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A Journal on Internal Medicine

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Panminerva Medica 1998 March;40(1):28-32

language: English

Persistently ­low car­diac out­put pre­dicts ­high mor­tal­ity in new­borns ­with car­di­o­gen­ic ­shock

Sabatino G., Ramenghi L. A., Verrotti A.*, Gerboni S., Chiarelli F.*

From ­the Neonatal Intensive Care Unit * Pediatric Clinic, University of Chieti, Italy


Background. Cardiogenic ­shock is an ­acute “unstable” ­state of cir­cu­la­to­ry dys­func­tion.
Objective. To eval­u­ate ­the hae­mod­y­nam­ic ­aspects of 45 new­born ­infants affect­ed by car­di­o­gen­ic ­shock, in rela­tion to eti­ol­o­gies ­and ­the mor­tal­ity ­rate.
Design. Retrospective, cor­re­la­tion ­study of eti­ol­o­gies, mor­tal­ity ­rate ­and hae­mod­y­nam­ic meas­ure­ments by Doppler ultra­sound param­e­ters.
Patients. 45 new­born ­infants ­with car­di­o­gen­ic ­shock, Gestational Age (GA) 37 (34-41), Birth Weight (BW) 2750 (1600-3600) g ­and a con­trol ­group of 20 neo­nates [GA 38 (34-40) ­wks, BW 2960 (1750-3800) g].
Measurements. Left ven­tric­u­lar Cardiac Output (CO) ­was meas­ured by a ­duplex scan­ner ­with ­pulsed Doppler ­and col­or ­flow map­ping ­echocar­di­og­ra­phy in ­the ­first 48 ­hours of ­life.
Results. In ­healthy new­borns CO ­was 240 mL/min/kg (210-280), in new­borns ­with car­di­o­gen­ic ­shock CO ­was 170 mL/min/kg (130-200), p<0.01. The Stroke Volume ­was 1.80 mL/kg (1.70-1.90) in ­the con­trol ­group ­and 1.20 (1.15-1.80) in ­the ­shocked ­group (p<0.05); Heart Rate ­was 146 ­beats/min (130-160) ­and 160 ­beats/mm (140-194), (p<0.01) respec­tive­ly. Twenty-­nine ­infants ­with car­di­o­gen­ic ­shock ­had CO≤150 mL/­min/kg ­and 5 of ­them (17.2%) ­died; 16 neo­nates ­had CO>150 mL/­min/kg ­and ­only ­one (6.2%) ­died (p<0.01). Twenty-­six of 36 new­borns ­with per­i­na­tal asphyx­ia ­had CO≤150 mL/­min/kg ­and 5 of ­them ­died, ­while ­only ­one of 10 ­infants ­with CO>150 mL/­min/kg ­died.
Conclusions. Our ­results ­show ­that per­sis­tent­ly ­low CO (≤150 mL/­min/kg) dur­ing ­the ­first 48 ­hours of ­life, in new­borns ­with car­di­o­gen­ic ­shock ­due to per­i­na­tal asphyx­ia is asso­ciat­ed ­with a sig­nif­i­cant­ly high­er mor­tal­ity.

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