Gopagondanahalli Krishna Revanna, Abdul Haium Abdul Alim, Vora Shrenik Jitendrakumar, Sundararaghavan Sreekanthan, Ng Wei Di, Choo Tze Liang Jonathan, Ang Wai Lin, Binte Mohamad Taib Nur Qaiyimah, Wijedasa Nishanthi Han Ying, Rajadurai Victor Samuel, Yeo Kee Thai, Tan Teng Hong
Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
Yong Loo Ling School of Medicine, Singapore, Singapore.
Front Pediatr. 2024 Apr 5;12:1349175. doi: 10.3389/fped.2024.1349175. eCollection 2024.
To evaluate serial tissue Doppler cardiac imaging (TDI) in the evolution of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) among extremely preterm infants.
Prospective observational study.
Single-center, tertiary-level neonatal intensive care unit.
Infant born <28 weeks gestation.
Utility of TDI in the early diagnosis and prediction of BPD-PH and optimal timing for screening of BPD-PH.
A total of 79 infants were included. Of them, 17 (23%) had BPD-PH. The mean gestational age was 25.9 ± 1.1 weeks, and mean birth weight was 830 ± 174 g. The BPD-PH group had a high incidence of hemodynamically significant patent ductus arteriosus (83% vs. 56%, < 0.018), longer oxygen days (96.16 ± 68.09 vs. 59.35 ± 52.1, < 0.008), and prolonged hospital stay (133.8 ± 45.9 vs. 106.5 ± 37.9 days, < 0.005). The left ventricular eccentricity index (0.99 ± 0.1 vs. 1.1 ± 0.7, < 0.01) and the ratio of acceleration time to right ventricular ejection time showed a statistically significant trend from 33 weeks (0.24 ± 0.05 vs. 0.28 ± 0.05, < 0.05). At 33 weeks, the BPD-PH group showed prolonged isovolumetric contraction time (27.84 ± 5.5 vs. 22.77 ± 4, < 0.001), prolonged isovolumetric relaxation time (40.3 ± 7.1 vs. 34.9 ± 5.3, < 0.003), and abnormal myocardial performance index (0.39 ± 0.05 vs. 0.32 ± 0.03, < 0.001). These differences persisted at 36 weeks after conceptional gestational age.
TDI parameters are sensitive in the early evolution of BPD-PH. Diagnostic accuracy can be increased by combining the TDI parameters with conventional echocardiographic parameters. BPD-PH can be recognizable as early as 33-34 weeks of gestation.
评估连续组织多普勒心脏成像（TDI）在极早产儿支气管肺发育不良相关肺动脉高压（BPD-PH）进展过程中的作用。
前瞻性观察性研究。
单中心三级新生儿重症监护病房。
孕龄小于28周的婴儿。
TDI在BPD-PH早期诊断和预测中的作用以及BPD-PH筛查的最佳时机。
共纳入79例婴儿。其中17例（23%）患有BPD-PH。平均孕龄为25.9±1.1周，平均出生体重为830±174克。BPD-PH组血流动力学显著的动脉导管未闭发生率较高（83%对56%，<0.018），吸氧天数更长（96.16±68.09对59.35±52.1，<0.008），住院时间延长（133.8±45.9对106.5±37.9天，<0.005）。左心室离心率指数（0.99±0.1对1.1±0.7，<0.01）以及加速时间与右心室射血时间之比从33周起呈现出具有统计学意义的趋势（0.24±0.05对0.28±0.05，<0.05）。在33周时，BPD-PH组等容收缩时间延长（27.84±5.5对22.77±4，<0.001），等容舒张时间延长（40.3±7.1对34.9±5.3，<0.003），心肌性能指数异常（0.39±0.05对0.32±0.03，<0.001）。这些差异在孕龄36周时仍然存在。
TDI参数在BPD-PH的早期进展过程中具有敏感性。将TDI参数与传统超声心动图参数相结合可提高诊断准确性。早在孕33 - 34周时就能识别出BPD-PH。
