Vijayashankar Sakethram S, Sanatani Gabrielle, Franciosi Sonia, Moodley Shreya, Ting Joseph Y
Division of Cardiology, Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Centre, Vancouver, British Columbia, Canada.
Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
Transl Pediatr. 2023 Jan 31;12(1):13-19. doi: 10.21037/tp-22-301. Epub 2022 Dec 13.
Our objective was to examine the clinical presentation, echocardiographic findings, and outcomes of newborns presenting with left ventricle (LV) dysfunction in the first 48 hours of life without perinatal asphyxia or structural heart disease. We hypothesize that LV dysfunction may occur due to maladaptation to extrauterine life.
This is a retrospective cohort analysis including infants born in a quaternary perinatal centre. Late preterm and term neonates who were diagnosed with left ventricular dysfunction at less than 48 hours of life were identified using an echocardiography clinical laboratory's database and extracorporeal life support database. LV dysfunction was defined as m-mode fractional shortening (FS) <28% or ejection fraction (EF) <50% on echocardiography or reduced function reported by a cardiologist. Data extracted included patient & maternal demographics, echocardiogram parameters, clinical status, and medications. The primary outcome measure was time to recovery of LV function based on echocardiography.
Of the 69 patients identified, 19 patients were included in the final analysis. The mean gestational age was 38 weeks. Thirteen (68%) infants did not have an underlying cause identified despite extensive work-up. Four (21%) infants had exposure to maternal illicit drug use during pregnancy. Three infants died, and all infants without identifiable etiologies had recovery of LV function within 14 days of life.
LV dysfunction can occur during the abrupt transition from fetal to neonatal circulation and can be associated with maternal illicit drug use.
我们的目标是研究出生后48小时内出现左心室（LV）功能障碍且无围产期窒息或结构性心脏病的新生儿的临床表现、超声心动图检查结果及预后。我们假设左心室功能障碍可能是由于对宫外生活适应不良所致。
这是一项回顾性队列分析，纳入在一家四级围产期中心出生的婴儿。利用超声心动图临床实验室数据库和体外生命支持数据库，识别出生后48小时内被诊断为左心室功能障碍的晚期早产儿和足月儿。左心室功能障碍定义为超声心动图检查中M型缩短分数（FS）<28%或射血分数（EF）<50%，或心脏病专家报告的功能减退。提取的数据包括患者及母亲的人口统计学信息、超声心动图参数、临床状况和用药情况。主要结局指标是基于超声心动图的左心室功能恢复时间。
在识别出的69例患者中，19例纳入最终分析。平均胎龄为38周。尽管进行了广泛检查，仍有13例（68%）婴儿未发现潜在病因。4例（21%）婴儿在孕期母亲有非法药物使用史。3例婴儿死亡，所有未查明病因的婴儿在出生后14天内左心室功能恢复。
左心室功能障碍可发生在从胎儿循环到新生儿循环的突然转变过程中，且可能与母亲非法药物使用有关。
