Electrocardiographic and echocardiographic findings in asphyxiated neonates: A tertiary care hospital based study

Abstract: BACKGROUND: Birth asphyxia causes multiorgan dysfunction. Cardiovascular effects of birth asphyxia are transient myocardial ischemia, tricuspid insufficiency, dilated cardiomyopathy. AIMS: To assess myocardial function in neonates with birth asphyxia. MATERIALS AND METHODS: Cross-sectional study was conducted on 90 neonates admitted in NICU over six months. Neonates were divided into 3 groups according to Hypoxic Ischemic Encephalopathy (HIE) staging of Sarnat and Sarnat. Cardiac function was assessed using Echocardiography (ECHO) and Serial Electrocardiography (ECG) on1 st , 3 rd and 7 th day of birth. Grading of ECG was done as per criteria defined by Jedeikin et al . Data was analyzed using statistical tools and compared with relevant studies. RESULTS: Out of 90 neonates with birth asphyxia, 33.3% had SARNAT score of grade I, 33.3% had SARNAT score of grade II and 33.3% had SARNAT score of grade III. ECG revealed worsening abnormalities with increasing SARNAT grade. On first day, 70% neonates in SARNAT grade 1 had normal ECGs, compared to only 40% in grade 3. ST depression was absent in grade 1 but present in 40% of grade 3 neonates. Improvement in ECG findings was seen by seventh day. Echocardiography supported correlation between cardiac dysfunction and HIE severity. Right ventricular hypokinesia was present in 36.7% while reduced ejection fraction in 56.7% of grade 3 cases, with significant association ( P = 0.002). Longer hospital stays (>10 days) were common in severe cases (54.4%). CONCLUSIONS: In birth asphyxia, ECG and ECHO serve as critical indicators of assessing the worsening cardiac function with increased HIE severity.