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A Neonatal Echocardiographic Z-Score Nomogram for a Developing Country

Background: Currently used pediatric Echocardiographic Z scores are mostly founded on western data and have restricted applicability for newborns in developing nations. Since biological parameters may vary in different populations the data from those studies cannot be applied to the Indian neonates directly. Aims & Objectives: This study was directed to obtain echocardiographic data of various routinely measured cardiovascular structures using 2D and M mode echocardiography in Indian newborns up to 24 hours after birth and to derive Z-Score graphs for those parameters. Materials and Methods: This was a prospective observational study of a cohort of normal newborns conducted at a tertiary care hospital in western India. Neonates with congenital heart disease on screening echo were excluded and 100 normal neonates were included in the study with the intention of obtaining echocardiographic data of various routinely assessed cardiac parameters and to obtain a Z - score graph for each parameter. Echocardiographic evaluation was done utilizing a GE vivid S6 system. For the assessment of the relationship of an individual parameter with respect to BSA, regression equation was applied. Results: 22 parameters were assessed and using polynomial regression model relation to Body surface area was assessed and Z score charts were derived. Conclusion: Majority of the Z score values and reference ranges in our study were lower compared to the western standards thus it emphasizes the need for such a Z score in a developing country and hence these Z score values obtained from our study could be useful as compared to western charts for use in developing countries for planning the appropriate cardiac intervention and surgery in the neonatal population. However, large-scale studies with heterogenicity of age groups will be needed before they can become clinically applicable in the general population.