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Echocardiographic assessment of cardiac function in shocked very low birthweight infants
1Department of Child Health, University of Liverpool, Liverpool Maternity Hospital.
Insights
Abnormal cardiac function significantly impacts hypotension and metabolic acidosis in ventilated very low birthweight infants. This cardiac dysfunction suggests alternative treatments to volume expansion may be needed for these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Physiology
Background:
- Hypotension and metabolic acidosis affect ~40% of ventilated very low birthweight infants within 24 hours of birth.
- The role of cardiac dysfunction in these conditions is not fully understood.
- Early identification of cardiac issues is crucial for appropriate management.
Purpose of the Study:
- To assess the contribution of abnormal cardiac function to hypotension and metabolic acidosis in very low birthweight infants.
- To compare cardiac performance between infants with and without these complications.
- To evaluate the implications for initial treatment strategies.
Main Methods:
- Utilized M-mode, 2D, and Doppler echocardiography in 75 very low birthweight infants.
- Compared 34 infants with hypotension (BP < 10th centile) or metabolic acidosis to 41 control infants.
- Assessed cardiac function parameters including shortening fraction, contractility, and output.
Main Results:
- Significantly lower median shortening fraction in the hypotensive/acidotic (shocked) group.
- 47% of shocked infants exhibited significantly worse left ventricular contractility and output compared to controls.
- Lower one and five-minute Apgar scores were observed in the shocked group.
Conclusions:
- Cardiac dysfunction is a significant feature in shocked very low birthweight infants.
- Findings suggest that volume expansion may not always be the optimal first-line treatment.
- Further research into cardiac-specific interventions is warranted for this vulnerable population.
Abstract:
The contribution of abnormal cardiac function to hypotension and metabolic acidosis, which affect approximately 40% of ventilated very low birthweight infants in the first 24 hours after birth was assessed using M mode, two dimensional, and Doppler echocardiography in 75 very low birthweight infants during the first few hours after birth. Thirty four infants whose blood pressure was less than the 10th centile or who had a metabolic acidosis in the first 24 hours were compared with 41 who showed neither feature. The median shortening fraction was significantly lower in the hypotensive/acidotic (shocked) group than in the controls. In 16 of 34 (47%) shocked infants left ventricular contractility and output were significantly worse than in the control subjects. One and five minute Apgar scores were also significantly lower in the shock group when compared with controls. Cardiac dysfunction was an important feature in the shocked very low birthweight infants. It is speculated that volume expansion may not always be the most appropriate first line treatment for such infants.