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Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

Published online by Cambridge University Press:  17 December 2019

Alessia Cappelleri ,
Neidin Bussmann ,
Susan Harvey ,
Phillip T. Levy Open the ORCID record for Phillip T. Levy [Opens in a new window] ,
Orla Franklin  and
Afif EL-Khuffash Open the ORCID record for Afif EL-Khuffash [Opens in a new window]
Alessia Cappelleri
Affiliation:
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland Neonatal Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Neidin Bussmann
Affiliation:
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
Susan Harvey
Affiliation:
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
Phillip T. Levy
Affiliation:
Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA
Orla Franklin
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
Afif EL-Khuffash*
Affiliation:
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
*
Author for correspondence: A. EL-Khuffash, FRCPI, MD, DCE, Consultant Neonatologist, Clinical Professor of Paediatrics, The Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland. Tel: + 353 1 817 1700; E-mail: afifelkhuffash@rcsi.ie
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Abstract

Background:

There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants.

Methods:

Forty-five healthy preterm newborns (mean ± standard deviation) gestation of 32.7 ± 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM™ system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring.

Results:

Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21–47%] and stroke volume [29%, 16–42%] increased with no change in heart rate [5%, −2 to 12%]. There was a rise in mean blood pressure [11%, 1–21%], but a decline in total peripheral resistance [−14%, −25 to −3%].

Conclusion:

Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.

Keywords

Late pretermspeckle trackingdeformationcardiac outputNICOM
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 2 , February 2020 , pp. 249 - 255
Copyright
© Cambridge University Press 2019

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