Prognostic Importance of Ejection Fraction, Shortening Fraction of Left Ventricle, and Prohormone Natriuretic Peptide Level in Neonates with Prenatal Asphyxia

Introduction Echocardiographic assessment of cardiac function in neonates with asphyxia is difficult due to tachycardia and increased index of left ventricular eccentricity caused by persistent pulmonary hypertension. Determination of prohormone natriuretic peptide according to previous studies may indicate a degree of cardiac insufficiency in adults, but its significance in the newborn period is not complete determined. The aim of this study was therefore to determine the importance of echocardiographic monitoring and prohormone natriuretic peptide levels assessments on survival and length of hospital stay of newborns with perinatal asphyxia.

Materials and Methods This case–control study included 120. Among them, 52 had perinatal asphyxia (defined as (1) Apgar’s score 5 <6/10 (1) lactates >2.5 mmol/L and base excess (BE) >10 mEq/L in the first 6 hours and disorder of the function of one or more organic systems (group I)), whereas 68 were asymptomatic neonates (group II). Echocardiography was performed in the first and third day of life, as well as the determination of NT-proBNP, troponin I, lactate and BE.

Results: We found that poor prognostic parameters for survival (in group I and in a unified group) were respectively low blood B values ​​in the first day, decreased BE in the first and third day, and increased lactates in the third day. A significant correlation of serum B-type natriuretic peptide (BNP) values in the first measurement comparing to the second was found, both in the control group and in the group with perinatal asphyxia. Infants showed lower left ventricle end-diastolic diameter (LVEDD) on the day 1 and decreased ventricular fractional shortening on the day 3, with higher number of days on MV and inotropic stimulation in group I. In addition, increased NT-ProBNP and eccentricity index in the first and third day and its positive trend were reported for all infants. A highly significant correlation of fractional shortening values in the first versus other measurements in the control group and in the group with perinatal asphyxia existed. Overall, the length of hospitalization depended significantly from levels of Lactate on day 1 and NT-proBNP on day 3, and of LVEDD and LV EF on day 1.

Conclusion Echocardiography, EF, FS, determination of NT-proBNP, lactate, and basal excess on day 1 and 3 is useful in evaluating the outcome of a newborn with perinatal asphyxia, and can indicate with significant likelihood the degree of cardiac dysfunction, prognosis of the disease and length of hospitalization.

Conflict of Interest

None declared.