Change in Blood Pressure and Pulse Pressure in Preterm Infants After Treatment of Patent Ductus Arteriosus With Indomethacin

Abstract

Background and ObjectivesPatent ductus arteriosus (PDA) is associated with increased morbidity and mortality in premature infants. Therefore, an early diagnosis and treatment of a hemodynamically significant PDA are very important. A widened pulse pressure is considered to be a well known clinical sign of a PDA in older infants and children; however, whether this is also applicable in the case of preterm infants remains to be confirmed. The aims of this study were to investigate the change in blood pressure (BP) before and after medical treatment of a PDA with indomethacin and to evaluate if the change in the pulse pressure in preterm infants with a medically treated PDA could be used as a reliable clinical predictor of a hemodynamically significant PDA.Subjects and MethodsBetween January 2005 and June 2009, a retrospective analysis was performed in preterm infants with a hemodynamically significant PDA (PDA group, n=72) and preterm infants without a PDA (control group, n=72) at the Chonnam National University Hospital Neonatal Intensive Care Unit. The PDA was closed by treatment with indomethacin. The BP was compared between the two groups over the seven days after the first dose of indomethacin.ResultsIn preterm infants with a hemodynamically significant PDA, the mean systolic (55.1±6.0 mmHg) and diastolic BPs (31.4±6.2 mmHg) were lower than those in the controls (mean systolic BP 58.0±6.4 mmHg, mean diastolic BP 34.7±6.0 mmHg) before indomethacin treatment. When the ductus arteriosus was successfully closed by indomethacin treatment, there was a gradual increase in both the systolic and diastolic BPs without any change in the pulse pressure.ConclusionThe results of this study show that a widened pulse pressure is not a useful clinical sign of a hemodynamically significant PDA in preterm infants. However, low systolic and diastolic BPs may be useful clinical signs of a hemodynamically significant PDA in preterm infants. If the systolic and diastolic BP is low, a PDA should be considered and echocardiography should be performed for early diagnosis and treatment.

Systemic Hypertension Requiring Treatment in the Neonatal Intensive Care Unit

“…6, 9 Hypertension related to patent ductus may be from increase in pulmonary congestion and hypoxemia, renal hypoperfusion, drug-related nephrotoxicity or secondary to thromboembolism. 6 Further, cardiac output increases after closure of the ductus and the additional output can lead to transient increases in blood pressure 32–34 .…”

Impact of Medical Treatment of Hemodynamically Significant Patent Ductus Arteriosus on Cerebral and Renal Tissue Oxygenation Measured by Near-Infrared Spectroscopy in Very Low-Birth-Weight Infants

“…According to Rios et al, hsPDA can be associated with circulatory insufficiency and hypotension, and medical treatment can normalize the blood flow and blood pressure of a preterm infant [30]. This was confirmed by other authors who studied the effect of medical treatment on the blood pressure of preterm infants in the presence of PDA [31,32].…”

Haemodynamic assessment and management of hypotension in the preterm

“…This does not translate into improved systemic blood flow and classically presents as a low diastolic BP and a high/normal preductal systolic BP (resulting in a wide pulse pressure) 36. However, invasive measurements of BP using umbilical arterial catheters may reveal lower systolic and diastolic pressures as postductal systemic blood flow may be compromised 37. Management strategies include elimination of the shunt (medical/surgical treatment) or a limitation in the velocity of the shunt by increasing PVR (permissive hypercapnia, increasing positive end-expiratory pressure).…”