Background: Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common functional cardiovascular disease in preterm infants. The necessity to treat hsPDA can neither be derived solely from clinical nor from echocardiographic criteria. Objective: The aim of this study was to establish non-invasive parameters which can differentiate hsPDA from non-hsPDA. Methods: Urinary protein levels of NT-proBNP, NGAL, and H-FABP were measured and correlated with the necessity of therapy for PDA. In 37 neonates (<1,500 g), urinary protein concentrations were tested on days 0, 2, and 7 by ELISA methodology. Of 37 infants, 12 required therapeutic interventions according to current treatment standards. Results: Infants receiving an intervention for PDA showed significantly higher levels of pro-BNP, NGAL, and H-FABP at all time points except for NT-proBNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples, the concentration of the three proteins correlated positively with each other. Conclusions: The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of PDA on systemic perfusion in preterm infants. Furthermore, NGAL and H-FABP may be used to indicate the necessity of pharmacological or surgical treatment of PDA.
Background: Infants with extremely low birth weight uniformly develop anemia of prematurity and frequently require red blood cell transfusions (RBCTs). Although RBCT is widely practiced, the indications remain controversial in the absence of conclusive data on the long-term effects of RBCT. Objectives: To summarize the current equipoise and to outline the study protocol of the ‘Effects of Transfusion Thresholds on Neurocognitive Outcome of extremely low birth-weight infants (ETTNO)’ study. Methods: Review of the literature and design of a large pragmatic randomized controlled trial of restrictive versus liberal RBCT guidelines enrolling 920 infants with birth weights of 400–999 g with long-term neurodevelopmental follow-up. Results and Conclusions: The results of ETTNO will provide definite data about the efficacy and safety of restrictive versus liberal RBCT guidelines in very preterm infants.
Background and aims:The shape of dilution curve will dramatically change after indicator passes through the cardiopulmonary system in the presence of intra-cardiac shunts and a PDA. The purpose of this study was to develop an accurate algorithm for shunt identification and apply it to archived clinical data.Methods: A mathematical model of indicator movement through cardiopulmonary system for three situations was developed:2) Right to left shunt;3) Left to right shunt.Three parameters of dilution curve were examined: 1) appearance time;2) asymmetry;3) curve width.Three possible scenarios were defined based on the probability "P" of shunt identification:2) Possible shunt; 5% < P < 90%;3) Shunt identified P> 90% In the model, the values for cardiac output, heart size and heart rate were varied. Results:In play-back mode the developed algorithm was applied to a clinical data archive of 1,188 dilution curves collected from adults (n=131) and from children (n=112) weighing between 0.9 -130 kg. Sensitivity of the method was 94%, and false positive diagnostic was 0.9%. [Dilution Curve Shunt Model]Conclusions: Automatic identification of shunts and PDA yielded acceptable accuracy. New PICU monitor (COstatus, Transonic Systems Inc., NY) in addition to measuring cardiac output and blood volumes, identifies the presence of intra-cardiac shunts based on developed algorithm. Next step will be to quantify the observed shunt flow value. The aim of the present study was to establish non-invasive parameters which reflect perfusiondependent consequences of the ductus for the organism of the preterm infant. Grant support: NIH SBIR # R44 HL061994 NT PRO-BNP, NGAL, AND H-FABP ARE INDICATORS OF HEMODYNAMIC RELEVANCE OF PATENT DUCTUS ARTERIOSUS IN PRETERM INFANTS
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