Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn

Sujith S. Pereira; Xander Jacquemyn; Shelby Kutty

doi:10.1515/jpm-2023-0346

Article

Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn

Sujith S. Pereira , Xander Jacquemyn and Shelby Kutty

Published/Copyright: September 16, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 9

Abstract

Objectives

Clinical parameters along with echocardiographic markers are used to interrogate the haemodynamics in persistent pulmonary hypertension of the newborn (PPHN). The aim of this study was to compare different echocardiographic markers in recent cohort of newborn infants with and without PPHN.

Methods

In this retrospective study, common echocardiographic markers were examined in infants>34 weeks’ gestation with PPHN (cases) and without PPHN (controls). Infants with congenital heart disease were excluded. Binary regression testing was used to evaluate echocardiographic markers predicting PPHN and death. In addition, diagnostic accuracy testing of echocardiographic markers using ROC was also performed. Intra-observer reliability for echocardiographic markers was examined using coefficient of variation (CoV) and intraclass correlation.

Results

Fifty-two infants were studied; 22 (42 %) infants with PPHN had significantly higher oxygen requirement, oxygenation index and ventilation days when compared with controls. Echocardiographic markers such as TR Vmax, S/D TR, PAAT, TAPSE and eccentricity index (EI) were significantly different between cases and controls. Receiver operator characteristics analysis of echocardiographic markers revealed TR Vmax 0.96 (0.9–1.0), S/D TR 0.95 (0.87–1.0) and end systolic EI 0.94 (0.87–1.0). These markers were found to predict death in this cohort of infants. CoV and Intra-observer reliability was good for various echocardiographic markers.

Conclusions

Among the various echocardiographic markers studied, TR Vmax when present along with S/D TR and end systolic EI had good intra-observer reliability and were diagnostic of PPHN and predicted death in this cohort. Future trials could use these markers in studies examining PPHN.

Keywords: newborn infants; persistent pulmonary hypertension of the newborn; echocardiographic predictors; eccentricity index

Corresponding author: Sujith S. Pereira, FRCPCH, FESC, PhD, Neonatal Unit, Homerton University Hospital, Homerton Healthcare NHS Foundation Trust, London, E9 6SR, UK; and Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine, London, UK, E-mail: s.s.pereira@qmul.ac.uk

Sujith Pereira, Xander Jacquemyn and Shelby Kutty contributed equally to this work.

Acknowledgments

The authors would like to thank Lyndsay Johnson, Portfolio Officer, Research and Innovation, Homerton University Hospital, London for her assistance with the study registration.

Research ethics: This study was performed in line with the principles of the Declaration of Helsinki (as revised in 2013). Approval was granted by HRA and Health and Care Research Wales (HCRW) (Reference 21/PR/0930).
Informed consent: Not applicable.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

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Received: 2023-08-22

Accepted: 2024-08-26

Published Online: 2024-09-16

Published in Print: 2024-11-26

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https://doi.org/10.1515/jpm-2023-0346

Keywords for this article

newborn infants; persistent pulmonary hypertension of the newborn; echocardiographic predictors; eccentricity index