An Early Heart Scan That Hints at the Road Ahead for the Tiniest Babies

What a Riyadh study of ultrasound heart scans in the first three days tells families about very premature babies — and what it cannot yet promise

When a baby is born more than eleven weeks early, the first few days are a time of intense watching. Doctors in Riyadh recently studied whether a quick, painless ultrasound scan of the heart, done in the first three days of life, could reveal which of these fragile babies were facing the hardest road ahead — either not surviving the first weeks, or developing severe chronic lung disease. The scans did reveal clear differences between babies who did well and those who did not, but the study also shows why an early scan is far better at describing a baby's circulation than at predicting his or her future.

Why the first days matter so much

Babies born before 29 weeks of pregnancy arrive with organs that are still being built, and the heart is no exception. A very premature baby's heart muscle has fewer and less organised muscle cells and less spare capacity than a full-term baby's, so it copes poorly when it is suddenly asked to do the demanding work of life outside the womb [1]. At the same time, the baby's circulation is going through enormous changes as the lungs take over from the placenta, and blood pressure readings and skin colour — the everyday signs nurses and doctors rely on — often stay reassuringly normal until a baby is already in trouble [2]. For a long time, teams had little choice but to steer care by those imperfect signs.

That began to change with a bedside technique called targeted neonatal echocardiography, or TNE — a focused ultrasound scan of the heart performed and read by the baby's own neonatal team rather than sent away to a cardiologist [3]. Instead of guessing at what a low blood pressure means, the team can now see how much blood each side of the heart is pumping, how well the heart muscle is squeezing, and how much pressure the lungs are placing on the heart. In 2024, an international group of experts agreed on a common set of standards for how these scans should be done and interpreted, giving the field a shared rulebook [4]. This study asked the next natural question: does one such scan, done very early, tell us where a baby is heading?

What the researchers did

The team reviewed the records of 122 babies, all born before 29 weeks and all cared for at a single large hospital in Riyadh, Saudi Arabia, between October 2023 and June 2025 [5]. Every baby had a standardised heart ultrasound within 72 hours of birth. The researchers then looked at two outcomes that matter enormously in this group: whether the baby survived to 36 weeks of adjusted age, and, among survivors, whether the baby developed severe bronchopulmonary dysplasia, a serious chronic lung condition that leaves babies needing substantial breathing support. Of the 122 babies, 24 (about 1 in 5) died, and 33 of the 98 survivors (about 1 in 3) developed severe lung disease [5].

The scan measured several things, including how much blood each ventricle pumped, how strongly the heart squeezed, and a marker called the eccentricity index, which reflects how much the wall between the two pumping chambers is being pushed out of shape by high pressure on the right side of the heart — the side that sends blood to the lungs [4],[5]. High pressure there is a sign that the lung circulation is under strain, something that connects directly to how the ductus arteriosus (a blood vessel that should close after birth) is behaving and to the pressure inside the lungs' blood vessels [6].

What they found

On the surface, the differences were dramatic. Babies who later died had much weaker heart pumping and much lower blood flow on that first scan than babies who survived, and every measurement pointed the same way. Taken at face value, the scan looked almost perfect at telling survivors from non-survivors.

But the researchers, to their credit, urge caution, and so should we. The babies who died were on average about two weeks more premature and 300 grams smaller than those who survived. Being extremely premature is itself the strongest reason a baby might both have a weaker early heart scan and be at higher risk of dying — so much of what the scan seemed to "predict" was really just restating how tiny and early these babies were [1],[5]. With only 24 deaths in the study and no separate test to check the results, the near-perfect accuracy is a statistical mirage rather than a reliable crystal ball. The honest reading is that the early scan mostly confirmed what gestational age and birth weight already told the team.

The most useful finding was quieter. When the researchers looked only at the babies who survived, almost none of the heart-strength measurements separated those who went on to develop severe lung disease from those who did not. The one measurement that still stood out was the eccentricity index — the marker of pressure on the right side of the heart [5]. In other words, among survivors, it was strain on the lung side of the circulation, rather than a weak heart pump, that tracked with the lung disease to come. That fits what doctors have long suspected: chronic lung disease of prematurity is closely tied to the health of the lungs' blood vessels [7],[8].

It helps to know what "severe bronchopulmonary dysplasia" actually means for a baby and family. It is a chronic lung condition of prematurity in which the tiny air sacs and the blood vessels around them do not develop normally, so the baby needs significant extra oxygen or breathing support at what would have been around the end of pregnancy. In this study, survivors who developed severe lung disease spent far longer on a breathing machine (a median of about 31 days versus 8) and on oxygen (about 97 days versus 54), and stayed in hospital much longer, than survivors who did not [5]. Those are the day-to-day realities the researchers were hoping an early scan might help anticipate — which is exactly why it matters to be honest about how much, and how little, one early scan can foretell.

The problem that motivated this research

To understand why this study matters, it helps to know how families and clinicians used to face these first days. Before bedside heart ultrasound became available, a team caring for a struggling premature baby often could not tell whether the problem was a heart that was not pumping enough, a leaky blood vessel diverting blood away from the body, or high pressure in the lungs — three problems that look similar at the cot side but need different responses [2],[6]. Treatment was frequently a matter of educated trial and error. Over the past two decades, some neonatal units built early ultrasound "screening" into their routine and reported better outcomes for extremely premature babies, including the very smallest born at 22 to 26 weeks [9],[10]. This new study is part of that larger effort to replace guesswork with a clearer picture of each baby's circulation.

What this means for families

If your baby has an early heart ultrasound, it is a good sign of attentive, modern care: the team is trying to understand exactly how your baby's heart and lungs are adapting, so they can support your baby in the most precise way possible [3]. It is fair to ask the team what the scan showed and how it is shaping your baby's treatment. What this study does not support is using that early scan to forecast whether your baby will survive or develop chronic lung disease. The scan is a snapshot of a fast-changing situation, and, as the researchers themselves emphasise, it largely reflects how premature your baby is rather than adding a separate prediction. A single early picture cannot capture how the lung circulation will change over the days and weeks that follow — and it is that changing picture, not one moment, that matters most for the lungs.

What researchers are working on next

The promising thread to pull is the pressure marker on the right side of the heart. Researchers now want to know whether following that measurement over time — not just once — can genuinely identify which surviving babies are drifting toward severe lung disease, so that those babies might be watched more closely or helped sooner [7],[9]. Answering that will take larger studies across many hospitals, with repeated scans and careful checking, before any early heart measurement can be trusted to guide decisions [10]. It will also take continued investment in training, because these scans are only as reliable as the skill of the people performing them [11]. For now, the early heart scan is best understood for what it truly is: a valuable window into a premature baby's circulation that helps the team care for your baby today, rather than a prediction of the months to come.

References

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