Lung Compliance in Newborns with Patent Ductus Arteriosus before and after Surgical Ligation

Gerhardt, Tilo; Bancalari, Eduardo

doi:10.1159/000241348

Cited by 105 publications

(44 citation statements)

References 17 publications

(25 reference statements)

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“…In preterm infants, a PDA alters mesenteric blood flow, impairs pulmonary mechanics, increases the risk of pulmonary hemorrhage and prolongs the need for mechanical ventilation. [1][2][3][4][5][6][7][8][9][10] The echocardiogram has been used as a gold standard for determining the presence of a PDA and for evaluating temporal changes in the magnitude of a PDA left-to-right shunt. Unfortunately, frequent echocardiographic studies can destabilize an infant, may not be readily available in all institutions and increase hospital costs.…”

Section: Introductionmentioning

confidence: 99%

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

2010

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Objective: Although B-type natriuretic peptide (BNP) concentrations seem to be useful for detecting the presence of patent ductus arteriosus, there is no information about their usefulness for monitoring changes in PDA shunt magnitude. Study Design:We performed a retrospective analysis of paired BNPechocardiogram measurements (obtained from infants (24 to 32 weeks gestation) with clinical suspicion of PDA).Result: Individual BNP concentrations (n ¼ 146, from 88 infants) were significantly related to shunt magnitude at the time of measurement and had good discriminating power for detecting a moderate-or-large shunt (area under receiver-operator characteristic curves (ROC-AUC) ¼ 0.85). In total, 36 infants had serial BNP-echocardiogram pairs (n ¼ 91) measured during their hospitalization. Changes (either increases or decreases) in BNP concentrations over time had only fair discriminating power (ROC-AUC ¼ 0.76) for detecting increases or decreases, respectively, in shunt magnitude. Conclusion:The high degree of variability in the BNP measurements made them less useful for monitoring changes in magnitude.

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Section: Introductionmentioning

confidence: 99%

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

2010

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“…The authors' hypothesis is that this beneficial effect is due to a decrease in the pulmonary vascular resistance with a consequent decrease in right to left shunts, an improvement in ventilation in atelectatic segments of the lungs and a decrease in oxygen consumption as a result of the blunted stress response. 22,23 In a randomized dose-ranging study in young infants and children 24 a fentanyl dose of 25 mcg kg À1 of fenatnyl was required to minimize hemodymanic and endocrine responses during the pre-bypass phase of cardiac surgery, even when isoflurane is also used.…”

Section: Outcome After Pda Closure In Preterm Infantsmentioning

confidence: 99%

Anesthetic technique and postoperative outcome in preterm infants undergoing PDA closure

et al. 2010

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Objective: To describe the various anesthetic techniques used for surgical closure of PDA in premature infants at the Montreal Children's Hospital and assess their impact on postoperative outcome.Study Design: The charts of all preterms who underwent PDA ligation during a 21-month period were reviewed for preoperative status, intraoperative anesthetic management and postoperative outcome. We determined the associations between independent variables and two postoperative outcome variables: unstable postoperative respiratory course (UPRC) and hypotension. Result:The mean weight at surgery of the 33 infants was 1.031 ± 0.29 kg. All infants, but one, received intraoperative opioids. Eight patients presented UPRC. Mean fentanyl doses were 5.3±2.6 mcg kg À1 for patients with UPRC vs 22.6 ± 16.6 mcg kg À1 for patients without UPRC (P ¼ 0.004). Applying the receiver-operator characteristic curve (ROC), 10.5 mcg kg À1 of fentanyl was established as the dose that discriminated and identified patients who experienced UPRC. The postnatal and postmenstrual age of the patient, birthweight, current weight, ventilator settings preoperatively, previous courses of indomethacin, sex and preoperative creatinine, were not correlated with the dose of fentanyl equivalent used. Logistic regression did not show a relationship between any of the previously mentioned factors and receiving a fentanyl equivalent of >10.5 mcg kg À1. The only factor associated with the total fentanyl equivalent dose (as a continuous variable) or receiving <10.5 mcg kg À1 (as a dichotomous variable) was the identity of the anesthetist involved, P<0.001. Conclusion:We conclude that the use of at least 10.5 mcg kg À1 of fentanyl equivalent as a component of the anesthetic regimen for surgical closure of a PDA in premature infants, avoids an unstable postoperative respiratory course.

