Department of Neonatology, IPGME&R, 244 AJC Bose Road, Kolkata-700020, India.
Department of Pediatrics, Medical College & Hospital, Kolkata, India.
Eur J Pediatr. 2023 Jun;182(6):2635-2644. doi: 10.1007/s00431-023-04941-1. Epub 2023 Mar 24.
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 36(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.
本研究旨在比较新生儿暂时性呼吸急促（TTN）与健康对照组婴儿的常规和组织多普勒超声心动图参数。这是一项在印度三级新生儿护理单元进行的横断面前瞻性观察研究。患有 TTN 的晚期早产儿和足月婴儿（LPTI）连续出生，有资格入组。对照组选自健康的 LPTI。在出生后第 12 小时（D1）和 48-72 小时（D3）进行常规和组织多普勒（心肌速度、心肌做功指数（MPI））超声心动图检查。常规超声心动图参数包括分数缩短（FS）、射血分数（EF）、心室输出、E/A 比值、分数面积变化（FAC）、三尖瓣环平面收缩期位移（TAPSE）、肺动脉收缩压（PASP）和肺动脉射血时间比加速（PATET）。比较 TTN 组和对照组的基线特征和超声心动图图像。在纳入的 60 名婴儿中，最终分析了 34 名 TTN 组和 20 名对照组婴儿。研究人群的平均（SD）胎龄和出生体重分别为 36（1.8）周和 2398（376）g。两组左心室（LV）参数相似。在 D1 时，右心室（RV）e'较小（6.42（1）cm/s 比 7.68（1.68）cm/s，p=0.022），E/e'较大（7.79（1.51）比 6.08（2.59），p=0.037），表明 RV 舒张功能障碍。RV MPI（0.61（0.11）比 0.44（0.12），p＜0.001）也更大，表明 RV 整体心肌功能障碍。在 D3 时也观察到类似的发现。在 D1（0.34（0.05）比 0.42（0.05），p＜0.001）和 D3（0.38（0.05）比 0.43（0.02），p=0.004）时，TTN 组的 PATET 较低，提示肺动脉压持续升高，尽管只有 2 名婴儿通过标准超声心动图检查发现患有肺动脉高压。结论：TTN 婴儿的心肌组织多普勒成像显示，隐匿性右心室舒张功能障碍继发于持续升高的肺动脉压。已知的：•新生儿暂时性呼吸急促可能与肺动脉高压有关。新的发现：•在患有新生儿暂时性呼吸急促的婴儿中，组织多普勒成像显示隐匿性右心室舒张功能障碍继发于肺动脉压升高，这是标准超声心动图无法检测到的。
