120 - Impaired right ventricular performance is associated with adverse short term neurological outcome in preterm infants less than 32 weeks of gestational age

Poster Number: 120
Publication Number: 120.427

Niki Oikonomopoulou, Hospital Clínico San Carlos, Madrid, Madrid, Spain; María José Rodriguez, Hospital Clínico San Carlos, Madrid, Madrid, Spain; Araceli Corredera Sánchez, Clínico San Carlos Hospital, Madrid, Madrid, Spain; Cristina Cortés-Ledesma, Clinico San Carlos Hospital, Madrid, Madrid, Spain; Eva Vierge Hernán, Hospital Clinico San Carlos, Madrid, Madrid, Spain; Jose Martínez-Orgado, Hospital Clinico San Carlos - IdISSC, Madrid, Madrid, Spain; Luis Arruza, Hospital Clinico San Carlos, Madrid, Madrid, Spain

Background: Preterm birth may have a negative effect on myocardial performance during the transitional period. However, there has been limited investigation on the relationship of postnatal cardiac dysfunction with short term neurological outcome in the preterm population. 

Objective: To analyze the association between bilateral ventricular performance and adverse neurological outcome, defined as the composite of death or interventricular hemorrhage grade II-IV or periventricular leukomalacia in serial brain ultrasound or magnetic resonance imaging at term.

Design/Methods: Prospective observational cohort study in preterm infants less than 32 weeks gestational age (GA) and less than 1500 g, who were born in our institution from September 2021 until Decembrer 2022. Participants underwent targeted neonatal echocardiographic studies in the first 24 hours of life (TNE1) and between 24 and 72 hours of life (TNE2). Cerebral oxygenation (near infrared spectroscopy) and Doppler velocities in the middle cerebral artery (MCA) were simultaneously measured. Echocardiographic parameters and their longitudinal variations between patients with normal and adverse neurological outcome were compared.

Results: Forty seven patients were included with a mean gestational age of 27.0 weeks (+ 1.98) and birth weight of 950 (800-1200) g. Tables 1 and 2 show TNE results and their variations. Sixteen (34%) patients presented adverse neurological outcome. In the first 24 hours, right ventricular cardiac output was directly correlated with MCA peak systolic velocity (R2 =0.11, F (1.41) =6.3, p</span>=0.01). Fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) values were lower in TNE1 in the group of patients with adverse outcome compared to the patients with normal outcome (FAC 23.1 vs 29.4, p=0.007, TAPSE 4.4mm VS 5.6mm, p=0.012). Both groups presented elevated right ventricular Tei index in TNE1, but lack of improvement from TNE1 to TNE2 was associated with adverse neurological outcome (median difference: -0.29 (-0.41,-0.08) vs. 0.20 (-0.02,1.11); p</span>=0.010)

Conclusion(s): Impaired right ventricular performance in the first 24 hours after birth and lack of improvement in the following 48 hours of the transitional period could be associated with an adverse short-term neurological outcome in preterm infants less than 32 weeks GA. Serial TNE evaluations and targeted treatment of right ventricular dysfunction during the first 72 hours of life may potentially improve outcomes in preterm babies