Echocardiographic Screening of Healthy Neonates for Measuring Pulmonary Artery Pressure

Study Overview
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Brief Summary
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The aim of the present prospective study was to evaluate dynamic changes in both pulmonary artery pressure and ductus arteriosus during the first 72 hours after birth.

Detailed Description
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Healthy newborn infants born in Alexandria University Children's Hospital were studied. Dynamic changes during the first 72 hours after birth were evaluated.

Official Title
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Echocardiographic Screening of Healthy Neonates for Measuring Pulmonary Artery Pressure

Conditions
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Pulmonary Hypertension of Newborn

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Gestational age: 37-42 weeks. Birthweight: 2500-4000 g. Exclusion Criteria: Neonates more than 6 hours of age at time of enrollment. Perinatal asphyxia or hypoxia (1 min Apgar scoring<7 points) Cardiac structural abnormalities detected by echocardiography except patent foramen ovale and patent ductus arteriosus Other clinically detected congenital malformations such as cleft lip and palate, omphalocele, meningocele, etc. Maternal history of gestational hypertension, gestational diabetes, hyperthyroidism, hypothyroidism, and autoimmune disease

Ages Eligible for Study
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Minimum Age: 0 Minutes
Maximum Age: 6 Hours

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pulmonary artery pressure (PAP) assessment - Tricuspid valve regurgitation peak velocity | This is measured in apical 4 chamber view, with continuous wave Doppler using modified Bernoulli equation. Systolic pulmonary artery pressure is equivalent to right ventricular systolic pressure in absence of outflow obstruction. Systolic Pulmonary Artery Pressure (SPAP) = Right Ventricular Systolic Pressure = 4x TR2 + Right Atrial Pressure (RAP) (RAP= 3-5 mmHg) | up to 72 hours | 
| Pulmonary artery pressure (PAP) assessment - Pulmonary regurgitation peak velocity | This is measured in short axis parasternal view with continuous wave Doppler using this equation: Mean Pulmonary Artery Pressure MPAP= 4xPR2 + Right Ventricular Diastolic Pressure (RVdP=2-5 mmHg) | up to 72 hours | 
| Pulmonary artery pressure (PAP) assessment - Transductal right-to-left flow peak velocity | This is measured in high short axis ductal view with continuous wave Doppler | up to 72 hours | 
| Pulmonary artery pressure (PAP) assessment - Interventricular septum configuration | This is measured in short axis parasternal view above level of papillary muscles, left ventricle is normally O shaped, D or crescent shape indicated bowing of septum due to RV dysfunction. | up to 72 hours | 
| Pulmonary artery pressure (PAP) assessment - Left ventricle systolic eccentricity index (LV-sEI) | This is measured in short axis parasternal view by measuring LV dimensions the parallel versus the perpendicular dimension. The normal ratio is 1. | up to 72 hours | 
| Right ventricular performance - Tricuspid annular plane systolic excursion(TAPSE) | This is measured using Mmode in apical 4 chamber view over lateral annulus of tricuspid valve | up to 72 hours | 
| Right ventricular performance - Myocardial Performance Index (MPI) | This is measured by using pulsed wave doppler to measure isovolumetric ejection time + isovolumetric relaxation time/ right ventricular ejection time. | up to 72 hours | 
| Right ventricular performance - E/A ratio | This is measured in apical 4 chamber view by pulsed wave Doppler on mitral valve. The cut off value: 0.8- 2. | up to 72 hours | 
| Left ventricular performance - Ejection fraction | This is measured using M-Mode in long axis parasternal view with a normal range of 55-75% | up to 72 hours | 
| Left ventricular performance - E/A ratio | This is measured in apical 4 chamber view by pulsed wave Doppler on mitral valve. The cut off value: 0.8- 2 | up to 72 hours | 
| Shunts evaluation - Patent Ductus arteriosus | Size will be evaluated in short axis parasternal view | up to 72 hours | 
| Shunts evaluation - Patent Ductus arteriosus | Direction will be evaluated in short axis parasternal view using color Doppler | up to 72 hours | 
| Shunts evaluation - Patent Foramen Ovale | Size will be evaluated in be viewed in subcostal view | up to 72 hours | 
| Shunts evaluation - Patent Foramen Ovale | Direction will be evaluated in subcostal view using color Doppler | up to 72 hours |