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“…Este exceso de líquido favorece la mantención o reapertura del ductus, el cual produce un aumento del flujo hacia los pulmones, predisponiendo a un edema pulmonar, con deterioro en la mecánica respiratoria 36 , prolongando de esta forma la necesidad de oxígeno suplementario y/o ventilación mecánica. Esta secuencia de eventos puede favorecer el desarrollo de DBP, especialmente si se mantienen por tiempo prolongado.…”

Section: Ductus Arterioso Persistente Y Administración De Líquidosunclassified

“…Además en las etapas iniciales de esta patología la capacidad funcional residual esta a menudo disminuida, debido a las atelectasias, pero durante las etapas más tardías existe atrapamiento de gas con hiperinsuflación 45 . Paralelamente el ductus arterioso persistente y la administración excesiva de líquidos, pueden conducir a edema intersticial pulmonar, disminuyendo la distensibilidad pulmonar y aumentando la resistencia de las vías aéreas 36 . También se ha reportado un aumento de la resistencia de las vías aéreas secundaria a la liberación de mediadores de inflamación, como leucotrienios y factor activador de plaquetas en niños con DBP 29 .…”

Section: Aumento De Resistencia De Vías Aéreasunclassified

Actualización en Presentación y Patogénesis de la Displasia Broncopulmonar

2009

Rev. chil. pediatr.

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Update on Presentation and Pathogenesis of Brochopulmonary DysplasiaBronchopulmonary dysplasia (BPD) remains as the most frequent chronic lung disease seen among babies with very low birth weight, contributing to their morbidity and mortality. An increase in the survival of very immature babies due to improvement in pre and post natal care, has resulted in an increase in the number of newborns with BDP, although there have been no changes in the actual incidence of the disease. Objective: To describe the evolution of DBP in recent decades, the current definition, and to describe and analyze the risk factors involved in the pathogenesis of this disease. Until a few years ago, the terms BPD and chronic lung disease were used as synonyms. After the workshop sponsored by the National Institute of Health in the United States in 2001, it was recommended that the term BPD be used to describe the pulmonary sequelae of immature babies. Classic severe BPD, as described by Northway et al over forty years ago, has evolved into milder forms of chronic pulmonary damage, the so-called "new BPD", characterized by impairment of alveolarización and vascularization of the immature lung in response to multiple injuries. BPD is a multifactorial disease where major risk factors are related to pulmonary immaturity, hyperoxia, baro/volutrauma, as well as inflamation and infection. Genetic susceptibility has recently been shown to be another important risk factor. Conclusion: Bronchopulmonary Dysplasia continues to be the most frequent sequelae affecting low birth weight infants. In the past four decades, the disease has been better defined, and new pathogenetic risk factors have been established. RESUMENLa Displasia Broncopulmonar (DBP) continúa siendo la enfermedad pulmonar crónica más frecuente que afecta al recién nacido de muy bajo peso, contribuyendo a su morbilidad y mortalidad. El aumento en la sobrevida de los recién nacidos muy inmaduros, debido a la mejoría en el cuidado pre y post natal, ha aumentado el número de recién nacidos con displasia, sin cambios en su incidencia. El objetivo de esta revisión es representar los cambios en la presentación clínica de la DBP en las últimas décadas y describir ACTUALIDAD CLINICAL OVERVIEW Rev Chil Pediatr 2009; 80 (3): 213-224

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Lung Compliance in Newborns with Patent Ductus Arteriosus before and after Surgical Ligation

Cited by 105 publications

References 17 publications

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

Anesthetic technique and postoperative outcome in preterm infants undergoing PDA closure

Actualización en Presentación y Patogénesis de la Displasia Broncopulmonar

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