252 - Neonatal outcomes related to the early discovery of alterations in cardiac function: A 7-10 days 4D-left-ventricle analysis

Publication Number: 4248.252

Daniel Moses, McGill University Faculty of Medicine and Health Sciences, Pierrefonds, PQ, Canada; Pasinee Kanaprach, Chaophaya Yommarat Hospital, Suphanburi, Suphan Buri, Thailand; Audrey Hébert, CHU de Quebec, Quebec city, PQ, Canada; Carolina Michel Macías, McGill University Faculty of Medicine and Health Sciences, Queretaro, Queretaro de Arteaga, Mexico; Shiran S. Moore, McGill University Faculty of Medicine and Health Sciences, Port Washington, NY, United States; Nina Nouraeyan, Jewish General Hospital, Montreal, PQ, Canada; Christine Drolet, Chu de Quebec, Laval University, Quebec, PQ, Canada; Anie Lapointe, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; andreanne villeneuve, CHU Sainte-Justine, Montréal, PQ, Canada; Brahim Bensouda, or, Montréal, PQ, Canada; Daniela Villegas Martinez, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Jessica Simoneau, McGill University Faculty of Medicine and Health Sciences, Vercheres, PQ, Canada; Catherine Daignault, MUHC, Montreal, PQ, Canada; Tiscar Cavalle-Garrido, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Adrian Dancea, MCH of MUHC, Montreal, PQ, Canada; Guilherme Santanna, McGill University Health Center, MONTREAL, PQ, Canada; Gabriel Altit, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Background: Extremely preterm infants ( < 29 weeks' gestation) undergo cardiovascular adaptation in the early postnatal period. Developmental immaturity may alter myocardial remodelling and function.

Objective: This study, part of a prospective (NORDIC-PREM) cohort, aimed to characterize left ventricular (LV) structure and function at 7-10 days of postnatal life using four-dimensional (4D)-echocardiography (echo), and to explore associations between early perinatal factors and LV mechanics in the first week of life.

Design/Methods: Prospective single-center cohort included extremely preterm infants admitted to the Montreal Children's Hospital NICU between 2019 and 2023. 4D echocardiograms were obtained between days 7-10 of postnatal life and analyzed by a single blinded observer using TOMTEC to estimate LV volumes, mass, deformation (strain), and torsion. In this preliminary analysis of the first 40 infants, participants were stratified by the median cohort birthweight (932 g) into two groups: Group 1 ( < 932 g) and Group 2 (≥ 932 g). Continuous variables were compared between groups using independent-samples t-tests or Mann-Whitney U tests, as appropriate. Body surface area (BSA) at the time of echo calculated using the Haycock's equation was used to normalized echo parameters. Multiple linear regression analyses were performed to assess the relationships between selected predictors and birthweight.

Results: Forty infants were included in this preliminary analysis. Group 1 ( < 932g, n=20) were more frequently intubated within 30 minutes of life (30% vs 5%, P=0.04) and prolonged hospitalization - Table 1. They exhibited smaller LV end-diastolic volumes, reduced stroke volume, lower LV mass, shorter LV length, more negative global longitudinal strain and higher LV torsion - Table 2. When normalized to BSA, dimensional parameters were not associated with birthweight, with the exception of LV length. In contrast, functional parameters-including ejection fraction, global longitudinal and circumferential strain, torsion, and twist-showed significant associations with birth weight - Table 3.

Conclusion(s): Among extremely preterm neonates at 7 to 10 days post-natal life, LV functional parameters by 4D-Echo was associated with birthweight when normalized to body surface area at time of evaluation. These findings suggest potentially an adaptive process. Ongoing analysis of the full cohort will determine whether these early LV metrics may be associated with later complications such as bronchopulmonary dysplasia, pulmonary hypertension and mortality.

Confirmation of Enrolment in McGill Medicine
McGill_Univ_Letter (1).pdf

Table 2. Echocardiographic Left Ventricular Measurements of Neonates Grouped by Birthweight
Legend: Data is represented as mean (SD) or median [IQR].

Table 3. Multiple Regression Analysis of Left Ventricular Metrics Normalized to Body Surface Area
Legend: Body Surface Area calculated as per Haycock's equation.