071 - Monitoring hAemodynamic Transition IN the dElivEry room: MATINEE 2 Study

Publication Number: 71.5782

Chiara Passarella, Ospedale Pediatrico Bambino Gesù, Laveno Mombello, Lombardia, Italy; Neidin Bussmann, Cork University Maternity Hospital, cork, Cork, Ireland; Alice Iride Flore, University College Cork, Rome, Lazio, Italy; Daragh Finn, University college cork, Cork, Cork, Ireland; Eugene M. Dempsey, University College Cork, Cork, Cork, Ireland

Background: Hemodynamic changes during the first mins after birth are dependent on the relationship between timing of cord clamping, lung aeration and the establishment of pulmonary blood flow. The use of echocardiography targeted to monitor this transition in preterm newborns receiving delayed cord clamping (DCC) have not been investigated.

Objective: To explore the temporal impact of cord clamping in preterm infants based on measures of adaptation including timing of first breath, initial heart rate and Apgar score.

Design/Methods: Prospective observational study. Infants with a gestational age of less than 37 weeks were eligible. Patients were divided in two groups based on good or poor adaptation defined clinically as an Apgar score in the first minute of life less than 5, timing of first breath greater than 30 sec, heart rate (HR) pre-DCC less than 100 and the presence of apnea after the first breath. Echocardiography was performed in before Delayed Cord Clamping (DCC) (T1), immediately after (T2), at five minutes (T3) and at twenty-four hours of life (T4). Pulmonary artery acceleration time indexed to right ventricle ejected time (iPAAT), together with pulsed wave Doppler derived cardiac output of both ventricles and TDI measures were calculated. All examinations were conducted by a single neonatologist and reviewed by a pediatric cardiologist. All echocardiographic parameters were compared with each other using Friedman’s test or repeated measures ANOVA

Results: 45 patients were recruited, 13 poor adaptors. Median (IQR) gestation was 33.3 (31.6-34.1) weeks, birth weight was 1860 (1478-2140) g. Heart rate increased from T1 to T3. LVO was higher prior to cord clamping in the good adaptors (108 vs 92mls/kg/min) and increased to 136 ml/kg/min at T3 in good adaptors (p value < 0,001). In poor adaptors LVO increased to 122 ml/kg/min (p value < 0,05) at T3. RVO was higher (169.8 vs 132 ml/kg/min) prior to cord clamping in the good adaptors, with a non significant reduction following cord clamping in the good adaptors and a non significant increase in the poor adapators (132 to 142 ml/kg/min). Paati is lower in the poor adaptors initially, increased in both groups over the next 5mins and is similar at 5mins (0.228 vs 0.225). At five minutes of life, both the RV and LV velocities returned to pre-DCC velocities. MPI increased at T2 regardless of state of adaptation; returning to baseline values at T3.

Conclusion(s): HR linearly increased in the first five minutes of life, without being negatively influenced by cord clamping. The potential negative impact of CC on pulmonary blood flow is offset by a reducing PVR.

Table 1
Table 1.pdfEchocardiographic values of preterm newborns with good adaptation

Table 2
Table 2.pdfEchocardiographic values of preterm newborns with poor adaptation

Graph 1
Graph 1.pdfGraphs of HR, LVOT, RVOT and iPAAT