Skip to main content

Advertisement

SpringerLink
Log in

Functional Echocardiographic Assessment of Myocardial Performance in Anemic Premature Infants: A Pilot Study

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This prospective observational study conducted in a neonatal intensive care unit aimed to evaluate echocardiographic changes provoked by anemia and transfusion of packed red blood cells (pRBCs) in premature infants. In this study, 32 anemic premature infants had serial echocardiographic assessment of left ventricular (LV) systolic performance, LV preload, and afterload immediately before, within 48 h, and up to 120 h after the transfusion of pRBCs. Pretransfusional evaluations also were compared with similar assessments of 71 nonanemic inpatient premature infants analogous for sex, gestational age at birth, and postnatal age. Left ventricular systolic performance was estimated from fractional shortening, LV output, and LV myocardial performance index (LVMPI). The LV preload was estimated from the LV end-diastolic dimension and the ratio of left atrium-to-aortic root dimension (LA/Ao ratio). The LV afterload was estimated from end-systolic wall stress. The LVMPI was found to decrease with increasing corrected gestational age in both the nonanemic (R = 0.173; p = 0.03) and anemic (R = 0.460; p = 0.007) infants. The LVMPI was the only index that changed after transfusion of pRBCs, decreasing in the younger anemic infants (p = 0.011) and increasing in the older anemic infants (p = 0.012). Finally, a significant inverse relationship between pre- and posttransfusional LVMPI values (R = 0.730; p < 0.001) was noted. The LVMPI may allow for identification of preterm infants more likely to be helped by transfusion of pRBCs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Holland BM, Jones JG, Wardrop CA (1987) Lessons from the anemia of prematurity. Hematol Oncol Clin North Am 1:355–366

    PubMed  CAS  Google Scholar 

  2. Alverson DC, Isken VH, Cohen RS (1988) Effect of booster blood transfusions on oxygen utilization in infants with bronchopulmonary dysplasia. J Pediatr 113:722–726

    Article  PubMed  CAS  Google Scholar 

  3. Cerussi A, Van Woerkom R, Waffarn F, Tromberg B (2005) Noninvasive monitoring of red blood cell transfusion in very-low-birthweight infants using diffuse optical spectroscopy. J Biomed Opt 10:051401

    Article  PubMed  Google Scholar 

  4. Frey B, Losa M (2001) The value of capillary whole blood lactate for blood transfusion requirements in anemia of prematurity. Intensive Care Med 27:222–227

    Article  PubMed  CAS  Google Scholar 

  5. Möller JC, Schwarz U, Schaible TF, Artlich A, Tegtmeyer FK, Gortner L (1996) Do cardiac output and serum lactate levels indicate blood transfusion requirements in anemia of prematurity. Intensive Care Med 22:472–476

    Article  PubMed  Google Scholar 

  6. Strauss RG, Mock DM, Johnson K, Mock NI, Cress G, Knosp L, Lobas L, Schmidt RL (2003) Circulating RBC volume, measured with biotinylated RBCs, is superior to the Hct to document the hematologic effects of delayed versus immediate umbilical cord clamping in preterm neonates. Transfusion 43:1168–1172

    Article  PubMed  Google Scholar 

  7. Wardle SP, Garr R, Yoxall CW, Weindling AM (2002) A pilot randomised controlled trial of peripheral fractional oxygen extraction to guide blood transfusions in preterm infants. Arch Dis Child Fetal Neonatal Ed 86:F22–F27

    Article  PubMed  CAS  Google Scholar 

  8. Caille V, Squara P (2006) Oxygen uptake-to-delivery relationship: a way to assess adequate flow. Critical Care 10(Suppl 3):S4

    Article  PubMed  Google Scholar 

  9. Lachance C, Chessex P, Fouron JC, Widness JA, Bard H (1994) Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity. J Pediatr 125:278–282

    Article  PubMed  CAS  Google Scholar 

  10. Tei C (1995) New noninvasive index for combined systolic and diastolic ventricular function. J Cardiol 26:135–136

    PubMed  CAS  Google Scholar 

  11. Tsutsumi T, Ishii M, Eto G, Hota M, Kato H (1999) Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index. Pediatr Int 41:722–727

    Article  PubMed  CAS  Google Scholar 

  12. Ishii M, Eto G, Tei C, Tsutsumi T, Hashino K, Sugahara Y, Himeno W, Muta H, Furui J, Akagi T, Fukiyama R, Toyoda O, Kato H (2000) Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: a right ventricular myocardial performance index. Pediatr Cardiol 21:416–421

