Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant

Ratner, Ian; Perelmuter, Bezalel; Toews, Warren H.; Whitfield, Jonathan M.

doi:10.1097/00003246-198506000-00012

Cited by 33 publications

(26 citation statements)

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“…This is in keeping with the findings of Ratner et al 3 In contrast to Ratner's study, however, we have shown the most dramatic reductions in blood pressure in those infants of <1000 g. Ratner did not look separately at this group of infants, analysing data on all infants of <1200 g. In our analysis the mean blood pressure in those with a HSDA did not differ significantly between infants of 1000-1200 g and those of 1201-1500 g.…”

Section: Discussionsupporting

confidence: 93%

“…These observations agreed with the find-ings of Ratner et al who showed that a HSDA was associated with a reduction in systolic and diastolic blood pressure. 3 Ratner et al used the left atrial aortic root ratio as an isolated measurement to assess ductal status and some indirect blood pressure measurements,3 both of which could have limited the accuracy of their observations. We decided to re-examine this issue in preterm infants with a birth weight <1500 g using direct two dimensional and Doppler echocardiographic diagnosis and only measurements of blood pressure made through an intra-arterial catheter.…”

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confidence: 99%

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Effect of patency of the ductus arteriosus on blood pressure in very preterm infants.

Evans

Moorcraft

1992

Archives of Disease in Childhood

120

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Forty one preterm infants (birth weight <1500 g) were studied by daily Doppler echocardiography for the first week of life to examine the effect of a haemodynamically significant ductus arteriosus (HSDA) on systemic blood pressure. Hourly records of blood pressure were averaged for each infant to produce a 24 hour mean value and the infants were then allocated to groups according to whether, by echocardiographic criteria, there was a HSDA on that day.In infants from 1000 to 1500 g the differences in all parameters of blood pressure between those with and without a HSDA were not significant. In infants <1000 g the mean blood pressure was significantly less in the infants with a HSDA throughout the first week of life. Systolic blood pressure was reduced by as much as diastolic blood pressure and as a result the pulse pressure did not differ. Infants <1000 g with a HSDA were given more plasma and a greater number received inotropic support. Gestational age, respiratory disease severity, and complication rates did not differ between those with and without a HSDA.The possibility of a clinically silent HSDA should be considered before large amounts of plasma volume expanders are given to treat hypotension in infants <1000 g.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Effect of patency of the ductus arteriosus on blood pressure in very preterm infants.

Evans

Moorcraft

1992

Archives of Disease in Childhood

120

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“…21 A marked rise in diastolic pressure, a surrogate of systemic vascular resistance, due to the elimination of the low-resistance pulmonary circuit has previously been reported. 22 The consequential rise in vascular resistance following surgical ligation may have an adverse impact on myocardial performance. In humans myocardial systolic dysfunction and low cardiac output has recently been demonstrated, reflecting changes in LV loading conditions.…”

Section: Pda Ligation and Myocardial Performancementioning

confidence: 99%

Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention

et al. 2008

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Objective: To investigate the effect of postnatal age at patent ductus arteriosus (PDA) ligation on postoperative need for cardiotropic support.Study Design: A significant proportion of premature infants with a hemodynamically significant ductus arteriosus (HSDA) require surgical intervention. The relationship of postnatal maturation to postoperative cardiorespiratory stability is poorly understood. All preterm neonates who underwent PDA ligation between October 2002 and September 2004 were identified and divided according to postnatal age at ductal ligation, into early (p4 weeks, n ¼ 29) and late (>4 weeks, n ¼ 36) groups. Neonatal birth demographics and morbidities, characteristics of the HSDA and reason for ligation were reviewed. Indices of cardiorespiratory stability (for example heart rate, mean arterial pressure) were recorded before and 1, 4, 8, 12 and 24 h following ligation. Details of perioperative cardiovascular interventions (for example crystalloid boluses, cardiotropic agents) were recorded.Result: There were no differences in baseline neonatal demographics between the groups although a greater number of babies requiring early ligation had contraindication to indomethacin as the main reason for ligation. Early PDA ligation was associated with increased postoperative cardiotrope requirement (27.6 vs 5.6%, P ¼ 0.02) and decreased systolic blood pressure 8 h after intervention (P<0.05). Although increased oxygenation index was observed in both groups during the first 12 h it was only sustained to 24 h in the early group (P<0.05). Age at ligation remained a significant risk factor for postoperative cardiotrope requirement on multiple logistic regression analysis.Conclusion: Surgical ligation of the ductus arteriosus in preterm infants less than 28 days old is associated with oxygenation difficulties, decreased systolic arterial pressure and an increased need for cardiotropic support in the initial 24 postoperative hours. These data suggest the need to prospectively characterize perioperative cardiovascular physiology and identify predictive factors of clinical deterioration.

