Electrocardiographic and Echocardiographic Findings in Asphyxiated Neonates

The myocardium is vulnerable to ischemic injury in acute perinatal asphyxia. Asphyxial cardiomyopathy increases mortality. Clinical assessment alone is not sufficient to evaluate myocardial injury.

This study was conducted over 2 years on neonates at the gestational age of 34 weeks or more with perinatal asphyxia. Electrocardiographic (ECG) and echocardiographic changes were studied with clinical details.

The study population comprised 57 neonates. Among them, 33 (57.9%) were male, 23 (40.4%) were born by cesarean section, and 3 (5.3%) were delivered via assisted vaginal delivery. Twenty-six neonates (45.6%) were intubated in the delivery room, and 15 (26.3%) required bag-and-mask ventilation at birth. The mean birth weight was 2679 g (461 g), and the mean gestation period was 38.4 weeks (1.6 wk).Central nervous system, hepatic, and renal involvement was observed in 53 (93%), 35 (61.4%), and 26 (45.6%) cases, respectively. Cardiac dysfunction was observed in 30 neonates (52.6%). Twenty cases (35.1%) required mechanical ventilation.ECG changes were observed in 44 neonates (77.1%). Grade I changes were observed in 10 cases (17.5%), Grade II in 14 (24.6%), and Grade III in 20 (35.1%). In 13 cases, ECG was normal. Twenty-six neonates (45.6%) had echocardiographic changes. Tricuspid regurgitation was observed in 8 cases (14%) and pulmonary artery hypertension with tricuspid regurgitation in 16 (28.1%). Mitral regurgitation with global hypokinesia was observed in 2 neonates, who eventually succumbed.

Our results demonstrated thatECG changes occurred in about three-fourths of asphyxiated neonates, and nearly half of the asphyxiated neonates had echocardiographic changes. Mitral regurgitation with global hypokinesia was associated with the worst outcome. (Iranian Heart Journal 2021; 22(2): 51-57)