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He M, Yang Z, Gan T, Tang J, Ran S, Zhang K. Echocardiographic parameters predicting spontaneous closure of ductus arteriosus in preterm infants. Front Pediatr 2023; 11:1198936. [PMID: 37397143 PMCID: PMC10310433 DOI: 10.3389/fped.2023.1198936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To evaluate the value of echocardiographic parameters in predicting early spontaneous closure of ductus arteriosus in premature infants. Methods 222 premature infants admitted to the neonatal ward of our hospital were selected, and patent ductus arteriosus was detected by echocardiography 48 h after birth. On the 7th day, whether the ductus arteriosus was closed naturally in this cohort was observed. The infants whose ductus arteriosus were not closed were identified as the PDA group (n = 109), and the other infants were included in the control group (n = 113). The echocardiographic parameters of the two groups of premature infants at 48 h after birth were single-factor statistically and Pearson correlation analyzed, and the parameters with statistically significant differences in single-factor analyzed were selected for multivariate logistic stepwise regression analysis. Results The ductus arteriosus shunt velocity and the pressure difference between the descending aorta and the pulmonary artery (ΔPs) in the PDA group were lower than those in the control group (P < 0.05). The pulmonary artery pressure (PASP) in the PDA group was higher than that in the control group (P < 0.05). According to the multivariate logistic stepwise regression analysis, only the maximum shunt velocity of ductus arteriosus was correlated with early spontaneous closure of ductus arteriosus in 48 h first echocardiographic parameters (P = 0.049). The receiver operating characteristic (ROC) curve indicates the optimal critical point of echocardiographic ductus arteriosus shunt velocity in premature infants 48 h after birth was 1.165 m/s. Conclusion Echocardiographic parameters are of great value in predicting the early spontaneous closure of ductus arteriosus in premature infants. In particular, the ductus arteriosus shunt velocity is correlated with the early spontaneous closure of ductus arteriosus.
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Affiliation(s)
- Minyu He
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengchun Yang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tian Gan
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Tang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Suzhen Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Zhang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
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Sun X, Chen L, Gao J. Predictive value of a nomogram model for adverse outcomes in very low birth weight infants with patent ductus arteriosus: A prospective study. Front Pediatr 2023; 11:1131129. [PMID: 37114009 PMCID: PMC10126240 DOI: 10.3389/fped.2023.1131129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Objective To establish a nomogram model incorporating markers of echocardiography and N-terminal pro brain natriuretic peptide (NT-proBNP) for predicting adverse outcomes of patent ductus arteriosus (PDAao) in very low birth weight infants and to evaluate the predictive values of the model. Methods A prospective study was conducted for very low birth weight infants who were admitted from May 2019 to September 2020. An echocardiogram and blood NT-proBNP test were carried out in the first 48 h after birth, and the arterial duct remained open in all patients. Other data collected included clinical symptoms and infant characteristics. A nomogram model was established to predict the risk of PDAao (including severe BPD, IVH, NEC or death). Internal verifications were performed for the nomogram, and the discrimination and calibration of the model were evaluated by the C-index and calibration curve. Results Eighty-two infants were enrolled and divided into an adverse outcome (AO) group and normal outcome (NO) group with 41 patients in each group. PDA diameter, PDA maximum flow velocity, left atrium diameter/aortic diameter (LA/AO) ratio and NT-proBNP level were independent risk factors for PDAao and were included in the nomogram model. The model presented good discrimination with a C-index of 0.917 (95% CI 0.859-0.975). The calibration curves in showed high consistency and indicated good Correspondence: between the event incidence predicted by the nomogram model and the true incidence of PDAao. Conclusion The nomogram model incorporating the PDA diameter, PDA maximum flow velocity, LA/AO ratio and NT-proBNP level in the first 48 h could early predict the later occurrence of PDAao in very low birth weight infants.
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Saha AK, Sardar SK, Majhi B, Chatterjee S. Clinical and echocardiographic characteristics associated with evolution of patent ductus arteriosus in preterm neonates: A prospective cohort study. J Neonatal Perinatal Med 2022; 15:537-544. [PMID: 35599501 DOI: 10.3233/npm-210930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously closed (within 7 days) and persistent PDA. RESULT We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates.
