Blood pressure or blood flow: which is important in the preterm infant? A case report of twins.
There is a poor association between systemic blood flow and blood pressure in preterm infants in the first days of life. Very preterm babies can have early low systemic blood flow with poor myocardial contractility but normal blood pressure. Superior vena cava flow measured by echocardiography can be used to determine systemic blood flow. Low superior vena cava flow is a risk factor for mortality and morbidity in preterm infants. We report the case of preterm twins with contrasting relationships among systemic blood flow, myocardial contractility and blood pressure. The first twin with normal blood pressure, but low superior vena cava flow and poor myocardial contractility in the first hours of life developed a severe intraventricular haemorrhage and died, despite cardiovascular support. The second twin with low blood pressure but normal superior vena cava flow did not develop adverse outcomes in the first days of life. These cases underline the usefulness of neonatal functional echocardiography in early understanding and management of the preterm infant, and the inaccuracy of other clinical parameters used to assess cardiovascular function.
Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Dharmesh M
DM
Shah
Manuela
M
Condò
Jennifer
J
Bowen
Martin
M
Kluckow
D001783:Blood Flow Velocity / Q000502:physiology*; D004200:Diseases in Twins / Q000175:diagnosis*; D004452:Echocardiography; D017809:Fatal Outcome; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007231:Infant, Newborn; D007234:Infant, Premature; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D014427:Twins; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*