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“…Evans and Moorcraft (14) found that both SAP, DAP and MAP were not lower in infants weighing 1000-1500 g with PDA compared with infants without PDA. Differences in SAP, DAP, and MAP were found in infants weighing less than 1000 g with PDA compared with infants without PDA (14,15). An absence of differences in PP in preterm infants with and without PDA in the first postnatal week has been reported (14,15).…”

Section: Gevers Et Almentioning

confidence: 97%

“…Differences in SAP, DAP, and MAP were found in infants weighing less than 1000 g with PDA compared with infants without PDA (14,15). An absence of differences in PP in preterm infants with and without PDA in the first postnatal week has been reported (14,15). Recently, blood pressure after indomethacin treatment for PDA was found to increase steadily during the first 3 d after treatment (16).…”

Section: Gevers Et Almentioning

confidence: 99%

Bisferiens Peaks in the Radial Artery Pressure Wave in Newborn Infants: A Sign of Patent Ductus Arteriosus

et al. 1995

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Previously, we found evidence that radial artery pressure wave forms in newborns represent central aortic wave forms, provided that pressure is measured with adequate accuracy. Therefore, we postulated that the neonatal radial artery wave form, like the adult aortic wave form, may contribute to cardiovascular diagnosis. We investigated whether radial artery wave forms in infants suffering from patent ductus arteriosus (PDA) are different from the wave forms as seen without the presence of PDA. We studied 34 newborn infants with a radial artery line and with the possible clinical diagnosis of PDA with left-to-right shunt. On the basis of echocardiographic examination to assess PDA, these infants were divided in two groups: infants with PDA ( n = 24) and without PDA ( n = 10). In 15 out of 24 infants with PDA, recordings were repeated after ductal closure. Blood pressure measurement was performed with a high fidelity cathetermanometer system using a tip-transducer (natural frequency 95 Hz, damping coefficient 0.15). Contour analysis was performed by describing morphology of the waves during PDA and without PDA. In 23 out of 24 infants with PDA, a pulsus bisferiens was present: two peaks separated by a deep cleft. The average pressure difference between the first pressure peak and the cleft [AP,,,,,] was 0.35 -C 0.19 kPa, and the average difference between the cleft and the second pressure peak [AP,,,,,] was 0.44 i . 0.23 kPa. The ratio of mean magnitude of AP,,,,, and AP,,,,, was 0.81 ? 0.26. None of the 10 infants without PDA showed pulsus bisferiens. In 13 out of 14 infants with pulsus bisferiens during PDA and studied again after ductal closure, this twin peaks contour had disappeared. Results strongly indicate that the presence of a bisferiens pressure pulse is a sign of PDA with hemodynamically significant left-to-right shunt. (Pediatr Res 37: 800-805, 1995)

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Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant

Cited by 33 publications

References 0 publications

Effect of patency of the ductus arteriosus on blood pressure in very preterm infants.

Effect of patency of the ductus arteriosus on blood pressure in very preterm infants.

Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention

Bisferiens Peaks in the Radial Artery Pressure Wave in Newborn Infants: A Sign of Patent Ductus Arteriosus

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