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Affiliation(s)
- A K Saha
- Department of Neonatology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
| | - S K Sardar
- Department of Neonatology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
| | - B Majhi
- Department of Cardiology, Bankura Sammilani Medical College and Hospital, Bankura, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
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Lu DF, Tong XM, Liu YF, Zhang H. Reference Values for Point-of-Care Echocardiographic Measurements of Preterm Infants in China. Front Pediatr 2022; 10:894152. [PMID: 35844737 PMCID: PMC9280336 DOI: 10.3389/fped.2022.894152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have examined the reference value of the left ventricular structure and function in preterm infants. This study was designed to establish a point-of-care echocardiographic reference range of left ventricular structure and function based on different gestational age, weight, and body surface area (BSA) for preterm infants within 7 days after birth. METHODS We retrospectively studied 489 patients with traditional echocardiographic data of left ventricular (LV) M-mode: LV end diastolic dimensions (LVED), LV end systolic dimension (LVES), end-diastolic interventricular septal thickness (IVSd), end diastolic LV posterior wall thickness (LVPWd), left atrial (LA) and aortic root (AO) diameters, and index of LA/AO, LV ejection fraction (LVEF), LV fractional shortening (LVFS), and pulsed wave Doppler: aortic valve flow rate (AV), peak mitral valve flow rate E(MV-E), peak mitral valve flow rate A(MV-A), and MV-E/A. The LV dimensions and the maximum blood flow velocities of the aortic valves and mitral valves according to gestational age, birth weight, and body surface area (BSA) are presented in percentiles tables. Percentile curves of aforesaid four cardiac measurements (LVED, LA diameter (LAD), MV-E, MV-E/A) using the R language Generalized Additive Models for Location, Scale and Shape (GAMLSS) method were developed according to different gestational ages and weights. RESULTS Measurements of all cardiac dimensions and Doppler maximum velocities of AV, MV-E, and MV-E/A showed a correlation with gestational age, weight, and BSA. LVED, LAD, MV-E, and MV-E/A showed a trend of increasing values with gestational age and weight on the percentile curves. CONCLUSION The percentile tables and graphs of these point-of-care echocardiographic data can provide reliable reference data for Chinese neonates. Normative values are recommended as a source of reference data for the identification of potentially abnormal echocardiography.
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Affiliation(s)
- Dan-Fang Lu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yun-Feng Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Department of Epidemiology Center, Peking University Third Hospital, Beijing, China
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Masutani S, Isayama T, Kobayashi T, Pak K, Mikami M, Tomotaki S, Iwami H, Yokoyama T, Toyoshima K. Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study. J Cardiol 2021; 78:487-492. [PMID: 34481720 DOI: 10.1016/j.jjcc.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is inconsistent evidence suggesting the clinical relevance of the early detection of future needs of preterm patent ductus arteriosus (PDA) surgery. We tested the hypothesis that echocardiographic indices at 3 days of age predict the future need for PDA surgery. METHODS We analyzed a database including the clinical and echocardiographic data of 710 preterm infants with gestational ages between 23 and 29 weeks in 34 Japanese neonatal intensive care units, and prospectively collected data over 14 months. The predictive or discriminative ability of each echocardiographic index at 3 days of age for future PDA surgical closure was evaluated using multivariable logistic regression analyses with adjustment for gestational age, sex, and small-for-gestational-age status, according to the areas under the receiver-operating characteristic curves (AUCs) of the models. RESULTS A total of 688 eligible patients (median gestational age: 26 weeks, body weight at birth: 843 g) were analyzed, of whom 77 (11%) underwent PDA surgery (median age: 21 days) after full consideration of clinical conditions. The AUC of PDA diameter (PDAd) was the largest, followed by that of the left pulmonary artery end-diastolic velocity (LPAedv). Compared with the ratio of left atrial-to-aorta diameter (AUC 0.76), PDAd (AUC 0.84, p < 0.001) and LPAedv (AUC 0.82, p = 0.003) were significantly better predictors of future PDA surgery. CONCLUSION Echocardiographic indices at 3 days of age, especially PDAd and LPAedv, may predict the future need for surgical closure of PDA in preterm infants.
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Affiliation(s)
- Satoshi Masutani
- Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
| | - Tetsuya Isayama
- Neonatology, National Center for Child Health and Development, Setagaya, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Japan
| | - Kyongsun Pak
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Japan
| | - Masashi Mikami
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Japan
| | - Seiichi Tomotaki
- Neonatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroko Iwami
- Neonatology, Osaka City General Hospital, Osaka, Japan
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de Klerk JCA, Engbers AGJ, van Beek F, Flint RB, Reiss IKM, Völler S, Simons SHP. Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review. Front Pediatr 2020; 8:541. [PMID: 33014935 PMCID: PMC7516116 DOI: 10.3389/fped.2020.00541] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.
