberger, Martin; Friedberg, Mark K.; Nestaas, Eirik; Michel-Behnke, Ina & Hansmann, Georg
(2016).
Transthoracic echocardiography in the evaluation of pediatric
pulmonary hypertension and ventricular dysfunction.
Pulmonary Circulation (PC).
ISSN 2045-8932.
6(1),
p. 15–29.
doi:
10.1086/685051.
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Nestaas, Eirik; Skranes, Janne Helen; Støylen, Asbjørn; Brunvand, Leif & Fugelseth, Drude
(2014).
The myocardial function during and after whole-body therapeutic hypothermia for hypoxic–ischemic encephalopathy, a cohort study.
Early Human Development.
ISSN 0378-3782.
90(5),
p. 247–252.
doi:
10.1016/j.earlhumdev.2014.01.014.
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Nestaas, Eirik; Fugelseth, Drude & Støylen, Asbjørn
(2014).
Automated, Objective and Expert-Independent Assessment of the Analyzability of Strain and Strain Rate in Tissue Doppler Images in Term Neonates by Analysis of Beat-to-Beat Variation.
Ultrasound in Medicine and Biology.
ISSN 0301-5629.
40(3),
p. 637–642.
doi:
10.1016/j.ultrasmedbio.2013.10.026.
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Lee, Anja; Nestaas, Eirik; Liestøl, Knut; Brunvand, Leif; Lindemann, Rolf & Fugelseth, Drude
(2014).
Tissue Doppler imaging in very preterm infants during the first 24 h of life: an observational study.
Archives of Disease in Childhood: Fetal and Neonatal Edition.
ISSN 1359-2998.
99(1),
p. F64–F69.
doi:
10.1136/archdischild-2013-304197.
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Eriksen, Beate Horsberg; Nestaas, Eirik; Hole, Torstein; Liestøl, Knut; Støylen, Asbjørn & Fugelseth, Drude
(2014).
Myocardial function in term and preterm infants. Influence of heart size, gestational age and postnatal maturation.
Early Human Development.
ISSN 0378-3782.
90(7),
p. 359–364.
doi:
10.1016/j.earlhumdev.2014.04.010.
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Background
Sparse knowledge exists on the differences in cardiac function between term and preterm infants. This study examines the impact of heart size, gestational age and postnatal maturation on myocardial function.
Aim
To assess and compare serial echocardiographic indices of myocardial function in term and moderately preterm infants.
Methods
Longitudinal, prospective, observational echocardiographic cohort study of 45 healthy term infants examined at day three and at 12–20 weeks postnatal age and 53 moderately preterm infants (gestational age 31–35 weeks) examined at day three and at term equivalent (4–10 weeks postnatal age).
Outcomes
Primary: Systolic mitral and tricuspid annular plane excursions and annular peak systolic pulsed wave tissue Doppler (pwTDI) velocities.
Secondary: Indices normalized for heart size.
Results
On day three, all indices were higher in the term than in the preterm infants whereas normalized systolic pwTDI velocities were lower in the term infants and normalized excursions showed no difference. All indices increased with advanced postnatal age. The indices in term infants on day three were lower than in preterm infants at term equivalent, with and without normalization. After postnatal maturation in both groups, all indices were higher in the term group (except left pwTDI), whereas normalized indices showed no consistent pattern.
Conclusions
Myocardial function indices increased with gestational age at birth and more profoundly with postnatal maturation. Serial examinations of non-normalized and normalized myocardial function indices showed no sustained differences between the preterm and the term infants.
Normalization by heart size may be of value when assessing myocardial function in infants.
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Eriksen, Beate Horsberg; Nestaas, Eirik; Hole, Torstein; Liestøl, Knut; Støylen, Asbjørn & Fugelseth, Drude
(2013).
Longitudinal assessment of atrioventricular annulus excursion by grey-scale m-mode and colour tissue Doppler imaging in premature infants.
Early Human Development.
ISSN 0378-3782.
89(12),
p. 977–982.
doi:
10.1016/j.earlhumdev.2013.09.006.
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Eriksen, Beate Horsberg; Nestaas, Eirik; Hole, Torstein; Liestøl, Knut; Støylen, Asbjørn & Fugelseth, Drude
(2013).
Myocardial function in premature infants: a longitudinal observational study.
BMJ Open.
3(3).
doi:
10.1136/bmjopen-2012-002441.