    Article  PubMed  CAS  Google Scholar 

  13. Eto G, Ishii M, Tei C, Tsutsumi T, Akagi T, Kato H (1999) Assessment of global left ventricular function in normal children and in children with dilated cardiomyopathy. J Am Soc Echocardiogr 12:1058–1064

    Article  PubMed  CAS  Google Scholar 

  14. Kluckow M (2011) Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates. J Pediatr 158:e13–e18

    Article  PubMed  Google Scholar 

  15. Murase M, Ishida A, Morisawa T (2009) left and right ventricular myocardial performance index (Tei Index) in very-low-birthweight infants. Pediatr Cardiol 30:928–935

    Article  PubMed  Google Scholar 

  16. Rowland DG, Gutgesell HP (1995) Noninvasive assessment of myocardial contractility, preload, and afterload in healthy newborn infants. Am J Cardiol 75:818–821

    Article  PubMed  CAS  Google Scholar 

  17. Silverman NH, Schiller NB (1984) Cross sectional echocardiographic assessment of cardiac chamber size and ejection fraction in children. Ultrasound Med Biol 10:757–769

    Article  PubMed  CAS  Google Scholar 

  18. Bifano EM, Curran T (1995) Minimizing donor blood exposure in the neonatal intensive care unit: current trends and future prospects. Clin Perinatol 22:657–669

    PubMed  CAS  Google Scholar 

  19. Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, Cress GA, Johnson KJ, Kromer IJ, Zimmerman MB (2005) Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 115:1685–1691

    Article  PubMed  Google Scholar 

  20. Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, Peliowski A, Rios A, LaCorte M, Connelly R, Barrington K, Roberts RS (2006) The premature infants in need of transfusion (PINT) study: a randomized controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low-birthweight infants. J Pediatr 149:301–307

    Article  PubMed  Google Scholar 

  21. Mimica AF, dos Santos AM, da Cunha DH, Guinsburg R, Bordin JO, Chiba A, Barros MM, Kopelman BI (2008) A very strict guideline reduces the number of erythrocyte transfusions in preterm infants. Vox Sang 95:106–111

    Article  PubMed  CAS  Google Scholar 

  22. Alverson DC (1995) The physiologic impact of anemia in the neonate. Clin Perinatol 22:609–625

    PubMed  CAS  Google Scholar 

  23. Izraeli S, Ben-Sira L, Harell D, Naor N, Ballin A, Davidson S (1993) Lactic acid as a predictor for erythrocyte transfusion in healthy preterm infants with anemia of prematurity. J Pediatr 122:629–631

    Article  PubMed  CAS  Google Scholar 

  24. Bifano EM, Smith F, Borer J (1992) Relationship between determinants of oxygen delivery and respiratory abnormalities in preterm infants with anemia. J Pediatr 120:292–296

    Article  PubMed  CAS  Google Scholar 

  25. Bard H, Fouron JC, Chessex P, Widness JA (1998) Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity in infants with bronchopulmonary dysplasia. J Pediatr 132:630–634

    Article  PubMed  CAS  Google Scholar 

  26. Evans N (2000) Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 36:169–171

    Article  PubMed  CAS  Google Scholar 

  27. Kluckow M, Seri I, Evans N (2008) Echocardiography and the neonatologist. Pediatr Cardiol 29:1043–1047

    Article  PubMed  CAS  Google Scholar 

  28. Skinner JR (1998) Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist? Arch Dis Child 78:401–402

    Article  PubMed  CAS  Google Scholar 

  29. Poulsen SH, Nielsen JC, Henning RA (2000) The influence of heart rate on the Doppler-derived myocardial performance index. J Am Soc Echocardiogr 13:379–384

    PubMed  CAS  Google Scholar 

  30. Tei C, Nishimura RA, Seward JB, Tajik AJ (1997) Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 10:169–178

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, S. Maria della Misericordia Hospital of Perugia, Azienda Ospedaliera di Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy

    Maurizio Radicioni, Stefania Troiani & Daniele Mezzetti

Authors
  1. Maurizio Radicioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefania Troiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniele Mezzetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio Radicioni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Radicioni, M., Troiani, S. & Mezzetti, D. Functional Echocardiographic Assessment of Myocardial Performance in Anemic Premature Infants: A Pilot Study. Pediatr Cardiol 33, 554–561 (2012). https://doi.org/10.1007/s00246-012-0154-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-012-0154-6

Keywords

Search

Navigation