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Affiliation(s)
- Johan C. A. de Klerk
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
| | - Aline G. J. Engbers
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
- Division of Systems Biomedicine and Pharmacology, Leiden Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Floor van Beek
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
| | - Robert B. Flint
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
- Department of Hospital Pharmacy, Erasmus UMC, Rotterdam, Netherlands
| | - Irwin K. M. Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
| | - Swantje Völler
- Division of Systems Biomedicine and Pharmacology, Leiden Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, Netherlands
- Division of BioTherapeutics, Leiden Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Sinno H. P. Simons
- Division of Neonatology, Department of Pediatrics, Erasmus UMC—Sophia Children's Hospital, Rotterdam, Netherlands
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What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study. J Cardiol 2019; 74:512-518. [DOI: 10.1016/j.jjcc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
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El-Saiedi S, AbdelMassih AF, Sedky Y, Malash A, Hussain N, Alfons M, Essam R. Development of tissue Doppler-derived predictors of hemodynamically significant patent ductus arteriosus and the ability to incorporate it in targeted neonatal echocardiography protocol. J Saudi Heart Assoc 2019; 31:69-74. [PMID: 30618483 PMCID: PMC6313813 DOI: 10.1016/j.jsha.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/21/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Hemodynamically significant (HS) patent ductus arteriosus (PDA) is a significant cause of mortality in preterm neonates. Early detection of HS PDA and pre-symptomatic closure may help in avoiding complications. For this to happen, easily performed predictors must be available; the aim of this paper is to test the reliability and repeatability of tissue Doppler-derived parameters for prediction of HS PDA. Methods Preterm neonates <32 weeks were screened with echocardiography at Day 3 of life; 80 neonates with PDA were classified into HS group and hemodynamically insignificant (HIS) group based on benchmark parameter namely left ventricular outflow to superior vena caval flow ratio (LVO/SVC), and a ratio ≥4 was considered predictive of HS PDA. Tissue Doppler-derived left ventricular myocardial systolic and diastolic velocities were also performed. Results In total, 105 neonates (55 among HS and 60 among HIS groups) were included in the study. Septal systolic velocity (S′) proved of high sensitivity (100%) in the prediction of HS PDA; nevertheless, it proved to be more repeatable than the initially discriminating parameter (LVO/SVC) with a Kappa of 0.92. Conclusion This study concludes that septal S′ can be reliably used even by neonatologists for pre-symptomatic detection of HS PDA. This may also indicate the need of adding tissue Doppler parameters to the standard protocol of targeted neonatal echocardiography.
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Affiliation(s)
- Sonia El-Saiedi
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
| | - Antoine Fakhry AbdelMassih
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt.,Consultant of Pediatric Cardiology, Children Cancer Hospital of Egypt (57357 Hospital), Cairo, Egypt
| | - Yasser Sedky
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
| | - Amr Malash
- Neonatology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
| | - Nouran Hussain
- Neonatology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
| | - Monica Alfons
- Neonatology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
| | - Rana Essam
- Neonatology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, EgyptEgypt
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Roushdy A, Abd el razek Y, Mamdouh Tawfik A. Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure. Echocardiography 2018; 35:71-78. [DOI: 10.1111/echo.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Alaa Roushdy
- Cardiology Department; Ain Shams University Hospital; Cairo Egypt
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Yum SK, Moon CJ, Youn YA, Lee JY, Sung IK. Echocardiographic assessment of patent ductus arteriosus in very low birthweight infants over time: prospective observational study. J Matern Fetal Neonatal Med 2017; 31:164-172. [DOI: 10.1080/14767058.2016.1278207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sook Kyung Yum
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cheong-Jun Moon
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Ah Youn
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Young Lee
- Division of Cardiology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Kyung Sung