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Objectives: Gestational and chronological age may have an impact on myocardial function. We studied the longitudinal changes of the atrioventricular tissue Doppler velocities in premature infants through the neonatal transitional period and at expected term and explored the reproducibility of the measurements. Design: Prospective, observational and longitudinal cohort study. Setting: Two-centre study, from a secondary and a tertiary neonatal intensive care unit. Participants: 55 infants (29 males) with gestational age 31–35 weeks and birth weight 1127–2836 grams. Primary and secondary outcome measures: Pulsed-wave atrioventricular left, septum and right ventricular annulus tissue Doppler systolic (S′), early diastolic (E′) and late diastolic (A′) velocities measured by repeated echocardiographic examinations days 1, 2 and 3 and at expected term. Results: All velocities increased significantly from the neonatal period to expected term (p<0.001). We found a significant correlation between gestational age and right-sided S′, E′ and A′ on day 1 (Pearson correlation 0.32–0.46, p<0.05), for S′ in all three walls and septal E′ and A′ on day 2 (Pearson correlation 0.27–0.49, p<0.05). There was a moderate linear correlation between left ventricle end-diastolic length and septal and right S′ at term and for septal E′ and A′ at day 1 (Pearson correlation 0.30–0.56, p<0.05). We found no correlation between heart rate and tissue Doppler velocities when controlling for the effect of fusion. Continuous positive airway pressure showed moderate effect where as persistence of the ductus arteriosus showed no effect on the tissue Doppler velocities. The E′/A′ relationship was consistently reversed throughout the study with frequently fused diastolic tissue velocity signals. Conclusions: Pulsed-wave atrioventricular annulus tissue Doppler velocities were related to gestational age, postnatal age and ventricular size. Right ventricle velocities showed more pronounced increase with postnatal maturation than left ventricle velocities. The degree of E′/A′ fusion influenced the diastolic tissue Doppler velocities and should be reported if present.
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Nestaas, Eirik; Støylen, Asbjørn & Fugelseth, Drude
(2012).
Myocardial performance assessment in neonates by one-segment strain and strain rate analysis by tissue Doppler - a quality improvement cohort study.
BMJ Open.
2(4).
doi:
10.1136/bmjopen-2012-001636.
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Objectives: To investigate one-segment strain and strain rate indices as measures of myocardial performance in asphyxiated term neonates. Design: Quality improvement cohort study. Setting: Newborns admitted to a neonatal intensive care unit at a Norwegian University Hospital for perinatal asphyxia and non-asphyxiated newborn recruited from the maternity ward at the same hospital. Participants: Twenty asphyxiated and 48 non-asphyxiated term neonates. Primary outcome measure: Strain and strain rate indices and repeatability measures. One-segment longitudinal strain and strain rate by tissue Doppler were assessed on days 1, 2 and 3 of life in nine heart walls. Repeatability was compared against measurements from two-segment analyses previously performed in the same images. Results: The 95% limits of agreement were significantly better for the one-segment than two-segment repeatability analyses, the inter-rater peak systolic strain (PSS) was (−3.1, 3.3) vs (−11.4, 18.3)%, the inter-rater peak systolic strain rate (PSSR) was (−0.38, 0.40) vs (−0.79, 1.15)/s, the intra-rater PSS was (−2.5, 2.6) vs (−8.0, 9.8)% and the intra-rater PSSR was (−0.23, 0.25) vs (−0.75, 0.80)/s (p<0.05). The myocardial performance was lower in the asphyxiated neonates (indices closer to zero) than in the non-asphyxiated neonates, PSS was −17.8 (0.6) (mean (SEM)) vs −21.2 (0.3)%, PSSR −1.43 (0.08) vs −1.61 (0.03)/s, early diastolic strain rate 1.72 (0.11) vs 2.00 (0.11)/s and strain rate during the atrial systole 1.92 (0.17) vs 2.27 (0.10)/s (p<0.05), despite no difference in fractional shortening (29.0 (0.5) vs 29.1 (1.0)%) (p>0.05). Conclusions: One-segment strain and strain rate assessed the reduced myocardial performance in asphyxiated neonates with significantly improved reproducibility as compared with two-segment analysis and was therefore more feasible than two-segment analyses for assessment of myocardial performance after perinatal asphyxia.
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Koestenberger, Martin; Friedberg, Mark K.; Ravekes, William; Nestaas, Eirik & Hansmann, Georg
(2012).
