Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

Abstract

Objective: To identify clinical and echocardiography predictors of the spontaneous closure of patent ductus arteriosus in preterm neonates.Methods: Sixty-one consecutive preterm neonates (gestational age 30±2 weeks, birth weight 1.2±0.2 kg) were evaluated by echocardiogram on their third day of life and those with patent ductus arteriosus were selected for a prospective cohort. Echocardiography was repeated weekly until they reached term. Based on their progress, the sample population was divided into two groups, depending on whether spontaneous closure of patent ductus arteriosus took place (Group A) or not (Group B). The prevalence of clinical signs of patent ductus arteriosus and echocardiography findings at baseline were compared between the groups.Results: Patent ductus arteriosus was found in 21 neonates (34%). Spontaneuous closure was observed during follow-up of seven patients (Group A, 33% of those with patent ductus arteriosus), in contrast with the remaining 14 patients (Group B, 67%). Clinical signs of patent ductus arteriosus were present in 14% of the patients in Group A, compared with 71% in group B (p = 0.01). At baseline, Group B had a larger ductus diameter in relation to Group A (2.6±0.6 mm vs. 1.4±0.6 mm; p = 0.003). The area under the ROC curve in relation to ductus diameter was 0.93 (p = 0.003) and 100% sensitivity for identifying cases without spontaneous closure was obtained at the cutoff point of 1.7 mm, while 100% specificity was observed taking 2.2 mm as the cutoff. Conclusions:In preterm neonates, a patent ductus arteriosus greater than 2.2 mm on the third day of life predicts no spontaneous closure and suggests a need for early treatment, especially when associated with clinical signs.J Pediatr (Rio J). 2005;81(6):454-60: Preterm neonates, echocardiography, patent ductus arteriosus. ResumoObjetivo: Analisar características ecocardiográficas e manifestações clínicas na evolução de recém-nascidos pré-termo com persistên-cia do canal arterial e identificar indicadores mais confiáveis do fechamento espontâneo deste.Métodos: Sessenta e um recém-nascidos pré-termo com idade gestacional de 30±2 semanas (26-34 semanas) peso de 1,2±0,2 kg (0,7-1,7 kg) foram avaliados semanalmente desde o terceiro dia de vida até o termo através de ecocardiograma. O diâmetro do canal arterial e medidas das cavidades cardíacas foram determinados. Avaliação clínica procurou detectar sinais clínicos de persistência do canal arterial. Recém-nascidos pré-termo com persistência do canal arterial foram divididos em dois grupos: Grupo A, onde houve fechamento espontâneo do canal arterial, e Grupo B, onde não houve. Análise estatística foi realizada através do teste t e curva ROC.Resultados: Vinte e um (34,4%) recém-nascidos pré-termo apresentaram persistência do canal arterial no terceiro dia de vida, sendo sete do grupo A e 14 do grupo B. Sinais clínicos de persistência do canal arterial ocorreram em 14,3% do grupo A e 71,4% do grupo B (p = 0,013). Persistência do canal arterial aumentou significativamente os...

Association of patent ductus arteriosus (PDA) with prematurity and low birth weight neonates

“…The wide variability in the incidence of patent ductus arteriosus (PDA) has been reported previously, this is probably due to the differences in criteria for diagnosis or in the management of small premature neonates. [17][18][19][20]24 In present study authors observed that the overall incidence of patent ductus arteriosus was 18.6% Almost similar results have been reported by R.Curtis Ellison George et al, they monitored 1689 infants out of which 342 (20.2%) had PDA. 12 Present results were almost similar to the results that have been reported by Bijan Siassi MD et al who conducted their study on the incidence and clinical feature of preterm LBW neonates.…”

Echocardiographic parameters of patent ductus arteriosus in preterm infants

“…Moreover, LAVI was more correlated to LVEDVI (r =0.633) than LA/AO ratio (r = 0.363). Previous reports suggesting LA/AO ratio as a sensitive and specific parameter in detecting PDA may be limited since the aorta was probably enlarged due to the high SV and CO, leading to no change in LA/AO [1]. We suggest that LAVI should be considered when performing the echocardiography to detect hsPDA which had hemodynamic significance.…”

“…Heart rate in each group was not significantly difference. Afilune, et al [1] also found that on the third day of life, only 52% of preterm neonates with PDA had clinical symptoms. Systolic function and diastolic function of the left ventricle were not significantly different in each group even in hsPDA which had left ventricular volume overload and higher SV and CO. Interestingly, LV MPI in hsPDA group was significantly lower than LV MPI in non-PDA group.…”

Perfusion Index as a Diagnostic Tool for Patent Ductus Arteriosus in Preterm Infants

“…The incidence of patent ductus arteriosus (PDA) in preterm infants is high, especially in those with birthweight (BW) <1,000 g (59%) or gestational age (GA) <30 weeks (52%) compared to those with BW ≥1,000 g (25%) or GA ≥30 weeks (24%) [1,2]. PDA is associated with morbidities, especially in preterm infants due to stealing of blood flow from the systemic circulation through the PDA into the pulmonary artery.…”