The Assessment of Myocardial Performance and the Impact of Pathological Processes on Cardiac Adaptation in the Neonatal Population using Functional Echocardiography
Introduction: Functional echocardiography is a rapidly expanding field in both research and clinical settings. Newer techniques facilitate comprehensive and objective assessments of myocardial performance not previously possible. Although work has been done to assess feasibility and obtain reference values for several new modalities in normal term and preterm infants, data is still lacking in several important disease states.
Objectives: We aim to study the impact of several important conditions on neonatal myocardial function over the transitional period. We hypothesise that myocardial function is impaired in certain conditions and that novel echocardiography techniques could improve our ability to characterise disease severity and predict important outcomes.
Methods: We recruited several cohorts of infants including: control preterm and term infants; preterm infants with haemodynamically significant ductus arteriosus and chronic lung disease; infants with hypoxic ischemic encephalopathy; monochorionic diamniotic twins with twin to twin transfusion; and infants with Down syndrome with structurally normal hearts. We performed three echocardiograms on Day 1 (6-12 hours), Day 2 (36-48 hours) and Day 5 – 7. We compared our results in disease patient cohorts with a cohort of healthy preterm and term infants.
Results: We have characterised myocardial performance in: preterm infants with and without disease; healthy term infants; infants with hypoxic ischemic encephalopathy; monochorionic diamniotic twins with and without twin to twin transfusion syndrome; and infants with Down syndrome with structurally normal hearts. We have demonstrated changes in haemodynamic status and cardiac function in these conditions and provided a rationale for these changes, in addition to exploring markers of outcome predication.
Conclusion: Several important neonatal conditions affect myocardial performance during the transitional period. An improved understanding of cardiac function can aid in our ability to predict outcome and monitor disease. In the future, functional echocardiography may act to guide intervention and improve our management of these patients.