Challenges in clinical identification of right ventricular dysfunction in preterm infants with persistent pulmonary hypertension of the newborn

Faith Zhu; Caio Barbosa de Oliveira; Nada Mohsen; Ashraf Kharrat; Poorva Deshpande; Luc Mertens; Amish Jain

doi:10.1016/j.earlhumdev.2024.105942

Challenges in clinical identification of right ventricular dysfunction in preterm infants with persistent pulmonary hypertension of the newborn

Early Hum Dev. 2024 Mar:190:105942. doi: 10.1016/j.earlhumdev.2024.105942. Epub 2024 Jan 23.

Authors

Faith Zhu¹, Caio Barbosa de Oliveira¹, Nada Mohsen², Ashraf Kharrat¹, Poorva Deshpande¹, Luc Mertens³, Amish Jain⁴

Affiliations

¹ Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada.
² Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada; Department of Pediatrics, Mansoura University, Mansoura, Egypt.
³ Department of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada. Electronic address: amish.jain@sinaihealth.ca.

PMID: 38306954
DOI: 10.1016/j.earlhumdev.2024.105942

Abstract

Background: Right ventricular dysfunction, typically qualitatively diagnosed (Q-RVd) in preterm infants, requires echocardiography which is not always acutely available. We aimed to identify clinical indices of Q-RVd in very preterm infants (gestational age, GA <32 weeks) with persistent pulmonary hypertension of newborn (PPHN) and examine the reliability and validity of Q-RVd.

Methods: Forty-seven infants with mean ± SD GA of 26.8 ± 2.7 weeks who had targeted neonatal echocardiography (TNE) ≤72 h old, during PPHN, were retrospectively studied. Three standard TNE clips were reviewed by two blinded assessors, and infants categorized as Q-RVd if moderate-severe RVd was diagnosed on ≥2 clips. Cardiopulmonary clinical indices at TNE and quantitative RV functional markers were compared between Q-RVd vs. no-RVd groups. Potential quantitative RVd definitions examined by classifying each measurement as "low" or "normal" using published data. Inter-rater agreement for Q-RVd assessed using Kappa statistics.

Results: Mean age at TNE was 25.3 ± 20.4 h with Q-RVd diagnosed in 19(40 %) infants. Q-RVd group demonstrated higher peak oxygen requirements (96 ± 9 % vs. 84 ± 16 %, p < 0.01); however, no clinical parameters at TNE differentiated the groups. Quantitative measures were lower in Q-RVd patients, confirming classification validity. Among tested quantitative definitions, low RV stroke volume was associated with lower systolic blood pressure (41±7 vs. 47±9 mmHg, p = 0.02) and higher shock index (4.02±0.80 vs. 3.44±0.72, p = 0.02). Kappa for Q-RVd was 0.55 (95%CI 0.32-0.77).

Conclusions: The non-specific nature of clinical markers of RVd in preterm infants with PPHN necessitates echocardiographic diagnosis of RVd. Studies should examine prognostic relevance of RVd and establish outcome-based quantitative definitions in preterm infants.

Keywords: Echocardiography; Persistent pulmonary hypertension newborn; Premature neonates; Right ventricular dysfunction.

MeSH terms

Humans
Hypertension, Pulmonary* / diagnostic imaging
Infant
Infant, Newborn
Infant, Premature
Reproducibility of Results
Retrospective Studies
Ventricular Dysfunction, Right* / diagnostic imaging