Kharrat Ashraf, Nissimov Sagee, Zhu Faith, Deshpande Poorva, Jain Amish
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Pediatr. 2025 Mar;278:114384. doi: 10.1016/j.jpeds.2024.114384. Epub 2024 Nov 6.
To examine cardiopulmonary physiological alterations associated with hypoxemic respiratory failure (HRF; fraction of inspired oxygen ≥0.60) among preterm neonates requiring vasopressors/inotropes during sepsis (septic shock).
We conducted a retrospective cohort study from 2015 through 2022 at a tertiary neonatal intensive care unit. Neonates <34 weeks gestational age who had septic shock and underwent a comprehensive targeted neonatal echocardiography (TNE) ≤72 hours of sepsis onset were included. TNE findings of patients with shock and HRF were compared with those with shock without HRF. Indices of pulmonary vascular resistance (PVR), right ventricular (RV) and left ventricular (LV) systolic and diastolic function, measured using conventional, tissue Doppler imaging and speckle-tracking echocardiography, were examined.
Of 52 included infants with septic shock, 19 (37%) also had HRF. Baseline characteristics were similar. On TNE, although the HRF group more frequently had bidirectional/right-to-left flow across the patent ductus arteriosus (67% vs 33%; P = .08), all indices of PVR and RV function were similar. However, the HRF group demonstrated reduced LV systolic function (ejection fraction, 51.8% ± 12.3% vs 62.6% ± 13.0%; global peak systolic longitudinal strain -15.2% ± 4.5% vs -18.6% ± 4.5%), diastolic function (early [2.3 ± 1.0/s vs 3.6 ± 1.2/s]) and late (2.4/s [IQR, 1.9-2.6/s] vs 2.8/s [2.3-3.5/s] diastolic strain rate), and higher frequency of LV output <150 mL/min/kg (44% vs 12%) (all P < .05).
Acute HRF occurring in preterm neonates with septic shock is associated with alterations in TNE measures of LV function, and not PVR or RV function. Future studies should evaluate the impact of supporting LV function in these patients.
研究脓毒症（脓毒性休克）期间需要血管加压药/正性肌力药物的早产儿中与低氧性呼吸衰竭（HRF；吸入氧分数≥0.60）相关的心肺生理改变。
我们于2015年至2022年在一家三级新生儿重症监护病房进行了一项回顾性队列研究。纳入孕周<34周、患有脓毒性休克且在脓毒症发作后≤72小时接受了全面的靶向新生儿超声心动图（TNE）检查的新生儿。将休克合并HRF患者的TNE检查结果与无HRF的休克患者进行比较。使用传统、组织多普勒成像和斑点追踪超声心动图测量肺血管阻力（PVR）、右心室（RV）和左心室（LV）收缩及舒张功能指标。
在纳入的52例脓毒性休克婴儿中，19例（37%）也患有HRF。基线特征相似。在TNE检查中，虽然HRF组动脉导管未闭出现双向/右向左分流的频率更高（67%对33%；P = 0.08），但PVR和RV功能的所有指标均相似。然而，HRF组的LV收缩功能（射血分数，51.8%±12.3%对62.6%±13.0%；整体峰值收缩期纵向应变-15.2%±4.5%对-18.6%±4.5%）、舒张功能（早期[2.3±1.0/s对3.6±1.2/s]）和晚期（舒张期应变率2.4/s[四分位间距，1.9 - 2.6/s]对2.8/s[2.3 - 3.5/s]）降低，且LV输出量<150 mL/min/kg的频率更高（44%对12%）（所有P<0.05）。
患有脓毒性休克的早产儿发生的急性HRF与TNE测量的LV功能改变有关，而非PVR或RV功能改变。未来研究应评估支持这些患者LV功能的影响。
