PERSISTENTLY LOW CARDIAC-OUTPUT PREDICTS HIGH MORTALITY IN NEWBORNS WITH CARDIOGENIC-SHOCK

Background. Cardiogenic shock is an acute ''unstable'' state of circul atory dysfunction. Objective. To evaluate the haemodynamic aspects of 45 newborn infants affected by cardiogenic shock, in relation to etiol ogies and the mortality rate. Design. Retrospective, correlation study of etiologies, mortality rate and haemodynamic measurements by Dopple r ultrasound parameters. Patients. 45 newborn infants with cardiogenic shock, Gestational Age (GA) 37 (34-41), Birth Weight (BW) 2750 (1600- 3600) g and a control group of 20 neonates [GA 38(34-40) wks, BW 2960 (1750-3800) g]. Measurements. Left ventricular Cardiac Output (CO) was measured by a duplex scanner with pulsed Doppler and color now mappin g echocardiography in the first 48 hours of life. Results, In healthy newborns CO was 240 mL/min/kg (210-280), in newborns with cardiogenic shock CO was 170 mL/min/kg (130-200), p<0.01. The Stroke Volume was 1. 80 mL/kg (1.70-1.90) in the control group and 1.20 (1.15-1.80) in the shocked group (p<0.05); Heart Rate was 146 beats/min (130-160) and 160 beats/mm (140-194), (p<0.01) respectively. Twenty-nine infants with c ardiogenic shock had CO less than or equal to 150 mL/min/kg and 5 of t hem (17.2%) died; 16 neonates had CO>150 mL/min/kg and only one (6.2%) died (p< 0.01). Twenty-six of 36 newborns with perinatal asphyxia had CO less than or equal to 150 mL/min/kg and 5 of them died, while only one of 10 infants with CO>150 mL/min/kg died. Conclusions. Our result s show that persistently low CO (less than or equal to 150 mL/min/kg) during the first 48 hours of life, in newborns with cardiogenic shock due to perinatal asphyxia is associated with a significantly higher mo rtality.