Non-Invasive Imaging for Congenital Heart Disease: Recent Innovations in Transthoracic Echocardiography.
Journal of Clinical & Experimental Cardiology.
doi:
10.4172/2155-9880.S8-002.
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Wataker, Heidi Jensen; Meberg, Alf & Nestaas, Eirik
(2012).
Neonatal Family Care for 24 Hours per Day: Effects on Maternal Confidence and Breast-Feeding.
Journal of Perinatal & Neonatal Nursing.
ISSN 0893-2190.
26(4),
p. 336–342.
doi:
10.1097/JPN.0b013e31826d928b.
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Fugelseth, Drude; RAMSTAD, HEIDI; Kvehaugen, Anne Stine; Nestaas, Eirik; Støylen, Asbjørn & Staff, Anne Cathrine
(2011).
Myocardial function in offspring 5-8 years after pregnancy complicated by preeclampsia.
Early Human Development.
ISSN 0378-3782.
87(8),
p. 531–535.
doi:
10.1016/j.earlhumdev.2011.04.006.
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Nestaas, Eirik; Støylen, Asbjørn; Brunvand, Leif & Fugelseth, Drude
(2011).
Longitudinal strain and strain rate by tissue Doppler are more sensitive indices than fractional shortening for assessing the reduced myocardial function in asphyxiated neonates.
Cardiology in the Young.
ISSN 1047-9511.
21(1),
p. 1–7.
doi:
10.1017/S1047951109991314.
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Lee, Anja; Liestøl, Knut; Nestaas, Eirik; Brunvand, Leif; Lindemann, Rolf & Fugelseth, Drude
(2010).
Superior vena cava flow: feasibility and reliability of the off-line analyses.
Archives of Disease in Childhood: Fetal and Neonatal Edition.
ISSN 1359-2998.
95(2),
p. F121–F125.
doi:
10.1136/adc.2009.176883.
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Lee, Anja; Liestøl, Knut; Nestaas, Eirik; Brunvand, Leif; Lindemann, Rolf & Fugelseth, Drude
(2009).
Superior vena cava flow - feasibility and reliability of the off-line analyses.
Archives of Disease in Childhood: Fetal and Neonatal Edition.
ISSN 1359-2998.
doi:
10.1136/adc.2009.176883.
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Nestaas, E; Stoylen, A; Støylen, Asbjørn; Brunvand, L & Fugelseth, D
(2009).
Tissue Doppler Derived Longitudinal Strain and Strain Rate During the First 3 Days of Life in Healthy Term Neonates.
Pediatric Research.
ISSN 0031-3998.
65(3),
p. 357–362.
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Nestaas, Eirik; Støylen, Asbjørn & Fugelseth, Drude
(2008).
Optimal types of probe, and tissue Doppler frame rates, for use during tissue Doppler recording and off-line analysis of strain and strain rate in neonates at term.
Cardiology in the Young.
ISSN 1047-9511.
18(5),
p. 502–511.
doi:
10.1017/S1047951108002655.
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Nestaas, Eirik; Støylen, Asbjørn; Sandvik, Leif; Brunvand, Leif & Fugelseth, Drude
(2007).
FEASIBILITY AND RELIABILITY OF STRAIN AND STRAIN RATE MEASUREMENT IN NEONATES BY OPTIMIZING THE ANALYSIS PARAMETERS SETTINGS.
Ultrasound in Medicine and Biology.
ISSN 0301-5629.
33(2),
p. 270–278.
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Nestaas, Eirik; Støylen, Asbjørn; Sandvik, Leiv; Brunvand, Leif & Fugelseth, Drude
(2007).
Feasibility and reliability of strain and strain rate measurement in neonates by optimizing the analysis parameters settings.
Ultrasound in Medicine and Biology.
ISSN 0301-5629.
33(2),
p. 270–278.
doi:
10.1016/j.ultrasmedbio.2006.08.006.
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Nestaas, Eirik; Bangstad, Hans J; Sandvik, Leiv & Wathne, Karl-Olaf
(2005).
Aminoglycoside extended interval dosing in neonates is safe and effective: a meta-analysis.
Archives of Disease in Childhood: Fetal and Neonatal Edition.
ISSN 1359-2998.
90(4),
p. F294–F300.
doi:
10.1136/adc.2004.056317.
