scholarly journals Comparison of left ventricular rotational mechanics between term and extremely premature infants over the first week of age

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001458
Author(s):  
Aisling Smith ◽  
Neidin Bussmann ◽  
Phillip Levy ◽  
Orla Franklin ◽  
Naomi McCallion ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Left Ventricular ◽  
Strong Positive Correlation ◽  
Term Infants ◽  
Time Points ◽  
Apical Rotation ◽  
Extremely Preterm ◽  
Basal Rotation ◽  
Rotational Mechanics

ObjectiveLeft ventricle (LV) rotational mechanics is an emerging tool to characterise LV function, but warrants further evaluation in neonates. The aim of this study was to compare LV rotational mechanics between term and extremely preterm babies over the first week of age.MethodsIn this prospective study, we serially assessed LV rotational parameters in 50 term infants and compared them with a historical dataset of 50 preterm infants born <29 weeks gestation. LV basal and apical rotation, LV twist, LV twist/untwist rate and torsion were derived using two-dimensional speckle tracking echocardiography at three time points over the first week of age.ResultsThere was no change in LV twist, LV torsion, basal rotation or apical rotation in term infants over the study period (all p>0.05). LV twist and torsion were higher in preterm infants, and increased over time. In preterm infants, basal rotation evolved from anticlockwise to clockwise rotation. Apical rotation remained anticlockwise in both groups (all p>0.05). LV twist rate (LVTR) and untwist rate was higher in preterm infants and increased over the three time points (all p>0.05). There was a strong positive correlation between LV torsion and LV untwist rate (LVUTR) in the entire cohort during the third scan.ConclusionTerm infants exhibit minimal LV twist which remains unchanged over the first week of age. This is in contrast to premature infants who demonstrate increasing indices of twist, torsion, LVTR and LVUTR over the first week, likely as a compensatory mechanism for reduced LV compliance.

scholarly journals Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age

2020 ◽  
Vol 30 (9) ◽  
pp. 1238-1246
Author(s):  
Gloria C. Lehmann ◽  
Philip T. Levy ◽  
Meghna D. Patel ◽  
Timothy Sekarski ◽  
HongJie Gu ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Neonatal Period ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Term Infants ◽  
Apical Rotation ◽  
Cardiopulmonary Complications ◽  
Rotational Mechanics ◽  
The Impact ◽  
Over Time

AbstractBackground:Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.Methods:Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.Results:Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).Conclusion:This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.

scholarly journals Radiation Exposure of Premature Infants Beyond the Perinatal Period

2018 ◽  
Vol 8 (11) ◽  
pp. 672-678
Author(s):  
Alexander H. Hogan ◽  
Eran Bellin ◽  
Lindsey Douglas ◽  
Terry L. Levin ◽  
Nora Esteban-Cruciani
Keyword(s):  
Radiation Exposure ◽  
Preterm Infants ◽  
Premature Infants ◽  
Low Socioeconomic Status ◽  
Urban Hospital ◽  
Term Infants ◽  
Hospital System ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Birth Hospitalization

OBJECTIVES: To determine the odds of premature compared with term infants exceeding the recommended radiation exposure threshold in the first year after discharge from birth hospitalization. METHODS: In this observational retrospective cohort study, we compared the radiation exposure of premature and term infants between 2008 and 2015 in an urban hospital system. The primary outcome was crossing the radiation exposure threshold of 1 millisievert. We assessed prematurity’s effect on this outcome with multivariable logistic regression. RESULTS: In our study, 20 049 term and 2047 preterm infants met inclusion criteria. The population was approximately one-half female, predominantly multiracial or people of color (40% African American and 44% multiracial), and of low socioeconomic status. Premature infants had 2.25 times greater odds of crossing the threshold compared with term infants after adjustment for demographics (95% confidence interval [CI]: 1.66–3.05). Adjustment for complex chronic conditions, which are validated metrics of pediatric chronic illness, attenuated this association; however, premature infants still had 1.58 times greater odds of crossing the threshold (95% CI: 1.16–2.15). When the final model was analyzed by degree of prematurity, very preterm and extremely preterm infants were significantly more likely to cross the threshold (1.85 [95% CI: 1.03–3.32] and 2.53 [95% CI: 1.53–4.21], respectively), whereas late preterm infants were not (1.14 [95% CI: 0.73–1.78]). CONCLUSIONS: Premature infants crossed the recommended radiation threshold more often than term infants in the year after discharge from birth hospitalization.

