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Left ventricular pumping during the transition-adaptation sequence in preterm infants: impact of the patent ductus

Sigrid Baumgartner1, Monika Olischar1, Martin Wald2

  • 1Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.

Pediatric Research
|March 15, 2018
PubMed

Insights

In preterm infants, the immature left ventricle (LV) adapts to afterload differently based on patent ductus arteriosus (PDA) status. Stable infants enhance LV contractility, while those with a hemodynamically significant PDA show lower contractility.

Area of Science:

  • Neonatal Physiology
  • Cardiovascular Adaptation
  • Pediatric Cardiology

Background:

  • The immature left ventricle (LV) in preterm infants faces high systemic afterload postnatally.
  • Understanding LV adaptation during the transition-adaptation period is crucial for clinical management.

Purpose of the Study:

  • To analyze changes in LV pumping dynamics during the transition-adaptation period in preterm infants.
  • To compare LV function in clinically stable infants versus those with a hemodynamically significant patent ductus arteriosus (hPDA).

Main Methods:

  • Applied a pump model to characterize LV pumping using effective arterial elastance (EA) and end-systolic LV elastance (EES).
  • Analyzed EA/EES coupling ratios and EA/EES graphs from echocardiography and blood pressure data.
  • Compared data between stable infants (S group) and infants with hPDA across early transition, late transition, and adaptation periods.

Main Results:

  • In stable infants, LV pumping showed an increased EA/EES ratio (0.65) due to low EES early on, followed by a rise in both EA and EES, and a lower ratio (0.45) with high EES during adaptation.
  • Infants with hPDA exhibited significantly lower EA and EES throughout transition-adaptation, resulting in a lower EA/EES coupling ratio.
  • Time-trend analyses revealed distinct patterns of LV adaptation between the two groups.

Conclusions:

  • Stable preterm infants enhance their immature LV contractility to manage high afterload, potentially aided by a physiological PDA.
  • Preterm infants with hPDA experience lower afterload but demonstrate consistently lower LV contractility, indicating an overloaded state.
  • LV pumping dynamics and contractility differ significantly based on PDA status during neonatal transition.

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