Extremely preterm infants with adverse neurological outcome present more frequently impaired right ventricular performance.

Abstract

Background: The relationship between cardiovascular impairment and adverse outcome is insufficiently studied in preterm populations. Our aim was to analyze and compare cardiac performance during postnatal transition in extremely low gestational age infants (ELGANs) with and without adverse short-term neurological outcome.

Methods: Prospective observational cohort study. Continuous multimodal monitoring and targeted neonatal echocardiographic studies were conducted within the first 24 h of life (TNE1) and between 24 and 72 h (TNE2). Adverse outcome was defined as the composite of death, significant interventricular hemorrhage, or white matter injury.

Results: Of the 46 patients included, 21(45.7%) presented adverse outcome. There were no differences in left ventricular performance. During TNE1, infants with adverse outcome exhibited lower tricuspid annulus plane systolic excursion (TAPSE) and right ventricular global longitudinal strain (GLS-RV), alongside longer RV isovolumic relaxation time (IVRT) and higher RV Myocardial Performance Index (MPI). RV output positively correlated with peak systolic and mean velocity of the middle cerebral artery. By TNE2, RV performance differences had disappeared.

Conclusions: Impaired RV performance during early postnatal period is more frequent in ELGANs with adverse neurological outcome. Cerebral blood flow relies more on RV output. The potential role of early RV dysfunction in brain damage deserves further research.

Impact: Extremely preterm infants with adverse short-term neurological outcome present more frequently right ventricular dysfunction during early postnatal period, with a positive correlation between cerebral blood flow velocities and right ventricular output. RV performance may play a critical role in maintaining adequate cerebral blood flow; thus a subtle dysfunction could aggravate brain injury. This is the first study pointing towards a potential association between early RV dysfunction and adverse neurological outcome during neonatal transition in extremely preterm infants. Our study highlights the importance of early cardiac assessment and provides a new perspective for improving neonatal care and outcomes for this vulnerable population.