Echocardiographic Changes and Clinical Outcomes During Invasive and Non-Invasive Ventilatory Sup-port in Neonates: A Prospective Cohort Study

Background: Different modes of respiratory support may affect cardiovascular performance and systemic hemodynamics differently in neonates. Objective: The study aimed to evaluate the effects of invasive and non-invasive respiratory support on hemodynamic status and clinical outcomes in neonates. Methods: This prospective observational cohort study was conducted in the NICU. We enrolled 90 neonates and allocated them to three groups: invasive ventilation, non-invasive ventilation, and a control. Echocardiographic measurements were performed, including stroke volume (SV), cardiac output (CO), cardiac index (CI), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (FAC), pulmonary artery systolic pressure (PASP), and myocardial performance indices for the left and right ventricles, as well as Doppler evaluation of the superior mesenteric and renal arteries. Assessments were conducted one hour after initiation of respiratory support and repeated after three days of ventilation. Results: After three days, invasive ventilation was associated with significantly lower SV, CO, CI, MAPSE, TAPSE, FAC, right ventricular SV, and pulmonary acceleration time, together with higher pulmonary artery systolic pressure compared with the non-invasive group (p=0.001, 0.001, 0.001, 0.002, 0.002, 0.006), respectively. The invasive group showed a significant reduction in Vmax values in the studied arteries. Neonates who developed acute kidney injury or died exhibited significantly impaired biventricular performance. Conclusions: Invasive mechanical ventilation is associated with lower cardiac output and evidence of greater impairment in both left and right ventricular functional indices over time, accompanied by higher rates of adverse clinical outcomes.