The diversity of rearranged immunoglobulin heavy chain variable region genes in peripheral blood B cells of preterm infants is restricted by short third complementarity-determining regions but not by limited gene segment usage

Blood ◽  
2001 ◽  
Vol 97 (5) ◽  
pp. 1511-1513 ◽  
Author(s):  
Michael Zemlin ◽  
Karl Bauer ◽  
Michael Hummel ◽  
Sabine Pfeiffer ◽  
Simone Devers ◽  
...  
Keyword(s):  
B Cells ◽  
Preterm Infants ◽  
Heavy Chain ◽  
Peripheral Blood ◽  
Gene Segment ◽  
Immunoglobulin Heavy Chain ◽  
Term Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Complementarity Determining Regions

The immunoglobulin diversity is restricted in fetal liver B cells. This study examined whether peripheral blood B cells of extremely preterm infants show similar restrictions (overrepresentation of some gene segments, short third complementarity-determining regions [CDR3]). DNA of rearranged immunoglobulin heavy chain genes was amplified by polymerase chain reaction, cloned, and sequenced. A total of 417 sequences were analyzed from 6 preterm infants (25-28 weeks of gestation), 6 term infants, and 6 adults. Gene segments from the entire VHand DH gene locus were rearranged in preterm infants, even though the DH7-27 segment was overrepresented (17% of rearrangements) compared to term infants (7%) and adults (2%). CDR3 was shorter in preterm infants (40 ± 10 nucleotides) than in term infants (44 ± 12) and adults (48 ± 14) (P &lt; .001) due to shorter N regions. Somatic mutations were exclusively found in term neonates and adults (mutational frequency 0.8% and 1.8%). We conclude that preterm infants have no limitations in gene segment usage, whereas the diversity of CDR3 is restricted throughout gestation.

scholarly journals Reference values for N-terminal Pro-brain natriuretic peptide in premature infants during their first weeks of life

2020 ◽  
Author(s):  
Agnes-Sophie Fritz ◽  
Titus Keller ◽  
Angela Kribs ◽  
Christoph Hünseler
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Preterm Infants ◽  
Premature Infants ◽  
Reference Values ◽  
Gestational Age ◽  
Temporal Distribution ◽  
Cross Sectional ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract The aim of our study was to observe the temporal distribution of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants of ≤ 31 weeks of gestational age (GA) during the first weeks of life. NT-proBNP values of 118 preterm infants born ≤ 31 weeks GA were determined during the first week of life, after 4 ± 1 weeks of life, and at a corrected GA of 36 ± 2 weeks. Infants were divided into two groups: those without relevant complications and those with complications related to prematurity. NT-proBNP values of infants without complications define our exploratory reference values. The Median NT-proBNP level of these infants was 1896 ng/l (n = 27, interquartile range (IQR): 1277–5200) during the first week of life, 463 ng/l (n = 26, IQR: 364–704) at 4 ± 1 weeks of life, and 824 ng/l (n = 33, IQR: 714–1233) at a corrected GA of 36 ± 2 weeks. Infants born < 28 + 0 weeks GA had significantly higher NT-proBNP values (n = 9, median: 5200, IQR: 1750–8972) than infants born ≥ 28 + 0–31 weeks GA (n = 18, median: 1528, IQR: 838–3052; p = 0.017). Growth restriction or PDA status could not account for the difference in NT-proBNP values between GA groups. Conclusions: The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks GA according to postnatal age. NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. Our results suggest an influence of GA on NT-proBNP values in the first week of life. What is Known:• Several complications related to prematurity, e.g., hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been associated with a temporary rise in NT-proBNP values in preterm infants during their first weeks of life.What is New:• This observational study provides reference values for NT-proBNP levels of very and extremely preterm infants during their first weeks of life.• In premature infants without complications, NT-proBNP values during their first week of life depend on gestational age at birth.

