Journal of the American Society of Echocardiography
Clinical Investigations in ChildrenNormalizing Echocardiographic Measurements in Children and NeonatesA Comprehensive Echocardiographic Protocol for Assessing Neonatal Right Ventricular Dimensions and Function in the Transitional Period: Normative Data and Z Scores
Section snippets
Study Design
For this prospective observational study, we recruited 50 healthy term neonates between December 2011 and September 2012 from the Mother and Baby Unit (Mount Sinai Hospital, Toronto, Ontario, Canada). The health records of all infants receiving routine postnatal care were screened, and eligible families were approached within 12 hours of birth. The institutional research ethics board approved the study, and written informed consent was obtained from all parents.
Inclusion and Exclusion Criteria
All healthy, term (gestational
Results
Fifty neonates (17 male) with a mean gestational age of 39.7 ± 1.2 weeks were included. Twelve neonates were delivered by cesarean section. The mean cord pH was 7.23 ± 0.07, and the median Apgar score at 5 min was 9 (range, 8–9). Two infants were noted to have premature atrial contractions during echocardiography that were confirmed by 12-lead electrocardiography. The mean time interval between the two scans was 19.9 ± 1.8 hours. Table 1 summarizes clinical and echocardiographic characteristics
Clinical Significance
In this study we describe a comprehensive echocardiographic protocol for imaging the right ventricle in neonates and establish normal values for various RV dimensions and functional parameters. Preservation of RV function is recognized as a critical prognostic factor in the management of cardiopulmonary disorders of adults, particularly in pulmonary hypertension.11, 12 Cardiopulmonary disorders are not uncommon during the newborn period. Acute pulmonary hypertension has been reported as a
Conclusions
A comprehensive quantitative RV appraisal using 2D echocardiography is feasible in neonates and should include measurements of RV dimensions and function using multiple 2D views. We propose that a practical echocardiographic protocol should include the measurement of posterior basal diameter in addition to the conventional apical RV-4C view–derived linear dimensions. Furthermore, RV functional assessment should include the following parameters, which demonstrated the least interobserver
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This work was funded by the Canadian Institutes of Health Research (MOP #93596 and 84290 to Dr Jankov). Dr Jain is supported by a Sick Kids Research Training Centre Clinician Scientist Training Program Doctoral Award. Dr Dallaire is a member of the Fonds de Recherche Santé Québec–funded Centre de Recherche Clinique Étienne-Le Bel.