Right and Left Ventricular Outputs and Tricuspid Annular Plane Systolic Excursion as Key Functional Echocardiographic Markers Distinguishing Septic from Non-Septic Neonates

Open Access

Abstract

Background: Neonatal sepsis remains a major cause of morbidity and mortality worldwide, yet its hemodynamic consequences are often under recognized. Clinical signs alone are unreliable for assessing cardiovascular compromise. Functional echocardiography provides real-time hemodynamic data, but which specific markers best distinguish septic from non-septic neonates remains to be fully characterized. Objective: To compare biventricular outputs, systolic functional indices, and tricuspid annular excursion between septic and non-septic neonates and identify key echocardiographic markers distinguishing the two groups. Methods & Materials: This cross-sectional comparative study was conducted in the Department of Neonatology, Bangladesh Medical University, from March 2022 to September 2023. A total of 50 neonates (25 with suspected sepsis and 25 healthy controls matched for gestational age) were enrolled. Functional echocardiography was performed within 12 hours of sepsis onset. Quantitative data were compared using independent t-tests, and categorical data using chi-square tests. Results: Septic neonates demonstrated significantly higher mean RVO (277.4±74.2 vs. 209±70 ml/kg/min, p=0.002) and LVO (339.5±43.2 vs. 276±74.9 ml/kg/min, p=0.001) compared to non-septic controls. Mean TAPSE was significantly lower in the septic group (0.49±0.13 vs. 0.74±0.34 cm, p=0.001). No significant differences were observed in EF (72±9.4 vs. 75.4±1.47%, p=0.080) or FS (37.1±3.1 vs. 37.5±1.8%, p=0.900) between the two groups. Conclusion: Elevated right and left ventricular outputs and reduced TAPSE are key functional echocardiographic markers that distinguish septic from non-septic neonates. These parameters may aid early hemodynamic assessment and guide targeted management in neonatal sepsis.