Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Ramos, Flordelisa; Rosenfeld, Charles R.; Roy, Lindsay E.; Koch, Joshua D.; Ramaciotti, Claudio

doi:10.1038/jp.2010.14

Cited by 42 publications

(40 citation statements)

References 18 publications

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“…25 We used the relationship of the PDA to LPA to define size and clinical significance. Large = PDA:LPA ratio > 1; Moderate = PDA:LPA ratio of < 1 but > 0.5; and small = PDA:LPA < 0.5.…”

Section: Methodsmentioning

confidence: 99%

“…Spontaneous closure of the PDA in extremely low gestational age neonates may not occur in the first week of life, and this delayed closure may be a physiological consequence of increased pulmonary vascular resistance from pulmonary immaturity. 25 Infants with a moderate to large PDA based on its relationship to the left pulmonary artery (LPA) have a 15-times greater likelihood of requiring treatment for clinically and hemodynamically significant PDA than those with a small PDA. 25 We therefore excluded infants with a moderate to large PDA in the first four days of age and any size PDA at 32 and 36 weeks PMA from the reference values.…”

Section: Methodsmentioning

confidence: 99%

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Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Levy

Dioneda

Holland

et al. 2015

Journal of the American Society of Echocardiography

101

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Background Right Ventricle fractional area of change (RV FAC) is a quantitative two- dimensional echocardiographic measurement of RV function. RV FAC expresses the percentage change in the RV chamber area between end-diastole (RVEDA) to end-systole (RVESA). The objectives of this study were to determine the maturational (age- and weight- related) changes of RV FAC and RV areas and to establish reference values in healthy preterm and term neonates. Methods A prospective longitudinal study was conducted in 115 preterm infants (23-28 weeks gestational age at birth, 500-1500 gram). RV FAC was measured at 24 hours of age, 72 hours of age, 32 weeks and 36 weeks postmenstrual age (PMA). The maturational patterns of RVEDA, RVESA, and RV FAC were compared to 60 healthy full term infants in a cross sectional study (> 37 weeks, 3.5 +/− 1 kg), who received echocardiograms at birth (n=25) and one month of age (n=35). RVEDA and RVESA were traced in the RV focused apical 4-chamber view, and FAC was calculated using the formula: 100 * [(RVEDA – RVESA)/RVEDA)]. Premature infants that developed chronic lung disease or had a clinically and hemodynamically significant PDA were excluded (n=55) from the reference values. Intra- and inter- observer reproducibility analysis was performed. Results RV FAC ranged from 26% at birth to 35% by 36 weeks PMA in preterm infants (n=60) and increased almost two times faster in the first month of age as compared to healthy term infants (n=60). Similarly, RVEDA and RVESA increased throughout maturation in both term and preterm infants. RV FAC and RV areas correlated with weight (r=0.81, p<0.001), but were independent of gestational age at birth (r=0.3, p=0.45). RVEDA and RVESA correlated with PMA in weeks (r=0.81, p<0.001). RV FAC trended lower in preterm infants with bronchopulmonary dysplasia (p=0.04), but did not correlate to size of PDA (p=0.56). There was no difference in RV FAC based on gender or need for mechanical ventilation. Conclusions This study establishes reference values of RV areas (RVEDA and RVESA) and RV fractional area of change (RV FAC) in healthy term and preterm infants and tracks their maturational changes during postnatal development. These measures increase from birth to 36 weeks PMA, and this is reflective of the postnatal cardiac growth as a contributor to the maturation of cardiac function These measures are also linearly associated with increasing weight throughout maturation. This study suggests that two-dimensional RV FAC can be used as a complementary modality to assess global RV systolic function in neonates and facilitates its incorporation into clinical pediatric and neonatal guidelines.

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“…25 We used the relationship of the PDA to LPA to define size and clinical significance. Large = PDA:LPA ratio > 1; Moderate = PDA:LPA ratio of < 1 but > 0.5; and small = PDA:LPA < 0.5.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Levy

Dioneda

Holland

et al. 2015

Journal of the American Society of Echocardiography

101

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“…Conventional echocardiography measurements were obtained in the study infants, including LV output (LVO), PDA diameter in 2D measured at the pulmonary end (we defined a haemodynamically significant PDA as being greater than 1.5 mm), the direction of flow and PDA shunt gradient, the mitral valve (MV) inflow velocity time integral (VTI), and the left atrial to aortic root ratio (LA:Ao) [16]. SVR was calculated using the formula: (mean systemic blood pressure - mean tricuspid valve inflow pressure gradient estimated as 4 mmHg)/LVO [17].…”

Section: Methodsmentioning

confidence: 99%

Longitudinal Assessment of Left and Right Myocardial Function in Preterm Infants Using Strain and Strain Rate Imaging

et al. 2015

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Background: There is a paucity of longitudinal data on left ventricular (LV) and right ventricular (RV) function in preterm infants of less than 29 weeks' gestation. Objective: The aim of this study was to describe changes in tissue Doppler-derived basal longitudinal strain (BLS) and systolic (SRs), early (SRe) and late (SRa) diastolic strain rates in extremely premature infants from birth to 36 weeks postmenstrual age (PMA). Methods: Echocardiographic assessments were carried out on days 1, 2, 5-7 and at 36 weeks PMA. We assessed the following associations: correlation with systemic vascular resistance (SVR) on day 1, influence of a patent ductus arteriosus (PDA) during days 5-7, and the effect of chronic lung disease (CLD). Results: In total, 105 infants with a median gestation of 27.1 weeks (IQR 26.0-28.1) and a birthweight of 965 g (IQR 785-1,153) were included. There was an increase in most of the measurements across the four time points. On day 1, there was a weak negative correlation between SVR and LV BLS (r = -0.3, p = 0.01), SVR and septal BLS (r = -0.4, p < 0.001) and SVR and LV SRe (r = -0.4, p = 0.005). On days 5-7, infants with a PDA >1.5 mm had higher LV BLS [-13.0 (2.4) vs. -11.9 (1.9)%, p = 0.03]. At 36 weeks, infants with CLD (n = 28/47) had lower RV BLS [-26.4 (5.0) vs. -30.7 (5.5)%, p = 0.01] and lower RV SRa [4.2 (1.3) vs. 5.3 (1.9) s^-1, p = 0.04]. Conclusion: Myocardial function undergoes important longitudinal changes in preterm infants. Left heart strain measurements appear to be weakly influenced by changes in preload and afterload. CLD appears to leave a negative impact on RV function.

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“…Nowadays, there are several approaches to PDA in the NICU and the clinical practices include prophylactic use of non-steroidal anti-inflammatory drugs (NSAID), medical early or late treatment with one, two or even three courses of NSAIDs, surgical closure, and observation and even no treatment at all. [32][33][34][35][36][37] As amidst many clinical studies there is not much studied about infants who have PDAs which last for more than three weeks, we designed this study with the aim to determine if the prolonged persistence of the PDA (PP-PDA) for >3 weeks is associated with greater morbidity in preterm infants <1250 g.…”

Section: Introductionmentioning

confidence: 99%

Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

2012

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Objective: Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants p28 weeks or 1250 g.Study Design: This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl À1 and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and w 2 . Significance was set at P<0.05.Result: PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA. Conclusion:A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.

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Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Cited by 42 publications

References 18 publications

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Longitudinal Assessment of Left and Right Myocardial Function in Preterm Infants Using Strain and Strain Rate Imaging

Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

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