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

Evans, Nick; Moorcraft, J.

doi:10.1136/adc.67.10_spec_no.1169

Cited by 120 publications

(66 citation statements)

References 8 publications

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“…We focused on the first 24 hours of life because that is when there is a need for diagnosis and treatment for hypotension 12,14 and because, later, many variables such as a patent ductus arteriosus precluded the recognition of a stable population. 28 In defining our stable group, like others, we excluded factors that affect blood pressure 8 -10 but allowed others, such as history of preeclampsia and antenatal steroids, that are now known not to influence MAP in ELBW infants. 11,14 Reference values extrapolated from linear regression models of larger and more mature infants have been found to be inaccurate 23,24 and have not addressed special populations such as ELBW infants and concordant and discordant twins.…”

Section: Discussionmentioning

confidence: 99%

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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Section: Discussionmentioning

confidence: 99%

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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“…After this time, pulmonary pressure continues to fall and ductal shunting has increased impact on blood pressure (4,33) and patterns of cerebral perfusion (34,35). In addition, it should be noted that the finding that upper body perfusion is maintained in the presence of ductal shunt is drawn from mean values seen across a large cohort of preterm infants, and it is clear that the transitional circulation varies greatly between individuals (17,36).…”

mentioning

confidence: 99%

Does Retrograde Diastolic Flow in the Descending Aorta Signify Impaired Systemic Perfusion in Preterm Infants?

et al. 2008

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High-volume systemic-to-pulmonary ductal shunting occurs frequently in preterm infants and is indicated by diastolic flow reversal in the descending aorta (DAo). We studied the relationship between ductal diameter, diastolic DAo reversal, and left ventricular output (LVO); and superior vena caval (SVC) flow (upper body perfusion) and DAo flow (lower body perfusion) in preterm (Ͻ31 wk) infants. Echocardiographic assessments were performed at 5, 12, 24, and 48 h postnatal age (80 infants, median gestation 28 wk, 1060 g). Incidence of ductal patency fell from 100% at 5 h to 72% at 48 h; incidence of pure systemic-to-pulmonary shunting increased from 66% to 95% of infants with patent ducts. In infants with duct diameter greater than the median, 35-48% of infants had DAo flow reversal. In infants with duct diameter greater than median, DAo reversal was associated with 23-29% increases in LVO at 5-48 h, and 35% decreases in DAo flow volume at 24 -48 h, but no differences in SVC flow. In conclusion, a large duct with left-to-right shunting is common in preterm infants. Retrograde DAo flow is a marker of high-volume shunt, evidenced by increased LVO. Preterm infants with high-volume ductal shunt may have preserved upper body perfusion but reduced lower body perfusion. T he clinical significance of shunting through the patent ductus arteriosus in the premature newborn infant remains uncertain (1-4). It is clear that prolonged patency of the ductus arteriosus is seen in preterm infants with respiratory distress (5), and can be associated with significant volume of systemic-to-pulmonary shunting (6). In addition, prolonged ductal patency is associated with a variety of adverse outcomes in preterm infants (7). However, a causative association between ductal shunting and adverse outcome has not been established (8,9), and clinical trials of therapeutic intervention have not demonstrated reductions in morbidity (1). There is increasing awareness that ductal patency may not be a primary pathologic entity but rather an epiphenomenon of prematurity itself (10).Circulatory impact of ductal shunt depends on the volume of shunt and the ability of the myocardium to produce a compensatory increase in left ventricular output (LVO). It has previously been suggested that in the first postnatal days shunt volume through the ductus would be low due to the relatively balanced pulmonary and systemic arterial pressures at this time (11). However, there is now substantial evidence that pulmonary pressure in surfactant treated infants falls rapidly after birth (12,13). High-volume ductal shunt, as evidenced by reversal of blood flow during diastole in the descending aorta (DAo), has been seen as early as 7 h after birth (8), and may occur days before clinical signs appear (5).LVO has been shown to increase with increased ductal shunting in many preterm infants (14). However, it is possible that the immature myocardium has a limited ability to increase output in the first postnatal day (15). The combination of high-volume ductal shunt...

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“…Several studies focusing on blood pressure and PP during PDA in preterm infants during the first days of life have been reported. 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).…”

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

Cited by 120 publications

References 8 publications

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Does Retrograde Diastolic Flow in the Descending Aorta Signify Impaired Systemic Perfusion in Preterm Infants?

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

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