Echocardiographic Screening for Myocardial Dysfunction Among Asphyxiated Newborns

Document Type : Original Article


1 Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.

2 Department of Cardiovascular Technology, School of Allied Health Science, Manipal Academy of Higher Education, Manipal, India.

3 Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

4 Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.


Background: Perinatal asphyxia/ischemia is an interruption in the availability of oxygen supply to the myocardium. We sought to assess myocardial function among asphyxiated and non-asphyxiated neonates using echocardiography.
Methods: The present case-control study was undertaken at the neonatal intensive care unit (NICU) of a tertiary care hospital. Neonates with asphyxia who were admitted to the NICU were included in the study. The diagnosis of asphyxia was established on the basis of the APGAR score at 1 and 5 minutes. Myocardial function was assessed in terms of serum cardiac troponin I (CTnI) and different echocardiographic parameters such as M-Mode, Doppler flow parameters, and tissue Doppler imaging.
Results: Thirty asphyxiated (the case group) and 30 non-asphyxiated (the control group) term neonates were enrolled in the study. The asphyxia group had significantly lower (P < 0.001) 1- and 5-minute APGAR scores than the controls. The asphyxia group had a higher serum CTnI value. The differences between the 2 groups concerning M-Mode parameters in the first 12 hours of life were statistically significant (P < 0.001). The case and control groups were also statistically significantly different regarding left atrial pressure at 48 hours following birth, calculated as a ratio of E/e’ (P < 0.001). The differences between the 2 study groups at 24 hours after birth as regards tissue Doppler parameters, including left ventricular ejection time and left ventricular Tei index, were also statistically significant (P < 0.001). The case and control groups also showed statistically meaningful differences concerning right ventricular ejection period/ ejection time at 24 hours after birth (P < 0.002).
Conclusions: It can be concluded that the myocardial function assessment using CTnI and different echocardiographic techniques is the most sensitive and specific method in the detection of ischemic cardiac injury in asphyxiated newborns. (Iranian Heart Journal 2021; 22(1): 91-99)


Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MWA, et al. Risk factors of birth asphyxia. Italian journal of pediatrics. 2014;40(1):94.
Singh V, Vohra R, Bansal M. Cardiovascular involvement in birth asphyxia. Journal of Clinical Neonatology. 2018;7(1):20-.
Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MWA, et al. “Risk factors of birth asphyxia”. Italian Journal of Pediatrics. 2014;40(1):94.
Lv H, Wang Q, Wu S, Yang L, Ren P, Yang Y, et al. Neonatal hypoxic ischemic encephalopathy-related biomarkers in serum and cerebrospinal fluid. Clinica chimica acta. 2015;450:282-97.
Simovic AM, Prijic SM, Knezevic JB, Igrutinovic ZR, Vujic AJ, Kosutic JL. Predictive value of biochemical, echocardiographic and electrocardiographic markers in non-surviving and surviving asphyxiated full-term newborns. Turkish Journal of Pediatrics. 2014;56(3).
Gouda MH, Hammad BS, Amen MA. Short-term prognostic value of serum cardiac troponin I levels in neonates with perinatal asphyxia. Alexandria Journal of Pediatrics. 2017;30(3):108.
Koestenberger M, Friedberg MK, Nestaas E, Michel-Behnke I, Hansmann G. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction. Pulmonary circulation. 2016;6(1):15-29.
Kanik E, Arun Ozer E, Rahmi Bakiler A, Aydinlioglu H, Dorak C, Dogrusoz B, et al. Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality? The Journal of Maternal-Fetal & Neonatal Medicine. 2009;22(3):239-42.
Bhasin H, Kohli C. Myocardial dysfunction as a predictor of the severity and mortality of hypoxic ischaemic encephalopathy in severe perinatal asphyxia: a case–control study. Paediatrics and international child health. 2019;39(4):259-64.
Jehlicka P, Huml M, Rajdl D, Mocková A, Matas M, Dort J, et al. How to interpret elevated plasmatic level of high-sensitive troponin T in newborns and infants? Physiological research. 2018;67(2):191-5.
Sobeih AA, El-Baz MS, El-Shemy DM, Abu El-Hamed WA. Tissue Doppler imaging versus conventional echocardiography in assessment of cardiac diastolic function in full term neonates with perinatal asphyxia. The Journal of Maternal-Fetal & Neonatal Medicine. 2020:1-6.
Matter M, Abdel-Hady H, Attia G, Hafez M, Seliem W, Al-Arman M. Myocardial performance in asphyxiated full-term infants assessed by Doppler tissue imaging. Pediatr Cardiol. 2010;31(5):634-42.
Goroshi M, Chand D. Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian heart journal. 2016;68(1):83-7.
Khattab AAA. Tei index in neonatal respiratory distress and perinatal asphyxia. The Egyptian Heart Journal. 2015;67(3):243-8.