Time of closure of ductus venosus in term and preterm neonates

Abstract

Aim-To investigate the relation between gestational age, birth weight, and antenatal corticosteroid administration and the time of ductus venosus closure. Methods-Ninety eight neonates of 30-41 weeks gestational age were studied by daily ultrasonography until ductus venosus closure. Results-In neonates of 30-33 weeks gestational age, the ductus venosus closed at 6.0 (2.4)days (mean (SD)); in those of 34-36 weeks gestational age, it closed at 6.1 (2.8) days; and in those of 37-41 weeks gestational age, it closed at 4.2 (2.1) days. The eVect of antenatal administration of corticosteroids on the time of closure was also investigated in neonates of 30-34 weeks gestational age. Closure occurred by 5.5 (2.4) days in the group given corticosteroids compared with 7.5 (2.1) days in the remainder. Conclusions-The ductus venosus closed sooner after birth in neonates of greater gestational age or higher birth weight. Antenatal corticosteroid administration had a significant eVect in promoting closure. (Arch Dis Child Fetal Neonatal Ed 2001;85:F57-F59) Keywords: ductus venosus closure; antenatal corticosteroids; gestational age; birth weightThe adaptation of the respiratory, circulatory, endocrine, metabolic, and nervous systems from the intrauterine to the extrauterine environment must be accomplished dynamically and smoothly at birth. The adaptation of the postnatal circulatory system is the most abrupt and dynamic of these changes. There are three specific vascular shunts in the fetal period: the foramen ovale, which by closing separates the left and right heart systems; the ductus arteriosus, which separates the pulmonary and systemic circulation; the ductus venosus, which separates the hepatoportal and systemic circulation. The pathophysiology and mechanism of closure and the pharmacological manipulation of the ductus arteriosus have been studied in detail. The ductus venosus, on the other hand, has been the subject of very little study because it is regarded as having little pathophysiological significance. A functionally patent ductus venosus was found to shunt at least 25% of the total portal blood flow in 50% of lambs between the second and sixth days of life, 1 which is a level that cannot be ignored. Moreover, the early postnatal period is an unstable phase for the respiratory and circulatory systems and often a period of frequent drug treatment. In addition, if feeding is started from an early age, liver metabolism and other factors aVect ductus venosus patency, and clinically there is the possibility of deleterious eVects on the body from endogenous and exogenous toxic substances.The purpose of this study was to investigate the relation of gestational age and birth weight to the time of functional closure of the ductus venosus, as well as whether or not antenatal administration of corticosteroids aVects the time of closure. Materials and methodsThe subjects were 98 neonates of 30-41 weeks gestational age, who were in the Perinatal Center of the Ehime Prefecture Central Hospital between June 1995 and D...

Endothelin‐induced constriction of the ductus venosus in fetal sheep: developmental aspects and possible interaction with vasodilatory prostaglandin

“…TXA 2 , on the other hand, is as potent as ET-1 in contracting the ductus (Adeagbo et al, 1985;see Results), but in exerting any effect it may only originate from extramural sources (Adeagbo et al, 1982;1985). Significant in the present context is also the observation that corticosteroids, while enhancing the susceptibility of fetal blood vessels to ET-1 (Docherty et al, 2001), are also capable of promoting the closure of the ductus in the prematurely born infant (Kondo et al, 2001). In addition, tests with big ET-1, specifically the demonstration of the susceptibility of the agent to the interfering action of phosphoramidon, point to the occurrence of a functional converting enzyme in the tissue.…”

“…While confirming the importance of extrinsic factors -resistance of the hepatic vascular district, magnitude of the umbilicocaval pressure gradient, blood viscosity -for the control of ductal flow (see Kiserud, 1999), this new line of investigation has yielded direct evidence, both in animals and humans, of an active tone regulation in the putative sphincter region as well as in the remainder of the vessel (Bellotti et al, 1998;Kiserud et al, 2000a). Coincidentally, it has demonstrated that ductus closure is delayed in preterm compared to term infants and, moreover, has ascertained that this sign of prematurity may subside after antenatal treatment with corticosteroids (Fugelseth et al, 1998;Loberant et al, 1999;Kondo et al, 2001). The latter observation is consistent with a gestation-linked maturation of local mechanism(s) that are amenable to upregulation.…”

“…No data are available in the living fetus to confirm this point. However, in the newborn it has been shown that prematurity is linked to delayed closure of the vessel (Fugelseth et al, 1998;Loberant et al, 1999;Kondo et al, 2001).…”

Postnatal anatomical and functional development of the heart: A species comparison

“…The ductus venosus, which carries portal and umbilical blood to the inferior vena cava, is functionally closed within hours of birth. Permanent closure begins a few days after birth and is complete by 18-20 days of age (Meyer and Lind, 1966;Fugelseth et al, 1997;Kondo et al, 2001). The duct becomes the ligamentum venosum in a fissure on the back of the liver.…”

Measuring Physiological Changes during the Transition to Life after Birth

“…This promotes functional closure of the FO, thus completing transition. The ductus venosus (DV) will remain patent up to days after birth [53]. However, it will not be of further influence to the cardiovascular system.…”