713 - Diastolic Dysfunction of Right Ventricle is associated with Intraventricular Hemorrhage in Extremely Low Birth Weight Infants

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 713
Publication Number: 713.234

Rutuja Kibe, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States; Smeeta R. Sardesai, Keck School of Medicine of the University of Southern California, Arcadia, CA, United States; Rowena Cayabyab, University of Southern California/LAC+USC Medical Center, Los Angeles, CA, United States; Manoj Biniwale, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; mohammad Amin. Adie, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Manuel Durand, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Mahmood ebrahimi, LAC+USC Medical Center, Encin, CA, United States; Bijan Siassi and Chahrezad S. Siassi, LAC+USC Medical Center, LOS ANGELES, CA, United States

Presenting Author(s)

Rutuja Kibe, MD (she/her/hers)

Neonatology Fellow
Keck School of Medicine of the University of Southern California
Los Angeles, California, United States

Background: Extremely low birth weight (ELBW) infants are at increased risk of intraventricular hemorrhage (IVH) due to risk factors like prematurity, germinal matrix fragility, invasive ventilation, pneumothorax, hemorrhagic disorders, and hemodynamic instability. Studies report hypoperfusion and reperfusion injury, and venous hemorrhage as potential mechanisms of IVH. IVH prevention bundle helped decrease the incidence of IVH in ELBW infants.

Objective: Compare right and left ventricle systolic and diastolic function in ELBW infants with and without IVH.

Design/Methods: Retrospective study of ELBW infants born at LAC+USC Medical Center from January 2015 to January 2022. Data was collected from electronic medical records. Echocardiograms were done by providers with expertise in functional echocardiograms (iE33/Epic Philips, 8-12 MHz transducer). Analysis was performed by one provider (MAA). Right ventricle (RV) systolic function was assessed by Fraction Area Change (FAC) and Tricuspid Annular Plane Systolic Excursion (TAPSE). RV diastolic function was assessed by tricuspid inflow Doppler velocity ratio of Early diastole/Atrial kick E/A waves. Left ventricle (LV) systolic function was assessed by shortening fraction (SF), and LV diastolic function was assessed by mitral inflow Doppler velocity ratio of E/A waves.

Results:

70 ELBW infants with a mean gestational age (GA) of 25 weeks were studied, 30 had no IVH and 40 had IVH. ELBW infants with IVH were younger in GA than those without IVH 25.1 vs 25.7 weeks (p =0.044). Those born via Cesarian section had less incidence of IVH, 75% vs 93% (p =0.04). 21% with IVH were born to mothers with pre-eclampsia vs 50% without IVH (p =0.01). No difference was seen between groups in birth weight, Apgar scores, rate of intubation, vasopressors use, necrotizing enterocolitis, pulmonary hemorrhage, and bronchopulmonary dysplasia. RV and LV systolic function in ELBW infants with IVH was normal in both groups. LV and RV diastolic function in ELBW infants with IVH was lower. Tricuspid E/A wave ratio was 0.61 in those with IVH vs 0.71 in those without IVH (p =0.04). Mitral E/A wave ratio was 0.69 in those with IVH vs 0.82 in those without IVH (p =0.03).

Conclusion(s): Both systolic and/or diastolic RV dysfunction can compromise systemic venous drainage, leading to central venous congestion, potentially increasing the risk of IVH in ELBW infants. Our findings revealed that ELBW infants with IVH had compromised biventricular diastolic function. Hemodynamic assessment during the first 3 to 4 days after birth is vital to target appropriate interventions to minimize the risk of IVH.