Functional echocardiographic assessment of cardiovascular status in infants with perinatal asphyxia.

Abstract

Background: Perinatal asphyxia can lead to multi-organ insult which includes cardiovascular dysfunction. The objective was to study the spectrum of haemodynamic compromise in infants with perinatal asphyxia. Method(s): Unit database was accessed to identify infants with perinatal asphyxia over the last 2 years. Information from medical records and archived echocardiographic images was retrieved. Functional echocardiograms were done as part of close haemodynamic monitoring and quality improvement activity. Infants were cooled according to Unit protocol. Result(s): Twelve infants with perinatal asphyxia were identified of which 10 were cooled. Mean gestation age and birthweight were 39 +/- 2.6 weeks and 3384 +/- 592 g respectively. Mean pH, base deficit and lactate levels were 6.9 +/- 0.24, -22 +/- 5.6 and 18.8 +/- 6.3 mmol/L, respectively. Median (range) troponin level was 0.47 mug/L (0.16-2.6); normal <=0.08 mug/L. Mean (SD) rectal temperature and the time of echocardiogram was 33.50C (0.5) and 8.4 h (4.2) respectively. At the time of echocardiogram, only one infant was hypotensive (mean blood pressure < gestation age) while half the infants were on inotropes. Majority of infants had low biventricular outputs. Median (range) superior vena caval flow was 31.2 mL/kg/min (12.6-96.2). Coronary flow was measured in the left anterior descending artery; markedly low flows were documented compared to historic controls. Coronary diastolic flow had a significantly positive correlation with left ventricular output. Higher troponin levels were associated with lower aortic stroke velocity. Conclusion(s): Haemodynamic compromise is widely prevalent in infants with perinatal asphyxia. A dichotomy between blood pressure and flow parameters was noted.