Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia

Christoph Czernik, Stefanie Rhode, Boris Metze, Gerd Schmalisch, Christoph Bührer, Christoph Czernik, Stefanie Rhode, Boris Metze, Gerd Schmalisch, Christoph Bührer

Abstract

Objectives: Elevated pulmonary vascular resistance occurs during the first days after birth in all newborn infants and persists in infants at risk for bronchopulmonary dysplasia (BPD). It is difficult to measure in a non-invasive fashion. We assessed the usefulness of the right ventricular index of myocardial performance (RIMP) to estimate pulmonary vascular resistance in very low birth weight infants.

Study design: Prospective echocardiography on day of life (DOL) 2, 7, 14, and 28 in 121 preterm infants (median [quartiles] gestational age 28 [26]-[29] weeks, birth weight 998 [743-1225] g) of whom 36 developed BPD (oxygen supplementation at 36 postmenstrual weeks).

Results: RIMP derived by conventional pulsed Doppler technique was unrelated to heart rate or mean blood pressure. RIMP on DOL 2 was similar in infants who subsequently did (0.39 [0.33-0.55]) and did not develop BPD (0.39 [0.28-0.51], p = 0.467). RIMP declined steadily in non-BPD infants but not in BPD infants (DOL 7: 0.31[0.22-0.39] vs. 0.35[0.29-0.48], p = 0.014; DOL 14: 0.23[0.17-0.30] vs. 0.35[0.25-0.43], p<0.001; DOL 28: 0.21[0.15-0.28] vs. 0.31 [0.21-0.35], p = 0.015).

Conclusions: In preterm infants, a decline in RIMP after birth was not observed in those with incipient BPD. The pattern of RIMP measured in preterm infants is commensurate with that of pulmonary vascular resistance.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of the study…
Figure 1. Flow diagram of the study population.
Figure 2. Doppler methodology.
Figure 2. Doppler methodology.
Measurement of the myocardial performance index by pulsed Doppler in the right ventricle capturing inflow and outflow. The “a” interval is the time from tricuspidal closing to opening, and the “b” interval is the ejection time in milliseconds.
Figure 3. Decrease in RIMP during the…
Figure 3. Decrease in RIMP during the neonatal period in infants who did or did not develop BPD (median and quartile values presented).

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