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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Cardiovascular function in children who had chronic lung disease of prematurity
Suchita Joshi1, Dirk G Wilson2, Sarah Kotecha1
1Department of Child Health, Cardiff University, Cardiff, UK.
Insights
Children with a history of chronic lung disease of prematurity (CLD) show normal heart function and no signs of pulmonary hypertension in childhood. This study confirms long-term cardiovascular health in CLD survivors.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Pulmonology
Background:
- Infants born prematurely with chronic lung disease of prematurity (CLD) often experience elevated pulmonary arterial pressure.
- It remains unclear if this elevated pressure persists into childhood in CLD survivors.
Purpose of the Study:
- To investigate if children with a history of CLD exhibit right ventricular dysfunction or pulmonary arterial hypertension at rest or during acute hypoxia.
- To compare these outcomes in 8-12-year-old CLD survivors with preterm and term-born controls.
Main Methods:
- Echocardiography with myocardial velocity imaging was performed on 90 children (28 CLD survivors, 32 preterm controls, 30 term controls).
- Measurements were taken at rest and during exposure to 15% and 12% oxygen for 20 minutes each.
Main Results:
- All groups demonstrated similar baseline cardiac function.
- During 12% oxygen breathing, the CLD group experienced a greater decrease in oxygen saturation compared to controls.
- Despite hypoxic stress, no significant differences in right ventricular function or pulmonary arterial pressure markers were observed between the CLD survivors and control groups.
Conclusions:
- Childhood survivors of CLD exhibit comparable left and right ventricular function at 8-12 years of age.
- There is no evidence of increased pulmonary arterial pressure in these children, even after hypoxic exposure.
Objectives:
Although increased pulmonary arterial pressure is common in infancy in preterm infants who develop chronic lung disease of prematurity (CLD), it is unknown if the increase persists into childhood. We, therefore, assessed if 8-12-year-old children with documented CLD in infancy had evidence of right ventricular dysfunction or pulmonary arterial hypertension at rest or in response to acute hypoxia when compared to preterm and term-born controls.
Methods:
We studied 90 children: 60 born at ≤32 weeks of gestation (28 with CLD and 32 preterm controls), and 30 term-born controls. All had echocardiography including myocardial velocity imaging, at rest and while breathing 15% oxygen and 12% oxygen for 20 min each.
Results:
Baseline oxygen saturation, heart rate, blood pressure and echocardiographic markers of left and right ventricular function were similar in all three groups. While breathing 12% oxygen, the oxygen saturation decreased to 81.9% in the CLD group compared to 85.1% (p<0.05) and 84.7% (p<0.01) in the preterm and term controls, respectively. In response to hypoxia, all three groups showed increases in velocity of tricuspid regurgitation, end-diastolic velocity of pulmonary regurgitation, and right ventricular relaxation time; and decreases in pulmonary arterial acceleration time and the ratio of right ventricular acceleration time to ejection time. However, there were no differences between groups.
Conclusions:
Childhood survivors of CLD have comparable left and right ventricular function at 8-12 years of age to preterm and term-born children, and no evidence of increased pulmonary arterial pressure even after hypoxic exposure.
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