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Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study

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Abstract

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12 h (D1) and 48–72 h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e’ was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e’ (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography.

  Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure.

What is Known:

•Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension.

What is New:

•Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

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Data availability

Data supporting the findings of this study will be made available to any researcher upon reasonable request through e-mail.

Abbreviations

TTN:

Transient tachypnea of the newborn

LPTI:

Late preterm and term infants

TDI:

Tissue Doppler imaging

RDS:

Respiratory distress syndrome

PDA:

Patent ductus arteriosus

SpO2 :

Oxygen saturation

POCUS:

Point of care ultrasound

RV:

Right ventricle

LV:

Left ventricle

s’:

Peak myocardial systolic velocity

e’:

Early diastolic myocardial velocity

a’:

Late diastolic myocardial velocity during atrial contraction

IVCT:

Isovolumic contraction time

IVRT:

Isovolumic relaxation time

ET:

Ejection time

MPI:

Myocardial performance index

FS:

Fractional shortening

EF:

Ejection fraction

LVO:

Left ventricular output

RVO:

Right ventricular output

PASP:

Pulmonary artery systolic pressure

FAC:

Fractional area change

PATET:

Pulmonary artery acceleration to ejection time ratio

TAPSE:

Tricuspid annular plane systolic excursion

SD:

Standard deviation

IQR:

Inter-quartile range

FiO2 :

Fraction of inspired oxygen

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Authors and Affiliations

  1. Department of Neonatology, IPGME&R, 244 AJC Bose Road, Kolkata-700020, India

    Anindya Kumar Saha, Syamal Sardar & Somnath Pal

  2. Department of Pediatrics, Medical College & Hospital, Kolkata, India

    Moumita Ghosh

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  4. Somnath Pal
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Contributions

Somnath Pal, Anindya Kumar Saha, and Syamal Sardar conceptualized and designed the study. Somnath Pal developed the protocol. Somnath Pal and Anindya Kumar Saha collected the data. Moumita Ghosh, Somnath Pal and Anindya Kumar Saha analyzed the data. Moumita Ghosh and Somnath Pal prepared the first draft. Somnath Pal and Moumita Ghosh critically reviewed the manuscript. Somnath Pal and Moumita Ghosh revised the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Somnath Pal.

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Ethics approval

Study was performed in line with the principles of Declaration of Helsinki. The institutional ethics committee of IPGME&R (IPGME&R Research Oversight Committee) approved the study (IPGME&R/IEC/2021/378).

Consent to participate

Written informed consent was obtained from the parents.

Competing interests

The authors declare no competing interests.

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Communicated by Daniele De Luca.

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Saha, A.K., Ghosh, M., Sardar, S. et al. Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study. Eur J Pediatr 182, 2635–2644 (2023). https://doi.org/10.1007/s00431-023-04941-1

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