scholarly journals Levels of Neonatal Thyroid Hormone in Preterm Infants and Neurodevelopmental Outcome at 5½ Years: Millennium Cohort Study

2010 ◽  
Vol 95 (11) ◽  
pp. 4898-4908 ◽  
Author(s):  
Caroline Delahunty ◽  
Shona Falconer ◽  
Robert Hume ◽  
Lesley Jackson ◽  
Paula Midgley ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Home Environment ◽  
Premature Infants ◽  
Thyroid Dysfunction ◽  
Neurodevelopmental Outcome ◽  
Millennium Cohort Study ◽  
Term Infants ◽  
Follow Up Study ◽  
Serum T4

Context: Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment. Objective: The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age. Design: We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation. Main Outcome Measures: We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs. Results: A total of 442 infants ≤34 wk gestation who had serum T4 measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T4 measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T4 level ≤ 10th percentile on d 7, 14, or 28 corrected for gestational age) scored significantly lower than euthyroid infants (T4 level greater than the 10th percentile and less than the 90th percentile on all days) on all McCarthy scales, except the quantitative. After adjustment for confounders of neurodevelopment, hypothyroxinemic infants scored significantly lower than euthyroid infants on the general cognitive and verbal scales. Conclusions: Our findings do not support the view that the hypothyroxinemic state, in the context of this analysis, is harmless in preterm infants. Many factors contribute both to the etiology of hypothyroxinemia and neurodevelopment; strategies for correction of hypothyroxinemia should acknowledge its complex etiology and not rely solely on one approach.

Abstract 2487: Torsional and Reverse Rotational Mechanics of the Left Ventricular Apex Is Abnormal in Patients with Type 2 Diabetes Mellitus Independent of Presence of Hypertension, Left Ventricular Hypertrophy, Elevated Filling Pressures and Left Atrial Volume

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Wei Zhao ◽  
Peng Li ◽  
Geu-Ru Hong ◽  
Shizhen Liu ◽  
Helene Houle ◽  
...  
Keyword(s):  
Ventricular Hypertrophy ◽  
Left Atrial Volume ◽  
Rotation Velocity ◽  
Left Ventricular ◽  
List Type ◽  
Type 2 Dm ◽  
Apical Rotation ◽  
Rotational Mechanics ◽  
Normal Lvef

Background : Diastolic dysfunction (DD) is common in patients with Type 2 DM even in the absence of HTN and LVH. We tested whether apical rotational mechanics offered any additional insights into DD in DM over conventional echo-Doppler measures. Methods: We studied 4 groups : 12 normals (wall thickness-WT 0.9±0.1cm); 17 patients with DM (WT 1.0±0.1cm, HbA1c 7±1%, BP 128±4/68±5 mmHg); 16 patients with DM +HTN (WT 0.9±0.1cm, HbA1c 7±1%, BP 134±23/72±18 mmHg); and 20 patients with DM+HTN+LVH (WT 1.4±0.2cm, HbA1c 7±4%, BP 135±13/76±9mmHg). All patients had normal LVEF and mitral E/A ratio. SAX of the LV apex and base were obtained. Velocity Vector Imaging (Siemens, CA) was used to measure: Longitudinal myocardial velocity (LMV, cm/sec) and strain (LS,%); Apical rotation velocity (ARV, cm/sec)and reverse rotation velocity(ARRV, cm/sec); Apical rotation (AR, degree) and LV torsion-LVTOR (degree/cm, and Circumferential (CS,%) and Radial strains (RS,%). Results: Figure shows LVTOR and % reduction in ARRV data. All other data will be presented. Thus, LV torsion is increased in DM alone or DM+HTN (-LVH) groups. But ARRV is reduced by ~ 20% in these groups even with relatively normal E/E’ ratio and LAVI. In the DM+HTN+LVH group, E/E’ and LAVI are increased and apical rotational mechanics resemble the same spectrum as the above groups but are more severe (~25% reduction in ARRV). Thus, reduction in ARRV is a marker of early DD in DM even in the absence of LVH . Conclusions: Apical rotational mechanics is more sensitive than conventional echo-Doppler measures to identify myocardial DD in type 2 DM even in the presence of normal E/A ratio, LAVI and LVEF, and in the absence of HTN and/or LVH.

