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Early diastolic dysfunction and respiratory morbidity in premature infants: an observational study

Presented at the Neonatal Society 2018 Summer Meeting.

Bussmann N1, Breatnach C1, Levy PT2, McCallion N1,4, Franklin O5, El-Khuffash A1,4

1 Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
2 Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
3 School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
4 Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland

Background: The relationship between diastolic function assessed over the first 12 hours following birth and early respiratory morbidity remains unexplored. We hypothesise that diastolic dysfunction measured over the first 12 hours of age is associated with the need for ventilation in preterm infants.

Methods: In this retrospective observational study of infants less than 32 weeks gestation, all infants underwent a comprehensive echocardiography assessment within 12 hours after birth. Tissue Doppler imaging was used to measure left ventricular (LV), septal and right ventricular (RV) s`, e`, and a` velocities. Measurements were compared between invasively ventilated infants and those on continuous positive pressure ventilation (CPAP) and between infants with and without pulmonary haemorrhage (PH).

Results: 183 infants were included. 96 infants were ventilated at the time of the echocardiogram. Ventilated infants have lower LV e` (3.4 ± 1.0 vs. 4.1 ± 1.5 cm/s, p<0.01) compared to infant on CPAP. A higher LV e` remained independently associated with a lower risk for invasive ventilation when adjusting for important confounders (LV e` adjusted OR 0.62, 95% CI 0.45 – 0.87, p<0.01). Infants with PH (n=11) had a lower LV e` (2.9 ± 1.2 vs. 3.8 ± 1.3 cm, p=0.04) when compared to infants without PH. This remained significant when adjusting for confounders (LV e` adjusted OR 0.64, 95% CI 0.46 – 0.90, p<0.001).

Conclusion: Left ventricular diastolic function in premature infants may play an important role in the evolution of respiratory morbidity as manifest by the need for invasive ventilation and pulmonary haemorrhage.

Corresponding author: neidinbussmann@gmail.com

References
1. Etzel, R; Balk, S; Bearer, C; Hendrick, J; Schell L. American Academy of Pediatrics Noise: A Hazard for the Fetus and Newborn (Committee on Environmental Health 1996-1997). Pediatrics. 1997;100(4):724–7
2. Aly HA, Ahmed AM. Effect of Noise on Neonatal Vital Data and Behavior in NICU. Clin Med Diagnostics.

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