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Published on: January 27, 2023
Assessment of myocardial performance in preterm infants less than 29 weeks gestation during the transitional period
Adam T James1, John D Corcoran1, Amish Jain2
1Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland.
Insights
Myocardial performance in preterm infants improves in the first 48 hours after birth. Echocardiography reveals enhanced systolic and diastolic function in both ventricles, indicating normal hemodynamic adaptation in stable neonates.
Area of Science:
- Neonatal cardiology
- Pediatric echocardiography
- Hemodynamic adaptation
Background:
- Transitional circulation and myocardial performance are not well understood in preterm infants.
- Early assessment of cardiac function is crucial for neonatal care.
Purpose of the Study:
- To assess myocardial performance in preterm infants (<29 weeks gestation) within the first 48 hours of life.
- To utilize comprehensive echocardiographic methods for evaluating cardiac function.
Main Methods:
- Prospective enrollment of infants <29 weeks gestation, excluding those small for gestation, on inotropes/inhaled nitric oxide, or septic.
- Assessment using conventional echocardiography, tissue Doppler imaging (TDI), strain and strain rate (SR), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (FAC).
- Measurements taken at approximately 10 and 45 hours post-delivery.
Main Results:
- No significant changes in left ventricular shortening or ejection fraction were observed.
- Systolic and diastolic TDI, septal peak systolic and early diastolic SR, and RV functional parameters (SR, late diastolic SR, TAPSE, FAC) showed significant increases.
- Right ventricular (RV) strain and early diastolic SR were exceptions, not showing significant changes.
Conclusions:
- Establishing normal hemodynamic adaptations in stable preterm infants is essential.
- This data provides a baseline for assessing myocardial performance in preterm infants with various disease states.
- Early echocardiographic assessment aids in understanding transitional circulation in neonates.
Background:
The transitional circulation and its effect on myocardial performance are poorly understood in preterm infants.
Aims:
We assessed myocardial performance in infants less than 29 weeks gestation in the first 48 h of life using a comprehensive echocardiographic assessment.
Design:
Infants <29 weeks gestation were prospectively enrolled. Small for gestation, infants on inotropes and/or inhaled nitric oxide and septic infants were excluded. Conventional echocardiography, left ventricular (LV), septal and right ventricular (RV) tissue Doppler imaging (TDI) and tissue Doppler-derived strain and strain rate (SR), tricuspid annular plane systolic excursion (TAPSE) and global RV fractional area change (FAC) were assessed at a median of 10 and 45 h post-delivery.
Results:
Fifty-four infants with a median [IQR] gestation and birth weight of 26.5 weeks [25.8-28.0 weeks] and 915 g [758-1142 g] were included. There was no change in shortening or ejection fraction across the two time points. Systolic and diastolic TDI of the LV, septum and RV increased across the two time points (all p values ≤ 0.01). There was an increase in septal peak systolic and early diastolic SR (p=0.002). Septal systolic strain and late diastolic SR did not change. With the exception of RV strain and early diastolic SR, all RV functional parameters including SR, late diastolic SR, TAPSE, and FAC increased across the two time points (all p values<0.01).
Conclusion:
Describing the normal hemodynamic adaptations in stable preterm infants during the transitional period provides the necessary information for the assessment of those parameters in various disease states.
