Serial pulsed Doppler assessment of early left ventricular output in critically ill very low-birth-weight infants.
Serial, detailed assessments of left ventricular output (LVO) in critically ill very low-birth-weight (VLBW) infants of four different gestational ages were performed in the early neonatal period using pulsed Doppler echocardiography. Initially, the LVO values of all groups at 3 hours of age were relatively high. However, LVO dropped transiently at 12 hours and then increased again after 24 hours reaching a steady level of 160-180 ml/kg/min after 48 hours of age. In all four groups, heart rate also decreased significantly at 12 hours of age but did not increase at 24 hours of age. Both the left ventricular stroke volume and the left ventricular ejection fraction in all groups exhibited similar longitudinal changes to those observed for LVO. The LVO values observed in the lower gestational age group were significantly lower than those observed in the upper gestational group before 24 hours of age. Both patent ductus arteriosus and mechanical ventilation did not significantly influence the changes in LVO of VLBW infants at least before 36 hours of age. Our results suggest that in the early neonatal period, there are drastic changes in LVO of VLBW infants that reflect not only changes in heart rate but also changes in myocardial contractility.