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Serial changes in myocardial function in preterm infants over a four week period: the effect of gestational age at
Muhammad Shahid Hussain Saleemi1, Afif El-Khuffash1, Orla Franklin2
1Department of Neonatology, Rotunda Hospital, Dublin, Ireland.
Insights
Myocardial performance improves in preterm infants from 28 weeks gestation by 4 weeks of life. Extremely preterm infants (24-27 weeks) showed no significant improvement in cardiac function during the first month.
Area of Science:
- Neonatal Cardiology
- Pediatric Echocardiography
- Cardiovascular Physiology
Background:
- Preterm infants exhibit impaired myocardial performance shortly after birth, which typically recovers by day 5.
- Tissue Doppler imaging (TDI) offers a reliable method for assessing myocardial function.
Purpose of the Study:
- To evaluate myocardial performance using TDI and shortening fraction (SF) in preterm infants across different gestational age groups.
- To analyze serial changes in cardiac parameters within the first four weeks of life.
Main Methods:
- Gestational age groups: 24-27 weeks (n=8), 28-31 weeks (n=12), and 32-35 weeks (n=13).
- Exclusion criteria: severe congenital malformations, hypoxic birth insult, inotropic support.
- Echocardiograms (TDI velocities: S', E', A'; LV SF) performed at 36-48 hours, 2 weeks, and 4 weeks of life.
Main Results:
- Significant increases in LV S' and E' velocities were observed in infants born at 28-31 and 32-35 weeks gestation.
- No significant improvement in myocardial function was noted in the most preterm group (24-27 weeks).
- Myocardial performance differed significantly between the 24-27 week group and the 32-35 week group at all time points.
Conclusions:
- Serial improvement in myocardial performance is evident in preterm infants from 28 weeks gestation onwards.
- Lack of observed improvement in the extremely preterm group may be attributed to a small sample size.
Background:
Myocardial performance is impaired in the first days of life in preterm infants but improves by day 5. Tissue Doppler imaging (TDI) is a novel and reliable means of assessing myocardial performance.
Objective:
To investigate myocardial performance using TDI and shortening fraction (SF) in preterm infants of different gestational age groups and serial changes in these parameters in first four weeks of life. Study design Infants less than 36 weeks of gestation were divided into group 1 (24-27 weeks, n=8), group 2 (28-31 weeks, n=12) and group 3 (32-35 weeks, n=13). Infants with severe congenital malformations, a hypoxic insult at birth, and those on inotropic support were excluded. Echocardiograms were performed at 36-48 hours, 2 weeks and 4 weeks of life. Left ventricular (LV) SF, systolic (S'), early diastolic (E') and late diastolic (A') TDI velocities were assessed. We analyzed the data using a repeated-measures ANOVA.
Results:
Thirty three infants underwent serial TDI and SF measurements. There was an increase in LV S' (p=.02) and E' (.01) velocities in group 2 , and in group 3 (p=.03 for S' and p=.04 for E'), but no significant increase in group 1 (p=.48 for S' and .32 for E'). At each study point, there was significant difference in myocardial performance between group 1 and 3 for each of the parameters (p<.05). There was no significant increase in SF over time in any of the groups.
Conclusion:
We describe a serial increase in myocardial performance in infants of 28 weeks gestation and above. While there was no change in myocardial performance among the most extremely preterm infants, this may have been the result of small sample size of the group.
