Breatnach Colm R, El-Khuffash Afif, James Adam, McCallion Naomi, Franklin Orla
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
Early Hum Dev. 2017 May;108:33-39. doi: 10.1016/j.earlhumdev.2017.03.012. Epub 2017 Apr 4.
Tissue Doppler imaging (TDI) is a useful marker of myocardial performance in preterm infants. We aimed to demonstrate serial changes in TDI velocity in preterm infants <29weeks gestation, to assess the impact of inotropes and a haemodynamically significant patent ductus arteriosus (hsPDA).
This was a prospective observational study of preterm infants <29weeks gestation. Echocardiography was performed at days 1, 2, 5-7 and at 36weeks, or before hospital discharge. Infants with hsPDA's on day 5-7 and those who received inotropes in the first week of life were not included in the Reference Cohort. Systolic (s) and diastolic (e and a`) velocity waves were assessed at the mitral and tricuspid annulus and basal septum.
One hundred and thirty nine infants with a mean (SD) gestation and birthweight of 26.7 (1.5) weeks and 946 (247) grams were enrolled. The 66 infants (47%) in the Reference Cohort demonstrated an increase in functional parameters with increasing age [LV s, Septal s, and RV s, Day 1-36weeks: 2.8 (0.6) to 4.7 (1.0), 2.4 (0.6) to 4.6 (0.8), 3.6 (0.6) to 6.9 (1.0) cm/s respectively; all p<0.05). The 24 infants who received inotropes had lower LV e [2.9 vs. 3.6cm/s], Septal e [2.3 vs. 2.8cm/s] and a [3.2 vs. 3.9cm/s], and lower RV a [3.3 vs. 3.9cm/s] on Day 1 (all p<0.05). Fifty five infants had a hsPDA on Day 5-7, demonstrating higher LV [4.7 vs. 4.0cm/s] and Septal e [3.9 vs. 3.3cm/s], and a higher LV E/e` [13 vs. 10] (all p<0.05).
Extremely preterm infants display a gradual increase in tissue Doppler velocities from birth until 36weeks corrected age. The presence of a hsPDA increases diastolic TDI velocities. Infants requiring inotropes have lower diastolic myocardial velocities on Day 1.
组织多普勒成像（TDI）是评估早产儿心肌功能的一项有用指标。我们旨在阐述孕龄小于29周的早产儿TDI速度的系列变化，以评估血管活性药物及血流动力学显著的动脉导管未闭（hsPDA）的影响。
这是一项针对孕龄小于29周早产儿的前瞻性观察性研究。在出生第1天、第2天、第5 - 7天以及36周时或出院前进行超声心动图检查。第5 - 7天患有hsPDA的婴儿以及出生后第一周接受血管活性药物治疗的婴儿未纳入参照队列。在二尖瓣、三尖瓣环以及室间隔处评估收缩期（s）和舒张期（e和a`）速度波。
共纳入139例婴儿，平均（标准差）孕龄和出生体重分别为26.7（1.5）周和946（247）克。参照队列中的66例婴儿（47%）显示随着年龄增长功能参数增加[左心室s、室间隔s和右心室s，出生第1天至36周：分别从2.8（0.6）增加至4.7（1.0）、从2.4（0.6）增加至4.6（0.8）、从3.6（0.6）增加至6.9（1.0）cm/s；均p<0.05]。24例接受血管活性药物治疗的婴儿在出生第1天左心室e[2.9对3.6cm/s]、室间隔e[2.3对2.8cm/s]和a[3.2对3.9cm/s]以及右心室a[3.3对3.9cm/s]较低（均p<0.05）。55例婴儿在第5 - 7天患有hsPDA，显示左心室[4.7对4.0cm/s]和室间隔e[3.9对3.3cm/s]较高，以及左心室E/e`[13对10]较高（均p<0.05）。
极早产儿从出生至矫正年龄36周，组织多普勒速度逐渐增加。hsPDA的存在会增加舒张期TDI速度。出生第1天需要血管活性药物治疗的婴儿舒张期心肌速度较低。
