Range of echocardiographic findings in term neonates with high oxygen requirements
Department of Neonatal Medicine, Royal Prince Alfred
Hospital and University of Sydney, Missenden Rd, Camperdown, Sydney,
NSW 2050, Australia
Correspondence to: Dr Nick Evans. Email: nevans{at}med.usyd.edu.au
AIMS
To examine the hypothesis that right to left
shunting occurs mainly in the lungs rather than through the fetal
channels in neonates.
METHODSThirty two term babies requiring over 70%
oxygen had daily colour Doppler echocardiograms until recovery.
Measurements included left ventricular fractional shortening, right and
left ventricular outputs, colour and pulsed Doppler ductal and atrial
shunting and systolic pulmonary artery pressure (SPAP) derived from
ductal shunt or tricuspid incompetence velocities.
RESULTSThe babies were retrospectively classified
into a respiratory group (n=19) and a persistent pulmonary hypertension
(PPHN) group (n=13) on the basis of clinical history and radiology. At the initial echocardiogram, just 50% of babies had suprasystemic SPAP.
Despite better oxygenation, more of the PPHN group had suprasystemic PAP (85% vs 26%). A correlation between SPAP and Oxygen
index (OI) was present only in the respiratory group (r=0.7). Low
ventricular outputs (<150 ml/kg/min) were common in both groups (53%
and 79%). The respiratory group had more closed ducts (47%
vs 0%) and those ducts which were patent were more
constricted (1.75mm vs 2.6 mm). Pure right to left ductal
shunts were seen in just 15% and pure right to left atrial shunts in
just 6% of all babies. The serial echocardiograms showed that SPAP
fell and ducts closed well before oxygenation improved. Ventricular
outputs increased with age in both groups.
CONCLUSIONSApart from early on in the sickest
babies with a primarily respiratory diagnosis and the babies with
primary PPHN, most right to left shunting occurred at an intrapulmonary level.
© 1998 by Archives of Disease in Childhood
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Osborn, D., Evans, N., Kluckow, M.
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