Unmasking right-sided heart failure in neonatal sepsis: The role of TAPSE in early detection

Neonatal sepsis is a leading cause of morbidity and mortality worldwide and is often complicated by myocardial dysfunction. While left ventricular (LV) impairment has been widely described, right ventricular (RV) dysfunction remains underrecognized. Tricuspid annular plane systolic excursion (TAPSE) is a simple, reproducible echocardiographic parameter to assess RV systolic function. This study aimed to evaluate the association between neonatal sepsis and ventricular dysfunction, focusing on right-sided heart failure indicated by reduced TAPSE. This study design is an observational-analytic with a cross-sectional design involved all infants aged 1-28 days that were admitted into NICU wards between May-June 2023. There were 53 infants included and were divided into two main groups: those with sepsis and those without. Each group was further stratified into two sub-groups based on birth weight: (1) sepsis with BW <1500 g, (2) sepsis with BW ≥ 1500 g, (3) no sepsis with BW < 1500 g, and (4) no sepsis with BW ≥ 1500 g. No significant differences were observed in LV systolic or diastolic parameters between septic and non-septic groups (Tei index p=0.69, EF p=0.65, FS p=0.77, MAPSE p=0.78). However, TAPSE was significantly lower in septic neonates (median 0.8 cm) compared to non-septic infants (median 0.9 cm, p=0.03), particularly among those with low birth weight. Neonatal sepsis is associated with RV systolic dysfunction, while LV function remains preserved. Reduced TAPSE may reflect early right-sided heart failure secondary to sepsis-induced pulmonary and myocardial injury, supporting TAPSE as a valuable tool for early detection and monitoring.