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Smith A, Maguire M, Livingstone V, Dempsey EM. Peak systolic to end diastolic flow velocity ratio is associated with ductal patency in infants below 32 weeks of gestation. Arch Dis Child Fetal Neonatal Ed 2015; 100:F132-6. [PMID: 25406463 DOI: 10.1136/archdischild-2014-306439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early diagnosis and effective treatment of the patent ductus arteriosus (PDA) in infants less than 32 weeks gestation remains contentious. OBJECTIVE To determine which clinical and echocardiographic parameters are associated with PDA patency in preterm infants less than 32 weeks gestation. DESIGN/METHODS This was a prospective cohort study. An echocardiography (echo) was performed within 12-48 h of birth and a follow-up echo at 1 month of life. Parental consent was obtained. RESULTS 55 babies were enrolled. Median (range) gestation was 28 (24-31) weeks and birth weight 1090 g (470-1800 g). ECHO 1 demonstrated that 50 babies had a PDA present within 48 h of birth, of which 19 were large (≥2 mm) (36%) and 31 were small (59%) on colour Doppler assessment of duct diameter. Three babies died before 1 month. At 1 month 30 babies still had a PDA (58%), 10 of which were large (19%) and 19 were small (36%). Parameters significantly associated with large PDAs versus no PDA at 1 month were gestational age (26 weeks vs 30 weeks, p=0.002), birth weight (860 g vs 1290 g, p=0.007) and ventilator support at 48 h (80% vs 17%, p=0.001). Echo parameters revealed that ductal size on colour Doppler (2.5 mm vs 1.5 mm, p=0.003), end diastolic flow velocity (57 m/s vs 147 m/s, p<0.001) and peak systolic to end diastolic flow velocity ratio (2.29 vs 1.23, p=0.001) at 48 h were associated with large PDAs at 1 month. CONCLUSIONS For infants less than 32 weeks gestation a peak systolic to end diastolic flow velocity ratio>2 within 48 h of birth is associated with a persistent large PDA at 1 month of age.
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Affiliation(s)
- A Smith
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland
| | - M Maguire
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - V Livingstone
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland Infant Centre, University College Cork, Cork, Ireland
| | - E M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland Infant Centre, University College Cork, Cork, Ireland
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Toyoshima K, Masutani S, Senzaki H, Kawataki M, Itani Y. Left Atrial Volume Is Superior to the Ratio of the Left Atrium to Aorta Diameter for Assessment of the Severity of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants. Circ J 2014; 78:1701-9. [DOI: 10.1253/circj.cj-13-1231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Satoshi Masutani
- Pediatric Cardiology, Saitama Medical Center, Saitama Medical University
| | - Hideaki Senzaki
- Pediatric Cardiology, Saitama Medical Center, Saitama Medical University
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13
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Sehgal A, Menahem S. Interparametric correlation between echocardiographic markers in preterm infants with patent ductus arteriosus. Pediatr Cardiol 2013; 34:1212-7. [PMID: 23370640 DOI: 10.1007/s00246-013-0640-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
Various echocardiographic parameters are determined in the assessment and evaluation of a patent ductus arteriosus. In isolation, many of these parameters have a low sensitivity and specificity for ductal hemodynamic significance compared with ductal size. This study aimed to correlate various echocardiographic parameters with ductal size (transductal diameter) in infants with a symptomatic patent ductus arteriosus and to ascertain the accuracy of various parameters in predicting a duct 3 mm in size or larger. In this retrospective study, preterm infants younger than 32 weeks gestation who were evaluated for the presence of a patent ductus arteriosus during the period June 2010-2012 were assessed. The following echocardiographic parameters were measured: transductal diameter (TDD), ductal velocity, end-diastolic left pulmonary artery flow, ductal diameter-to-left pulmonary artery ratio (TDD:LPA), left atrial-to-aortic root ratio (LA:Ao), left ventricular output-to-superior vena cava flow ratio (LVO:SVC), transmitral E:A ratio, and isovolumic relaxation time (IVRT). The study enrolled 52 infants with a mean gestation age of 26 ± 2 weeks and a mean birth weight of 837 ± 240 g. The mean transductal diameter was 2.8 ± 0.5 mm. Transductal diameter correlated significantly with ductal velocity, end-diastolic LPA flow, TDD:LPA ratio, LA:Ao ratio, and LVO:SVC ratio but not with transmitral indices. The LVO:SVC ratio had the highest specificity (0.83) and sensitivity (0.95) for detecting a duct 3 mm in size or larger, the area under the curve being 0.95 (95 % confidence interval [CI], 0.85-0.99). Significant correlations between ductal size and surrogate markers of pulmonary overcirculation were noted.
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Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Medical Centre, Melbourne, Australia.
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