Background Sick preterm neonates may have significant cardiac dysfunction. Blood pressure (BP) may be a surrogate marker however mean BP alone does not indicate the nature of myocardial dysfunction.

Aim To analyse biventricular myocardial velocities and myocardial performance indices (MPI) using tissue Doppler imaging (TDI) in preterm neonates <30 weeks gestation, with and without hypotension, in the first 24 h of life.

Methods 25 preterm neonates were recruited: 15 were normotensive and 10 were hypotensive. The hypotensive group (HT) received between 1 and 5 interventions (fluid and inotropes) till they were normotensive. Peak systolic (S’), early diastolic (E’), late diastolic (A) myocardial velocities and MPIs from the lateral annulus of the left and right atrio-ventricular valves were measured. Scans were performed after each intervention.

Results The left ventricular (LV) MPI was significantly higher in the hypotensive group compared to the normotensive group (p = 0.01) suggesting left ventricular dysfunction. Biventricular MPIs decreased significantly when hypotension was corrected, indicating an improvement in myocardial function (RV p = 0.01, LV p = 0.05). Trans-mitral E’ also showed an improvement following intervention for HT suggesting improvement in left ventricular relaxation (p = 0.02).

Conclusion Although our study is small we have demonstrated that hypotensive preterms have impaired left ventricular function. Myocardial function improved after intervention in the hypotensive group. More studies are needed to investigate the application of TDI as an adjunct in clinical decision making when managing preterm babies with hypotension.