Electrocardiographic and Echocardiographic Findings in Asphyxiated Neonates

Document Type : Original Article


Department of Pediatrics, Kasturba Medical College, MAHE University, Manipal, India.


Background: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.
Methods: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.
Results: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.
Conclusions: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)


  1. Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005; 83: 409-17.
  2. Adcock LM. Perinatal Asphyxia. In: Cloherty JP, editor. Manual of Neonatal Care, 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2011. p. 519-28.
  3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Intrapartum and Postpartum care of women: Guidelines for perinatal care. 5th edn. Elk Grove Village (II): AAP: 2002:124-61.
  4. Rehan VK, Phibbs RH. Delivery Room Management. In: Mhairi MG, Mary MKS, Martha DM, editor. Avery's Neonatology, 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 285-03.
  5. Ana MA, Alfredo GA, Francisco G,  Fernando C, Margarita  B, Fort Q. Multiple organ involvement in perinatal  asphyxia : The Journal of Pediatrics. 1995; 127: 786 – 93.
  6. Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post asphyxial hypoxic ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004; 89: 152 – 55.
  7. Perlman JM, Tack ED, Martin T, Shackelford G, Amin E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child: 1988; 43: 617 – 20.
  8. Volpe JJ. Hypoxic-ischemic encephalopathy: Clinical aspects. In: Neurology of the Newborn, 5th ed, Saunders Elsevier, Philadelphia 2008. p.400.
  9. Jedeikin R, Primhak A, Shennan AT, Swyer PR, Rowe RD. Serial electrocardiographic changes in healthy and stressed neonates. Arch Dis Child 1983, 58:605–11.
  10. Kanik E, Ozer EA, Bakiler AR, 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? J Matern Fetal Neonatal Med 2009; 22: 239–42.
  11. Barberi I, Calabro MP, Cordaro S, Gitto E, Sottile A, Prudente D, et al. Myocardial Ischemia in neonates with perinatal asphyxia. Electrographic, echocardiographic and enzymatic correlations. Eur J Pediatr 1999; 158: 742–7.
  12. Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J. Usefulness of cardiac Troponin T and Echocardiography in the diagnosis of Hypoxic Myocardial Injury of Full-term Neonates. Biol Neonate 2005; 88: 19–23.
  13. Walther FJ, Siassi B, Ramadan NA, et al. Cardiac output in newborn infants with transient myocardial dysfunction. J Pediatr 1985; 107: 781-85.
  14. Bernstein D. The fetal-to-neonatal circulatory transition. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 17th ed. Philadelphia: W.B. Saunders; 2004. pp 1479- 81.
  15. Agarwal R, Jain A, Deorari AK, Paul VK. Post-resuscitation Management of Asphyxiated Neonates. Indian J Pediatr, 2008; 75: 175-81.
  16. Clark SJ, Yoxall CW, Subhedar NV. Measurement of right ventricular volume in healthy term and preterm neonates. Arch Dis Child Fetal Neonatal Ed 2002; 87(2):89-93.
  17. Rajakumar PS, B. Bhat V, Sridhar MG, Balachander J, Konar BC, Narayanan P, Chetan G: Cardiac Enzyme Levels in Myocardial Dysfunction in Newborns with Perinatal Asphyxia. Indian J Pediatr 2008; 75(12):1223-25
  18. Kattwinkel J, ed. American Academy of Pediatrics/American Heart Association: Textbook of Neonatal Resuscitation, 4th ed. Elk grove village, IL, American Academy of Pediatrics, American Heart Association, 2000.
  19. Donnelly WH, Bucciarelli RL, Nelson RM. Ischemic papillary muscle necrosis in stressed newborn infants. J Pediatr 1980; 96(2):295-300.
  20. Mandal Ravi RN, Ruchi Gupta, Kapoor AK. Evaluation of activity of creatine Phosphokinase (CPK) and its Isoenzyme CPK-MB in perinatal asphyxia and its implications for myocardial involvement. Bull NNF 1999; 13: 2-7
  21. Dattilo G, Tulino V, Tulino D, Lamari A, Falanga G, Marte F et al. Perinatal asphyxia and cardiac abnormalities. Int J Cardiol 2011 Mar 3; 147(2):e39-40.
  22. Herdy GV, Lopes VG, Aragão ML, Pinto CA, Tavares-Júnior PA, Azeredo FB et al. Perinatal asphyxia and heart problems. Arq Bras Cardiol1998, 71: 121-26.
  23. Costa S, Zecca E, De Rosa G, De Luca D, Barbato G, Pardeo M et al. Is serum Troponin-T a useful marker of myocardial damage in newborn infants with perinatal asphyxia? Acta Paediatr 2007; 96: 181-84
  24. Liu J, Li J, Gu M. The correlation between myocardial function and cerebral hemodynamics in term infants with hypoxic-ischemic encephalopathy. J Trop Pediatr 2007; 53: 44–8.
  25. 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. Paediatr Int Child Health. 2019 Nov; 39(4):259-264.