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Nestaas, Eirik; Holtmon, Lena Wighus; Johansen, Kari B. & Meberg, Alf
(2003).
Erytrocyttransfusjoner i en neonatalenhet.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
123(18),
p. 2575–2576.
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Nestaas, Eirik; BJARKØ, LISA; Kiserud, Torvid; Haugen, Guttorm Nils & Fugelseth, Drude
(2024).
Corrigendum to “Heart function by M-mode and tissue Doppler in the early neonatal period in neonates with fetal growth restriction”, [Early Hum. Dev. 183 (2023) 105809] (Early Human Development (2023) 183, (S0378378223001056), (10.1016/j.earlhumdev.2023.105809)).
Early Human Development.
ISSN 0378-3782.
doi:
10.1016/j.earlhumdev.2024.106032.
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BJARKØ, LISA; Fugelseth, Drude; Harsem, Nina Kittelsen; Kiserud, Torvid; Haugen, Guttorm Nils & Nestaas, Eirik
(2024).
Correction to: Cardiac morphology in neonates with fetal growth restriction (Journal of Perinatology, (2023), 43, 2, (187-195), 10.1038/s41372-022-01538-8).
Journal of Perinatology.
ISSN 0743-8346.
doi:
10.1038/s41372-024-02104-0.
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Wataker, Heidi Jensen; Nestaas, Eirik & Asbjørnsen, Rikke Aune
(2022).
Virtual home care for premature and sick newborns: Parents' experiences and preliminary results from a usability and feasibility pilot trial.
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Muhsen, Wisam S.; Nestaas, Eirik; Hosking, Joanne & Latour, Jos
(2022).
Exploring right ventricular function applicability in a prediction model to identify preterm infants with early bronchopulmonary dysplasia (REPORT-BPD study): a mixed-methods observational cohort feasibility study protocol.
Pilot and Feasibility Studies.
8(1),
p. 1–10.
doi:
10.1186/s40814-022-01201-1.
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Background Bronchopulmonary dysplasia (BPD) is a chronic disease that affects the immature lungs of preterm infants. Infants born before 32 weeks of gestation are at a greater risk of developing BPD due to the need for respiratory support with higher oxygen requirement. Pulmonary vascular remodelling in early BPD can impose an additional burden on the right ventricle (RV) and RV dysfunction. This protocol outlines the study design and aims to formulate a prediction model to identify early BPD through the data generated from echo scans analysis. Methods The mixed-methods observational cohort feasibility study, which comprises three work-packages (WPs), will be conducted at the regional neonatal unit, University Hospital Plymouth, Plymouth, UK. WP-I will recruit 40 preterm infants; each participant will have two heart scans performed in the first ten days after birth (DABs). WP-II will collect the documentation of the participating preterm infants’ parents in the study neonatal unit diaries in the first 10 DABs. WP-III will involve semi-structured interviews of 10–15 parents of participating preterm infants and 10–15 health professionals who participated in WP-I. The study recruitment will be conducted over 18-months. The start date is 01 June 2022. WP-I and WP-II recruitment will occur during this period, while WP-III recruitment will occur during the second half. The results are expected to be submitted for publication by mid-2024. Discussion This paper outlines the study design. If the study successfully identifies the most sensitive echo parameter in recognising the RV dysfunction associated with early BPD, it will be an important finding in constructing an early BPD prediction model. Trial registration ClinicalTrials.gov Identifier is NCT05235399
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Wataker, Heidi Jensen; Nestaas, Eirik & Asbjørnsen, Rikke Aune
(2021).
Virtual home care for premature and sick newborns: Parents' experiences and results from a feasibility pilot trial.
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Nestaas, Eirik
(2018).
Neonatologist Performed Echocardiography offers haemodynamic assessments that go beyond clinical signs and biochemical tests.
Acta Paediatrica.
ISSN 0803-5253.
107(12),
p. 2044–2045.
doi:
10.1111/apa.14601.
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Eriksen, Beate Horsberg; Nestaas, Eirik & Fugelseth, Drude
(2012).
Functional echocardiography and cerebral blood doppler velocity measurements: Repeated examinations for clinical assessment in moderately preterm infants.
Journal of Maternal-Fetal & Neonatal Medicine.
ISSN 1476-7058.
25.
doi:
10.3109/14767058.2012.667977.
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Published
Jan. 12, 2021 3:11 PM
- Last modified
May 5, 2025 8:44 AM