Related Experiment Video
Updated: Jul 11, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Hemodynamic evaluation of extremely low birth weight infants during the first 7 days of life
Sun Mee Tan1, Hidehiko Nakanishi2, Shuji Ishida1
1Department of Pediatrics, Kitasato University Hospital, Japan.
Insights
Extremely low birth weight infants show hemodynamic instability in the first two days, with altered adaptation in small for gestational age and histological chorioamnionitis cases. Severe intraventricular hemorrhage impacts early hemodynamics and PDA incidence.
Area of Science:
- Neonatal physiology
- Pediatric cardiology
- Perinatal medicine
Background:
- Extremely low birth weight (ELBW) infants face significant transitional challenges.
- Understanding hemodynamic status is crucial for intensive management of ELBW infants.
Purpose of the Study:
- To investigate the hemodynamic status of ELBW infants during the transitional period.
- To identify factors associated with hemodynamic instability in ELBW infants.
Main Methods:
- Retrospective cohort study of 62 ELBW infants.
- Analysis of left ventricular ejection fraction (LVEF), end-systolic wall stress (ESWS), internal dimension in diastole (LVIDd), and mean arterial pressure (MAP).
- Comparison between small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival groups.
Main Results:
- Mean arterial pressure (MAP) gradually increased; LVEF and ESWS showed instability in the first two days.
- SGA infants exhibited altered LVEF and higher MAP; hCAM group showed lower LVIDd.
- Severe IVH was associated with decreased LVEF, higher ESWS, and increased hemodynamic significant patent ductus arteriosus (hsPDA).
Conclusions:
- ELBW infants experience initial hemodynamic instability, with gradual MAP increase and eventual stabilization.
- SGA and hCAM infants demonstrate altered hemodynamic adaptation.
- Severe IVH is linked to early hemodynamic compromise and a higher incidence of hsPDA.
Background And Aim:
We aimed to investigate the hemodynamic status of extremely low birth weight (ELBW) infants during the transitional period under intensive management.
Methods:
This retrospective cohort study analyzed left ventricular ejection fraction (LVEF), left ventricular end-systolic wall stress (ESWS), left ventricular internal dimension in diastole (LVIDd), and mean arterial pressure (MAP) of ELBW infants during their first week of life. Small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival to discharge infants were compared to their counterparts.
Results:
Sixty-two infants (25.7 ± 2.1 weeks, 700.7 ± 165.4 g) were analyzed. MAP gradually increased. Median LVEF was 69.8 % on day 1, decreased to 62.7 % on day 2, then increased throughout the week. ESWS was lowest at birth, rose to 28.2 g/cm2 on day 2, and decreased on day 6. There were no significant changes in LVIDd. SGA infants had higher MAP throughout, higher LVEF on day 2 and 3, but lower LVEF on day 5 to 7. LVIDd was lower in hCAM group. Severe IVH group had a more significant drop in LVEF on day 2, higher ESWS, and a higher incidence of hemodynamic significant patent ductus arteriosus (hsPDA). Non-survival had lower LVIDd.
Conclusions:
MAP increased gradually. Hemodynamic instability was observed in the first two days, with decreased LVEF and increased ESWS before stabilization. We observed an alteration in hemodynamic adaptation in SGA and hCAM infants. Severe IVH group experienced early hemodynamic instability and a higher incidence of hsPDA.
