None of the authors has any conflict of interest to declare in connection with this paper.
FV and GF designed the study. SG performed ECHO, supervised by MF and AB. GA and AA analysed and interpreted data. FV, SG and AA drafted the manuscript; the first draft was revised by MF, AB and GF. All the authors gave final approval of the version to be submitted.
Surfactant treatment reduces respiratory morbidity and mortality in preterm infants. Data on its haemodynamic consequences are conflicting. The aim was to characterise the haemodynamic effects of surfactant treatment on cardiac function in preterm newborns with respiratory distress syndrome (RDS).
Preterm infants (gestational age <34 weeks, birth weight <2000 g) with RDS, who received surfactant within 72 hours of life, were recruited.
Echocardiography was performed before surfactant, and 2 and 24 hours after. Left and right ventricular peak systolic, early diastolic and late diastolic myocardial velocities were measured using Tissue Doppler Imaging (TDI), while characteristics of the ductus arteriosus, pulmonary artery pressure, right ventricular (RVO) and left ventricular output were measured by standard echocardiography. Tricuspidal Annular Plane Systolic Excursion (TAPSE) was measured on the free wall of the tricuspid annulus.
Fourteen patients were studied. Surfactant was associated with a decrease in pulmonary pressure and an increase in RVO. The improvement of right ventricular function was also confirmed by a significant increase in right peak systolic velocity and in TAPSE. Left ventricular velocities did not change significantly after surfactant.
Surfactant administration in preterm infants with RDS did not impair myocardial contractility and was followed by increased RVO, in agreement with other parameters of right ventricular function. TDI and TAPSE appeared to be reliable and feasible in this population. The addition of TDI and TAPSE to standard neonatal echocardiography may provide additional information about cardiac function.
Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, Charry L, Bastidas JA, Perez LA, Rojas C, Ovalle O, Celis LA, Garcia-Harker J, Jaramillo ML: Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics. 2009, 123: 137-142. 10.1542/peds.2007-3501. CrossRefPubMed
Terry MH, Merritt TA, Harding B, Schroeder H, Merrill-Henry J, Mazela J, Gregory TJ, Segal R, Power GG, Blood AB: Pulmonary distribution of lucinactant and poractant alfa and their peridosing hemodynamic effects in a preterm lamb model of respiratory distress syndrome. Pediatr Res. 2010, 68: 193-198. CrossRefPubMed
Martin-Duran R, Larman M, Trugeda A, de Prada JA V, Ruano J, Torres A, Figueroa A, Pajaron A, Nistal F: Comparison of doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization. Am J Cardiol. 1986, 57: 859-863. 10.1016/0002-9149(86)90627-2. CrossRefPubMed
Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW: Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiograph. J Am Soc Echocardiogr. 2011, 24: 1057-1078. 10.1016/j.echo.2011.07.014. CrossRefPubMed
Kaul S, Tei C, Hopkins JM, Shah PM: Assessment of right ventricular function using two-dimensional echocardiography. Am Hear J. 1984, 107: 526-531. 10.1016/0002-8703(84)90095-4. CrossRef
Azpurua H, Norwitz ER, Campbell KH, Funai EF, Pettker CM, Kleine M, Bahtiyar MO, Malkus H, Copel JA, Thung SF: Acceleration/ejection time ratio in the fetal pulmonary artery predicts fetal lung maturity. Am J Obs Gynecol. 2010, 203: 40-e1–8 CrossRef
Koestenberger M, Nagel B, Ravekes W, Urlesberger B, Raith W, Avian A, Halb V, Cvirn G, Fritsch P, Gamillscheg A: Systolic right ventricular function in preterm and term neonates: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 258 patients and calculation of Z-score values. Neonatology. 2011, 100: 85-92. 10.1159/000322006. CrossRefPubMed
- Pilot observational study on haemodynamic changes after surfactant administration in preterm newborns with respiratory distress syndrome
- BioMed Central
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