Evaluation of the congenital hypothyroidism detection strategy in extremely preterm infants in western Andalusia

2021 ◽  
Author(s):  
Ricardo Rubio-Sánchez ◽  
David Núñez-Jurado ◽  
Enrique Melguizo-Madrid ◽  
Ana Isabel Álvarez-Ríos ◽  
Carmen Delgado-Pecellín
Keyword(s):  
Retrospective Study ◽  
Preterm Infants ◽  
Congenital Hypothyroidism ◽  
Premature Infants ◽  
Free T4 ◽  
Detection Strategy ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Screening Population ◽  
The Moment

Objective: To identify extremely premature infants (< 31 weeks of gestation and/or < 1,500 grams) affected by congenital hypothyroidism (CH) with delayed elevation of thyrotropin (TSH) and to evaluate the detection strategy for this pathology in our reference screening population. Study Design: A descriptive and retrospective study was carried out with samples collected from western Andalusia and the autonomous city of Ceuta. Results: This protocol allowed us to detect six neonates with delayed TSH elevation. One of them, due to serious heart problems, died without being able to confirm CH. In two neonates, however, it was possible to detect CH, another two presented a persistent TSH elevation but normal free T4, and another one presented a temporary TSH elevation. Conclusion: It is essential to repeat the CH screening in extremely premature infants; not only at the age of 15 days, but also with a third sample at the moment of hospital discharge to detect cases with delayed TSH elevation.

Abstract 3186: Right Ventricular Apical Pacing Impairs Left Ventricular Apical and Basal Rotation and Induces Apical-Basal Rotation Dyssynchrony

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ken Matsuoka ◽  
Masami Nishino ◽  
Masahiko Hara ◽  
Shinpei Nakatani ◽  
Akihito Hashimoto ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Pacemaker Implantation ◽  
Acute Effect ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Apical Rotation ◽  
Av Conduction ◽  
Basal Rotation

Backgrounds: Although right ventricular apical (RVA) pacing has been reported to result in asynchronous patterns of left ventricular (LV) contraction reducing the LV ejection fraction (EF), LV torsion in RVA pacing has been unknown. We hypothesized that RVA pacing impairs rotation of LV apex and base and synchrony between LV apical and basal rotation, leading to the reduction of LV torsion. Methods: We studied 30 adult patients with sick sinus syndrome who had undergone DDD pacemaker implantation. Right ventricular pacing leads were positioned at the right ventricular apex. Changing from the intrinsic AV conduction to RVA pacing, we assessed the acute effect on echocardiac parameters; LV EF, tissue Doppler imaging (TDI) derived intraventricular delay, LV rotation and torsion, and LV apical-basal rotation dyssynchrony. Results: Results were shown in a table . Changing from the intrinsic AV conduction to RVA pacing, LV EF reduced (P=0.0003) and TDI derived intraventricular delay prolonged (P<0.0001). During RVA pacing, values of peak rotation in LV apex and LV base were significantly lower than those during intrinsic AV conduction (P=0.007 and 0.003, respectively). Correspondingly, LV torsion decreased significantly (P<0.0001). During the intrinsic AV conduction, LV apex and base rotated at the almost same time, while, during RVA pacing, LV basal rotation was delayed as compared to LV apical rotation. Consequently, apical-basal rotation dyssynchrony during RVA pacing was significantly longer than that during the intrinsic AV conduction (P=0.02). Conclusion: RVA pacing decreases LV rotation and torsion and induces LV apical-basal rotation dyssynchrony, resulting in partially LV systolic dysfunction. Comparison between Intrinsic AV Conduction and RVA Pacing

Sign in / Sign up

Export Citation Format

Share Document