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Echocardiogram Done Early in Neonatal Sepsis
  1. Rania H. Tomerak, MD,
  2. Ayman A. El-Badawy, MD,
  3. Gehan Hussein, MD,
  4. Nermin R.M. Kamel, MD,
  5. Abdel Rahman A. Razak, MD
  1. From the Neonatal Tertiary Care Unit, Cairo University Children’s Hospital, Cairo, Egypt.
  1. Received September 26, 2011, and in revised form December 21, 2011.
  2. Accepted for publication January 5, 2012.
  3. Reprints: Rania H. Tomerak, MD, 3 El Maleka Zebeida Square off Ahmed Orabi Street, Madinet El Talabah, Mohandessin, Cairo, Egypt. 12411. E-mail: raniatomerak{at}
  4. The authors declare that they have no competing interests.
  5. All authors have made substantial contributions to conceptualization and design: Rania Tomerak interpreted the data, wrote the manuscript, and responded to the reviewers’ comments; Gehan Abdel Gelil did the echocardiography; Abdel Rahman Razak got the acquisition of data; and Nermin Kamel has been involved in editing the manuscript and revising it.
  6. All authors read and approved the final manuscript.
  7. Equipment of the Cairo University Children’s Hospital were used. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

What Does It Add?


Background One of the major organs affected in neonatal sepsis is the heart. Echocardiogram provides real-time information on the cardiovascular performance rather than dependence on the clinical signs alone, which might lead to misjudgment.

Aim of the Work To assess left ventricular (LV) functions in septic neonates early after admission using transthoracic color Doppler Echocardiography.

Patients and Methods Echocardiography was done to 30 septic and 30 nonseptic newborns who were divided among 4 groups (septic full-term, 14; septic preterm, 16; nonseptic full-term, 21; and nonseptic preterm, 9). Comparisons were made among the 4 groups using analysis of variance and post hoc test regarding the systolic function (using ejection fraction and fractional shortening), the diastolic function (using the early patrial peak/atrial peak flow velocity ratio), and the global LV function (using myocardial performance index).

Results The E-wave and the early peak flow velocity/atrial peak flow velocity ratio were significantly lower in the septic neonates, whether full-term or premature, compared to their corresponding age groups in the nonseptic newborns, suggesting LV diastolic dysfunction (P < 0.001 and P < 0.014, respectively). No difference was found in the diastolic function between the full-term and the preterm neonates whether lying within the septic group or in the nonseptic group. Myocardial performance index was significantly higher in the septic neonates who died than in the survivors (P < 0.001).

Conclusion Neonatal sepsis is associated with LV diastolic dysfunction.

Key Words
  • echocardiogram
  • neonatal sepsis
  • E/A ratio
  • myocardial performance index
  • diastolic dysfunction

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