Key result
Mid-to-late preterm infants show a ~34% increase in left ventricular output over the first 48 hours.
Why the study?
There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation during the transitional period.
Observational (n=45)
Mean Difference: 34 (95% CI 21–47)
Offers normative ventricular mechanics data for asymptomatic mid-to-late preterm infants; extends sparse evidence but leaves clinical utility open.
BACKGROUND: There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants. METHODS: Forty-five healthy preterm newborns (mean ± standard deviation) gestation of 32.7 ± 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM™ system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring. RESULTS: Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21-47%] and stroke volume [29%, 16-42%] increased with no change in heart rate [5%, -2 to 12%]. There was a rise in mean blood pressure [11%, 1-21%], but a decline in total peripheral resistance [-14%, -25 to -3%]. CONCLUSION: Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.
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Cappelleri et al. (2019) conducted an observational in asymptomatic mid-to-late preterm infants (n=45). Transitional period (first 48 hours of life) vs. Day 1 baseline was evaluated on Left ventricular output change between Day 1 and Day 2 (mean increase 34%, 95% CI 21-47). During the first 48 hours of life, mid-to-late preterm infants demonstrated increased right ventricular function and a 34% mean increase in left ventricular output (95% CI 21-47%).
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