Cardiac changes in asphyxiated neonates-need for early detection to improve long-term outcome
Keywords:Birth asphyxia, Echocardiography, Electrocardiography, Myocardial changes, Neonate
Background: Cardiac changes are common in Perinatal asphyxia. Detecting them early will help in specific management and good long-term outcome. Cardiac monitoring is recommended in every resuscitation as per NRP 7. Objective of present study was to evaluate myocardial dysfunction in neonates having Hypoxic Ischemic Encephalopathy by clinical, electrocardiographic and echocardiographic examination.
Methods: Observational analytical study of 79 neonates who suffered from asphyxia as per selection criteria were done at medical college hospital. Myocardial dysfunction was evaluated by clinical features assessed on first 2 days and electrocardiographic and echocardiographic examination was done after 24 hours. Data were collected and analysed by SPSS 21 software.
Results: Respiratory distress was found in 67.08% of the subjects. Prolonged capillary refill time was found in 39.24% of the subjects. Mean QTc (ms) interval was prolonged in non-survivors (496.6±20.8) when compared with survivors (418.2±33.7) (p - 0.000). T wave changes were present in non-survivors (94.7%) when compared to survivors (41.7%) (LR- 19.558). ST wave changes were present in non-survivors (73.7 %) compared with survivors (10%) (LR- 28.483). Mean Ejection Fraction (%) was shortened in non-survivors (53.79±7.53) compared with survivors (71.48±10.28) (p-0.000). Significant tricuspid regurgitation (78.94%) was present among non-survivors compared to survivors (10%) (LR- 17.859). Evidences of significant pulmonary artery hypertension were found in most of the (78.94%) non-survivors compared to survivors (10%) (LR-22.4). Similarly, severe grades of asphyxia had significantly high findings of increased CRT, reduced EF, LVES, ST and T wave changes etc.
Conclusions: Cardiac changes in severe asphyxia are high and can be identified early by clinical, electroctrocardiographic and echocardiographic examination.
PHFI, AIIMS, and SC- State of India’s Newborns (SOIN) 2014- a report. Zodpey S and Paul VK, editors. Public Health Foundation of India, All India Institute of Medical Sciences and Save the Children. New Delhi, India.
National family health survey 2015-16, Available form http://rchiips.org/nfhs/factsheet_nfhs-4.html.
National Neonatal and Perinatal Database Report 2002-2003:1-58.
International Statistical Classification of Diseases and related Health problems 10th revision (ICD-10) Version for 2010. Chapter XVI. P20 Intrauterine Hypoxia. P21 Birth asphyxia.
Antonucci R, Porcella A, Pillon MD. Perinatal asphyxia in the term newborn. J Pediatr Neonat Individual Medic. 2014;3(2):e030269.
Adcock LM, Papile LA. Edited by: Cloherty JP, Eichenwald EC, Stark AR. Perinatal asphyxia. Manual of neonatal care. Wolters Kluwer, New Delhi. 2008;518-23.
Van Marter LJ. Edited by: Cloherty JP, Eichenwald EC, Stark AR. Persistent Pulmonary hypertension of the newborn. Manual of neonatal care. Wolters Kluwer, New Delhi. 2008; 518-523.
Malcolm I. Levene, Linda de Vries, Hypoxic Ischemic Encephalopthy. In: Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 2-Volume Set 8th edition. Martin, Richard; Fanaroff, Avroy; Walsh, Michele, Elsevier, 2005;8:938-55.
Archer N. Cardiovascular disease In: Roberton's Textbook of Neonatology by Janet M. Rennie, Elsevier;2005:619-657.
Levene M, Evans DJ. Hypoxic Ischemic brain injury In: Roberton's Textbook of Neonatology by Janet M. Rennie, ELSEVIER; 2005.
Hill A. Neurological disorders, In: Avery's Neonatology: Pathophysiology and Management of the Newborn. Mhairi G. MacDonald, Martha D. Mullett, Mary M. K. Seshia, editors. Lippincott Willams and Wilkinsi. 2005;969-77.
Weiner GM, Zaichkin J, editors. Textbook of Neonatal Resuscitation (NRP), 7th Ed. American Academy of Pediatrics and American Heart Association; 2016.
Rajakumar PS, Bhat BV, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Cardiac Enzyme Levels in Myocardial Dysfunction in Newborns with Perinatal Asphyxia. Indian J Pediatr. 2008;75:1223-5.
Goel M, GohiyaPoorva, Yadav BS. Assessment of Myocardial Function in Birth Asphyxia. Int J Med Res Rev. 2013;1(5):228-32.
Agrawal J, Shah GS, Poudel P, Baral N, Agrawal A, Mishra OP. Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy. Ital J Pediatr. 2012;38:33.
Jedeikin R, Primhak A, Shennan AT, Swyer PR, Rowe RD. Serial electrocardiographic changes in healthy and stressed neonates. Arch Dis Child. 1983;58:605-11.
Fang Xiao-yi, Li Yu-guang, Weng Li-jian. The clinical significance of serum levels of CK-MB and CTN-I combined with corrected QT dispersion to evaluate the severity of myocardial injury after asphyxia in neonates. B Heart J. 1983;50(6):540-9.
Aleksandra M. Simovic, Sergej M. Prijic, Jasmina B. Knezevic, Zoran R. Igrutinovic, Ana J. Vujic. Predictive value of biochemical, echocardiographic and electrocardiographic markers in non-surviving and surviving asphyxiated full-term newborns. The Turkish J Pediatr. 2014;56:243-9.
Razzaq A, Quddusi AI, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29(5):1099-1104.