Abstract
ObjectivesIn preterm infants, postnatal myocardial adaptation may be complicated by bronchopulmonary dysplasia (BPD). We aimed to describe the development of left ventricular function by serial 2D, Doppler, and speckle tracking echocardiography (2D-STE) in infants with and without BPD during the neonatal period and compare these to anthropometric and conventional hemodynamic parameters.Study DesignProspective echocardiography on day of life (DOL) 1, 7, 14, and 28 in 119 preterm infants <1500 g birth weight of whom 36 developed BPD (need for oxygen supplementation at 36 weeks gestational age). Non-BPD and BPD infants differed significantly in median (IQR) gestational age (25.5(24–26.5) weeks vs. 29(27–30) weeks, p<0.001) and birth weight (661(552–871) g vs. 1100(890–1290) g, p<0.001).ResultsThe intra- and inter-observer variability of the 2D-STE parameters measured did not depend on time of measurement, although there were significant differences in the reproducibility of the parameters. Low intra- and inter-observer variability was seen for longitudinal systolic strain and strain rate mid septum with a median CV (coefficient of variation) of <4.6%. Much higher CVs (>10%) were seen for the apical segment. While anthropometric parameters show rapid development during the first 4 weeks of life, the speckle tracking parameters did not differ statistically significantly during the neonatal period. Infants with and without BPD differed significantly (p<0.001) in the development of anthropometric parameters, conventional hemodynamic parameters except for heart rate, and 2D-STE parameters: global longitudinal systolic strain rate (GLSSR) and longitudinal systolic strain for the mid left wall (LSSR). The largest differences were seen at DOL 1 and 7 in GLSSR (p<0.001) and in LSSR (p<0.01).ConclusionsReproducible 2D-STE measurements are possible in preterm infants <1500 g. Cardiac deformation reveals early (DOL 1 and 7) ventricular changes (GLSSR and LSSR) in very low birth weight infants who develop BPD.
Highlights
After birth, newborn life is dominated by a process of adaption
The intra- and inter-observer variability of the 2D-STE parameters measured did not depend on time of measurement, there were significant differences in the reproducibility of the parameters
Low intra- and interobserver variability was seen for longitudinal systolic strain and strain rate mid septum with a median coefficient of variation (CV) of,4.6%
Summary
Newborn life is dominated by a process of adaption. In order to survive deprived of the maternal supply of oxygen and metabolites, the infant’s organism has to develop significantly in the first hours and days of life [1,2]. One of the most important developments here is the transition from fetal to postnatal circulation. For preterm and for very low birth weight (VLBW) infants (birth weight,1500 g), this transition is especially difficult. While the pathophysiologic processes that lead to bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) are still incompletely understood, they are closely linked to the immaturity of the cardiorespiratory system in this population [3,4]. BPD development is based on the immaturity of the lung tissue in combination with oxidative stress [5]. Increased right ventricular afterload and pulmonary hypertension (PH) are common complications of BPD, and recent studies have increased awareness that PH worsens the clinical course, morbidity and mortality of BPD [6]
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