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Updated: Oct 17, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Efficiency of left ventricular diastolic function increases in healthy full-term infants during the first months of
A Kozák-Bárány1, E Jokinen, T Rantonen
1Department of Paediatrics, University of Turku, Finland. ankoba@utu.fi
Insights
Systolic performance remained stable, while diastolic function improved in healthy infants during the first six months. Early and atrial transmitral parameters showed the most significant changes in the first month, indicating enhanced left ventricular relaxation and compliance.
Area of Science:
- Pediatric Cardiology
- Neonatal Physiology
- Echocardiography
Background:
- Left ventricular diastolic filling and systolic performance undergo significant changes in early infancy.
- Understanding these postnatal changes is crucial for assessing cardiac health in newborns.
- Serial echocardiography provides a non-invasive method to track these developmental alterations.
Purpose of the Study:
- To investigate postnatal changes in left ventricular diastolic filling and systolic cardiac performance in healthy full-term infants.
- To analyze age-related variations in transmitral Doppler flow velocity patterns and fractional shortening area.
- To establish normative data for cardiac function during the first six months of life.
Main Methods:
- Serial echocardiographic measurements were performed monthly from day 3-5 up to six months in 20 healthy full-term infants.
- Systolic performance was assessed using fractional shortening area (FSA).
- Diastolic function was evaluated by analyzing transmitral pulsed-wave Doppler flow velocity patterns, including early (E) and atrial (A) velocities and integrals.
Main Results:
- Fractional shortening area (FSA) remained stable throughout the six-month observation period.
- Left ventricular peak early (E) and atrial (A) velocities and their integrals were significantly lower at birth compared to one month of age.
- During the subsequent five months, E velocity and E integral increased, while A velocity and A integral remained stable. The E/A velocity ratio, E/A integral ratio, and early filling fraction (EFF) increased, and early filling deceleration time shortened.
Conclusions:
- Healthy full-term infants exhibit age-related improvements in left ventricular diastolic function but not systolic performance during the first six months postnatally.
- The most pronounced changes in diastolic parameters occurred within the first month, suggesting rapid development of left ventricular relaxation and compliance.
- Continued maturation of left ventricular relaxation likely drives the observed diastolic improvements in the subsequent months.
Abstract:
Postnatal changes in left ventricular diastolic filling and systolic cardiac performance were studied monthly by serial echocardiographic measurements from days 3-5 up to six months in 20 healthy full-term infants. The fractional shortening area (FSA = (left ventricular end-diastolic area - end-systolic area)/end-diastolic area) was assessed for systolic performance, and transmitral pulsed-wave Doppler flow velocity patterns were analysed for diastolic function. FSA remained stationary during the observation. After birth, left ventricular peak early (E) and atrial (A) velocities and the respective integrals were lower than at one month of age (47+/-5 vs. 63+/-6 cm/s and 44+/-6 vs. 57+/-5 cm/s and 3.33+/-0.40 vs. 4.05+/-0.53 cm and 2.74+/-0.40 vs. 3.18+/-0.53 cm; P < 0.05). During the next five months, the early parameters (E velocity and E integral) increased but the atrial indices (A velocity and A integral) did not change. During the whole observation the E/A velocity ratio, the E/A integral ratio and the early filling fraction (EFF) increased. The early filling deceleration time was longer during the first month than later (87+/-10 vs. 72+/-13 ms; P < 0.05). In conclusion, age-related changes were observed in the diastolic but not in the systolic performance in healthy full-term infants during the first six months. The most intensive changes took place in the early and atrial transmitral parameters during the first month of life, suggesting an improvement in both left ventricular relaxation and compliance. During the following five months, the early mitral parameters increased but the atrial diastolic values remained stable. These changes may mainly be determined by the improvement in left ventricular relaxation.
