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Myocardial function in term and preterm infants. Influence of heart size, gestational age and postnatal maturation
Beate Horsberg Eriksen1, Eirik Nestaas2, Torstein Hole3
1Department of Paediatrics, Møre and Romsdal Hospital Trust, NO-6026 Ålesund, Norway; Department of Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Cardiac function in preterm infants matures significantly with age. Serial echocardiography reveals no sustained differences in myocardial function between preterm and term infants after normalization for heart size.
Area of Science:
- Neonatal cardiology
- Pediatric echocardiography
- Myocardial function assessment
Background:
- Limited data on cardiac function differences between term and preterm infants.
- Investigating the influence of heart size, gestational age, and postnatal maturation on myocardial function.
Purpose of the Study:
- To compare serial echocardiographic indices of myocardial function in term and moderately preterm infants.
- Assess changes in cardiac performance during early postnatal development.
Main Methods:
- Longitudinal, prospective, observational echocardiographic cohort study.
- Involved 45 term and 53 moderately preterm infants (gestational age 31-35 weeks).
- Examinations conducted at specific postnatal ages, including term equivalent for preterm infants.
Main Results:
- Initially, term infants showed higher cardiac function indices than preterm infants.
- Normalized systolic velocities were lower in term infants on day three.
- All indices increased with postnatal age; normalized indices showed no consistent pattern after maturation.
Conclusions:
- Myocardial function improves with gestational age and postnatal maturation.
- Serial assessment revealed no sustained differences between preterm and term infants.
- Heart size normalization is valuable for assessing infant myocardial function.
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 12-20weeks postnatal age and 53 moderately preterm infants (gestational age 31-35weeks) examined at day three and at term equivalent (4-10weeks 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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