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Post-transitional adaptation of the left heart in uncomplicated, very preterm infants
Koert De Waal1, Nilkant Phad1, Anil Lakkundi1
11Neonatal Intensive Care Unit,John Hunter Children's Hospital,Newcastle,Australia.
Insights
The preterm infant heart
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular research
- Fetal and neonatal physiology
Background:
- The postnatal period presents significant physiological changes for preterm infants.
- Monitoring cardiovascular function is crucial for managing potential complications.
- Understanding normal adaptation is key for timely intervention.
Purpose of the Study:
- To describe longitudinal left ventricular function in uncomplicated preterm infants.
- Utilize conventional and novel echocardiography techniques.
- Assess cardiac adaptation in the first 28 days post-birth.
Main Methods:
- Prospective echocardiography at days 3, 7, 14, 21, and 28 in 25 preterm infants (<30 weeks gestation).
- Speckle tracking analysis for left ventricular volume, deformation, and myocardial velocities.
- Measurement of patent ductus arteriosus, cardiac dimensions, and atrial volume.
Main Results:
- Stroke volume increased by 24% over 28 days.
- Cardiac dimensions and systolic basal myocardial velocity increased; wall stress and deformation remained unchanged.
- Diastolic function showed fetal characteristics; left ventricular compliance was maintained.
Conclusions:
- The preterm heart increases in size and maintains systolic and atrial function in the first 28 days.
- Longitudinal deformation remained stable, indicating preserved left ventricular function during maturation.
- Early diastolic maturation was independent of overall cardiac adaptation.
Background:
The postnatal period in preterm infants involves multiple physiological changes occurring immediately after birth and continuing for days or weeks. To recognise and treat compromise, it is important to measure cardiovascular function. The aim of this study was to describe longitudinal left ventricular function using conventional and novel echocardiography techniques in preterm infants who did not experience significant antenatal or postnatal complications and treatments.
Methods:
We prospectively obtained cardiac ultrasound images at days 3, 7, 14, 21, and 28 in 25 uncomplicated, preterm infants <30 weeks of gestation. Speckle tracking analysis of the four chambers and short-axis images provided parameters of left ventricular volume, deformation, and basal myocardial velocities. The patent ductus arteriosus, cardiac dimensions, and atrial volume were also measured.
Results:
Stroke volume increased by 24% during the study period (1.05-1.30 ml/kg, p<0.05). Cardiac length, diameter, and systolic basal myocardial velocity increased with unchanged wall stress and deformation parameters. Diastolic function parameters resembled that of the fetus with predominance of atrial contraction compared with early diastolic velocities. Blood pressure and estimates of left ventricular filing pressure increased, suggesting that left ventricular compliance did not change in this period.
Conclusion:
Stroke volume increased in the first 28 days after preterm birth. The preterm heart adapted by increasing its size, while maintaining systolic and atrial function, independent of early diastolic maturation. Longitudinal deformation of the left ventricle remained unchanged, suggesting relatively preserved function with maturation.
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