Résumé
Extremely low gestational age newborns (ELGANs, born <28 weeks GA) present cardiocirculatory immaturity, often associated with mortality and/or severe morbidity. Management of their hemodynamic instability remains complex, and non-standardized. Objective: to assess the ability of several echocardiographic parameters (measured on days 1 and 3 of life) to predict mortality and/or severe morbidity in these patients. Method: this prospective, observational, single-center study included neonates born <28 weeks GA and admitted to our neonatal intensive care unit from January 2023 to January 2024. An association between early echocardiographic parameters and mortality and/or severe morbidity (grade III or IV intraventricular hemorrhage, type 2b or 3 necrotizing enterocolitis and severe bronchodysplasia) was sought. Results: 50 neonates were included with a median gestational age of 25+3 [25+0-26+0] weeks GA and a median birth weight of 780 [666-925] g. The composite criterion of mortality and/or severe morbidity was observed in 44% of patients. This composite criterion was associated with decreases in TAPSE, subpulmonary and superior vena cava VTI, maximum velocity (Vmax) of the ductus arteriosus, and mean aortic velocity. The thresholds of these parameters obtained with ROC curves made it possible to define that the association of a TAPSE <4.7 mm, a superior vena cava VTI <10.3 cm, and a Vmax in the ductus arteriosus <160 cm/s on day 1 of life is associated with an increased risk of mortality and/or severe morbidity. The effect persisted after adjustment for birth weight and sex (OR 12.8; p=0.017). Conclusion: early echocardiography in ELGANs is a valuable tool to identify hemodynamic instability. Parameters suggestive of pulmonary hypertension, right ventricular dysfunction and low systemic flow are associated with high mortality and/or severe morbidity. Further studies are needed to validate these data and guide treatment.