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Post-transitional adaptation of the left heart in uncomplicated, very preterm infants

Published online by Cambridge University Press:  24 January 2017

Koert De Waal ,
Nilkant Phad ,
Anil Lakkundi  and
Peter Tan
Koert De Waal*
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Nilkant Phad
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Anil Lakkundi
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Peter Tan
Affiliation:
University of Newcastle, Newcastle, New South Wales, Australia
*
Correspondence to: Dr K. de Waal, Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Lookout road, New Lambton, NSW 3205, Australia. Tel: +61 2 49214362; Fax: +61 2 49214408; E-mail: koert.dewaal@hnehealth.nsw.gov.au
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Abstract

Background

The postnatal period in preterm infants involves multiple physiological changes occurring immediately after birth and continuing for days or weeks. To recognise and treat compromise, it is important to measure cardiovascular function. The aim of this study was to describe longitudinal left ventricular function using conventional and novel echocardiography techniques in preterm infants who did not experience significant antenatal or postnatal complications and treatments.

Methods

We prospectively obtained cardiac ultrasound images at days 3, 7, 14, 21, and 28 in 25 uncomplicated, preterm infants <30 weeks of gestation. Speckle tracking analysis of the four chambers and short-axis images provided parameters of left ventricular volume, deformation, and basal myocardial velocities. The patent ductus arteriosus, cardiac dimensions, and atrial volume were also measured.

Results

Stroke volume increased by 24% during the study period (1.05–1.30 ml/kg, p<0.05). Cardiac length, diameter, and systolic basal myocardial velocity increased with unchanged wall stress and deformation parameters. Diastolic function parameters resembled that of the fetus with predominance of atrial contraction compared with early diastolic velocities. Blood pressure and estimates of left ventricular filing pressure increased, suggesting that left ventricular compliance did not change in this period.

Conclusion

Stroke volume increased in the first 28 days after preterm birth. The preterm heart adapted by increasing its size, while maintaining systolic and atrial function, independent of early diastolic maturation. Longitudinal deformation of the left ventricle remained unchanged, suggesting relatively preserved function with maturation.

Keywords

Speckle tracking echocardiographypreterm infantreference valuesleft ventricular function
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1167 - 1173
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Copyright
© Cambridge University Press 2017 

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