The often forgotten systemic effects of ductus arteriosus: impact on decision-making and future trials

Sehgal, Arvind; Mulcahy, Brendan; Pharande, Pramod; Varma, Suraj

doi:10.1038/s41372-021-01163-x

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…Obtaining echocardiograms to identify PDA in preterm infants requires considerable time/personnel resources. The current workflow usually includes echo lab notification, sonographer assignment and review of any previous echocardiograms, travel to/from the neonatal intensive care unit to perform the study, entering study measurements/findings, and cardiologist review and report generation 7 . This extended workflow has led neonatal care teams to perform their own targeted echocardiography for PDA to expedite care.…”

Section: Discussionmentioning

confidence: 99%

“…The current workflow usually includes echo lab notification, sonographer assignment and review of any previous echocardiograms, travel to/from the neonatal intensive care unit to perform the study, entering study measurements/ findings, and cardiologist review and report generation. 7 This extended workflow has led neonatal care teams to perform their own targeted echocardiography for PDA to expedite care. One small, single center study demonstrated this strategy expedited care with a reduction in needless medication doses.…”

Section: Discussionmentioning

confidence: 99%

“…Ductal closure in preterm infants specifically is thought to be due in part to the prematurity's regulatory effect on factors influencing ductal tone such as low fetal PO 2 and decreased metabolism of vasodilators such as prostaglandin and prostacyclin by the lungs 3,4 . The presence of a significant left to right shunt from a PDA is associated with a number of poor outcomes in preterm infants including intraventricular hemorrhage, chronic lung disease, necrotizing enterocolitis, renal failure, metabolic acidosis, feeding intolerance, pulmonary hemorrhage, and an increased risk of mortality 5–7 …”

mentioning

confidence: 99%

“…3,4 The presence of a significant left to right shunt from a PDA is associated with a number of poor outcomes in preterm infants including intraventricular hemorrhage, chronic lung disease, necrotizing enterocolitis, renal failure, metabolic acidosis, feeding intolerance, pulmonary hemorrhage, and an increased risk of mortality. [5][6][7] Despite decades of research on PDA in preterm infants and a large body of publications including multicenter clinical trials, a causal link between PDA and poor outcomes has remained difficult to consistently demonstrate. The lack of clear causality has led to variability in the treatment of PDA in preterm infants among centers and even neonatologists within the same center.…”

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confidence: 99%

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Automated Identification of Patent Ductus Arteriosus Using a Computer Vision Model

Erno

Gomes

Baltimore

et al. 2023

J of Ultrasound Medicine

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ObjectivesPatent ductus arteriosus (PDA) is a vascular defect common in preterm infants and often requires treatment to avoid associated long‐term morbidities. Echocardiography is the primary tool used to diagnose and monitor PDA. We trained a deep learning model to identify PDA presence in relevant echocardiographic images.MethodsEchocardiography video clips (n = 2527) in preterm infants were reviewed by a pediatric cardiologist and those relevant to PDA diagnosis were selected and labeled (PDA present/absent/indeterminate). We trained a convolutional neural network to classify each echocardiography frame of a clip as belonging to clips with or without PDA. A novel attention mechanism that aggregated predictions for all frames in each clip to obtain a clip‐level prediction by weighting relevant frames.ResultsIn early model iterations, we discovered training with color Doppler echocardiography clips produced the best performing classifier. For model training and validation, 1145 such clips from 66 patients (661 PDA+ clips, 484 PDA− clips) were used. Our best classifier for clip level performance obtained sensitivity of 0.80 (0.83–0.90), specificity of 0.77 (0.62–0.92) and AUC of 0.86 (0.83–0.90). Study level performance obtained sensitivity of 0.83 (0.72–0.94), specificity of 0.89 (0.79–1.0) and AUC of 0.93 (0.89–0.98).ConclusionsOur novel deep learning model demonstrated strong performance in classifying echocardiography clips with and without PDA. Further model development and external validation are warranted. Ultimately, integration of such a classifier into auto detection software could streamline PDA imaging workflow. This work is the first step toward semi‐automated, bedside detection of PDA in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Automated Identification of Patent Ductus Arteriosus Using a Computer Vision Model

Erno

Gomes

Baltimore

et al. 2023

J of Ultrasound Medicine

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“…Infants with hsPDA are at high risk for AKI. It is hypothesized that hsPDA leads to AKI through reduced descending aorta blood volume, due to the concept of "ductal steal" or "systemic artery steal," thereby causing hypoperfusion (prerenal azotemia) to the kidneys [6,7]. This is supported by findings demonstrating lower renal oxygen saturation (Rsat) values among extremely premature infants with hsPDA [8].…”

Section: Introductionmentioning

confidence: 99%

Renal Oxygen Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

et al. 2023

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Objective: Decreased near-infrared spectroscopy (NIRS) measures of renal oxygen saturation (Rsat) have identified preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA). NIRS may further identify infants at risk for acute kidney injury (AKI) in a population with concern for hsPDA. Design: Review of infants ≤29 weeks gestation undergoing NIRS and echocardiography due to concern for hsPDA. The hsPDA was defined by two of the following: moderate-large size, left to right shunt, aortic flow reversal, left atrial enlargement. AKI was defined by neonatal modified Kidney Disease Improving Global Outcomes (KDIGO). Rsat and cerebral saturation (Csat), averaged over 1 hour, were evaluated for the 24 hour period around echocardiography. Result: Among 77 infants, 29 (38%) had AKI by neonatal modified KDIGO criteria. hsPDA was found on echocardiography in 59 (77%). There were no differences in hsPDA in infants with and without AKI (p=0.1). Rsat was not associated with AKI (p=0.3). Infants on dopamine had less Rsat variability (p<0.01). Conclusion: Rsat prior to echocardiography did not discriminate AKI in this cohort of preterm infants at risk for hsPDA, however data may not capture optimal timing of Rsat measurement before AKI.

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Renal Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

Rose

Frymoyer

Bhombal

et al. 2022

Preprint

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Objective: Decreased near-infrared spectroscopy (NIRS) measures of renal saturation (Rsat) have identified hemodynamically significant PDA (hsPDA) and may delineate infants at risk for acute kidney injury (AKI). Design: Review of infants 29 weeks gestation undergoing NIRS and echocardiography due to concern for PDA. hsPDA was defined by two of the following: moderate-large size, left to right shunt, aortic flow reversal, left atrial enlargement. AKI was defined by neonatal KDIGO. Rsat and cerebral saturation (Csat) were evaluated for 24 hours before echocardiography. Result: Among 77 infants, hsPDA was found on echocardiography in 59 (77%). There were no differences in hsPDA in infants with and without AKI. Rsat was not associated with AKI (p=0.3) or hsPDA (p=0.5). Infants on dopamine had less Rsat variability (p=0.001). Conclusion: Rsat prior to echocardiography did not discriminate AKI in the preterm hsPDA population, however data may not capture optimal timing of Rsat measurement before AKI.

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The often forgotten systemic effects of ductus arteriosus: impact on decision-making and future trials

Cited by 3 publications

References 17 publications

Automated Identification of Patent Ductus Arteriosus Using a Computer Vision Model

Automated Identification of Patent Ductus Arteriosus Using a Computer Vision Model

Renal Oxygen Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

Renal Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

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