Abstract
BackgroundSurfactant treatment reduces respiratory morbidity and mortality in preterm infants. Data on its haemodynamic consequences are conflicting. The aim was to characterise the haemodynamic effects of surfactant treatment on cardiac function in preterm newborns with respiratory distress syndrome (RDS).MethodsPreterm infants (gestational age <34 weeks, birth weight <2000 g) with RDS, who received surfactant within 72 hours of life, were recruited.Echocardiography was performed before surfactant, and 2 and 24 hours after. Left and right ventricular peak systolic, early diastolic and late diastolic myocardial velocities were measured using Tissue Doppler Imaging (TDI), while characteristics of the ductus arteriosus, pulmonary artery pressure, right ventricular (RVO) and left ventricular output were measured by standard echocardiography. Tricuspidal Annular Plane Systolic Excursion (TAPSE) was measured on the free wall of the tricuspid annulus.ResultsFourteen patients were studied. Surfactant was associated with a decrease in pulmonary pressure and an increase in RVO. The improvement of right ventricular function was also confirmed by a significant increase in right peak systolic velocity and in TAPSE. Left ventricular velocities did not change significantly after surfactant.ConclusionsSurfactant administration in preterm infants with RDS did not impair myocardial contractility and was followed by increased RVO, in agreement with other parameters of right ventricular function. TDI and TAPSE appeared to be reliable and feasible in this population. The addition of TDI and TAPSE to standard neonatal echocardiography may provide additional information about cardiac function.
Highlights
Surfactant treatment reduces respiratory morbidity and mortality in preterm infants
Moderate and even severe respiratory distress syndrome (RDS) are increasingly being treated with nCPAP and surfactant administration using the “InSurE” procedure (Intubation, Surfactant, Extubation) rather than with mechanical ventilation [2]
Previous studies have investigated cardiac function after surfactant therapy in preterm infants using standard ultrasound methods. These methods have several limitations in preterm newborns, because cardiac function is affected by heart rate, preload and afterload, which are extremely variable during the first days of life
Summary
Surfactant treatment reduces respiratory morbidity and mortality in preterm infants. Data on its haemodynamic consequences are conflicting. The aim was to characterise the haemodynamic effects of surfactant treatment on cardiac function in preterm newborns with respiratory distress syndrome (RDS). Treatment with surfactant improves oxygenation previous studies that surfactant administration is associated with a low diastolic arterial pressure; the consequences of this change is unknown, but possible effects include compromised coronary artery perfusion leading to myocardial fatigue and low cardiac output [10]. Previous studies have investigated cardiac function after surfactant therapy in preterm infants using standard ultrasound methods. These methods have several limitations in preterm newborns, because cardiac function is affected by heart rate, preload and afterload, which are extremely variable during the first days of life. Tissue Doppler Imaging (TDI) is a relatively new echocardiographic technique which provides velocities of the myocardial wall during the cardiac cycle; it allows the quantification of both regional and global systolic and diastolic function and has the advantage over pulse-wave Doppler (PWD) of being less dependent on preload and afterload than standard echocardiography (ECHO) [12,15,16,17,18]
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