Early echocardiographic predictors of death or early severe morbidity in extremely low gestational age neonates: a prospective study

To identify early echocardiographic markers predictive of death or early severe morbidity in extremely low gestational age neonates (ELGANs).

Prospective observational single-centre study in level 3 neonatal intensive care unit, Montpellier University Hospital, France. Fifty live-born ELGANs (< 28 weeks' gestational age) admitted between January 2023 and January 2024, excluding major malformations and congenital heart disease. Neonatologist-performed echocardiography (NPE) at 12 ± 12 h (Day 1) and 72 ± 12 h (Day 3), assessing biventricular function, ductal flow, and systemic output.

death or early severe morbidity (severe intraventricular haemorrhage or bronchopulmonary haemorrhage). Associations between echocardiographic parameters and the composite outcome were assessed using ROC curves and 1:1 propensity score matching (sex, birthweight, gestational age). The composite outcome occurred in 21/50 infants (42%). On Day 1, lower tricuspid annular plane systolic excursion (TAPSE < 4.8 mm) and right ventricular velocity-time integral (RV VTI < 7.8 cm) were independently associated with the outcome (AUCs: 0.76 and 0.83, respectively). On Day 3, lower ductal flow velocities were significantly associated with adverse outcomes, suggesting persistent hemodynamically significant PDA. Other parameters (e.g., left ventricular function or systemic output) were not predictive after adjustment.

Early echocardiographic indicators of right ventricular dysfunction (TAPSE, RV VTI) are associated with mortality or early severe morbidity in ELGANs. These markers may reflect myocardial immaturity and elevated pulmonary vascular resistance, underscoring the importance of heart-lung interaction in early neonatal care. Further multicentre studies are needed to confirm these findings and refine targeted hemodynamic management strategies.

• Extremely low gestational age neonates (ELGANs) are at high risk of early death and severe morbidity due to cardiovascular immaturity • Neonatologist-performed echocardiography (NPE) is increasingly used for bedside hemodynamic assessment in preterm infants, but robust early prognostic markers are still lacking What is new: • This study identifies two early echocardiographic parameters-TAPSE < 4.8 mm and RV VTI < 7.8 cm on day 1-as significantly associated with death or early severe morbidity in ELGANs • These findings support the incorporation of early targeted echocardiographic assessment of right ventricular function into standard care for ELGANs.