on behalf of the Canadian Neonatal Network (CNN), and Canadian Preterm Birth Network (CPTBN) Investigators* Objective To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at <26 weeks of gestation or <750 g birth weight.

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An 11-year-old patient with diagnosis of hypertrophic cardiomyopathy (HCM) developed marked elevation of troponin I in the absence of electrocardiographic signs of ischemia after two episodes of supraventricular tachycardia. At follow-up the level of troponin I returned to normal. The role of troponin I in patients with HCM as a risk marker deserves further evaluation.

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BackgroundSeveral studies have reported a deterioration in cardiovascular status following surgical ligation of patent ductus arteriosus (PDA). Our group has previously reported a worsening of myocardial function as assessed by the myocardial performance index (MPI). MPI, also known as the Tei index, is a Doppler-derived measure of global myocardial function. It is inversely related to myocardial function.ObjectiveTo identify the clinical and echocardiographic predictors of MPI in a group of preterm infants undergoing surgical PDA closure.MethodsPreterm infants who had a PDA ligation during the period of March 2004 to September 2005 comprised our study population. Data were collected both retrospectively (n = 11) and prospectively (n = 8). Cardiac function was assessed before and after PDA ligation using a Philips SONOS 5500 ultrasound machine. Relevant variables including birth weight, gestational age, postmenstrual age (PMA), age at ligation, dopamine dose, PDA size, and ventilatory mean airway pressure (MAP) were collected. Univariate and multivariate linear regression models were used to investigate the relationship between MPI and clinical or echocardiographic variables.ResultsComplete sets of data were available in 19 preterm infants (GA 25.7 ± 2 wks, Bwt 788 ± 257 g, PMA 28.6 ± 2.7 wks) who underwent PDA ligation on day of life 20 ± 12. Consistent with our previously reported findings, MPI increased from 0.26 ± 0.11 to 0.55 ± 0.21 following the PDA ligation (p < .001). In this patient population, after adjusting for the need of MAP ≥ 9 cmH2O and the requirement of dopamine ≥ 10 μg/kg/min, PDA size was significantly associated with an increase in MPI values (R 2 = .31, p = .03).ConclusionFollowing PDA ligation, the size of the PDA predicts the deterioration in cardiac function as measured by the MPI.