Ultrasonographic study of ductus venosus in healthy neonates

Fugelseth, Drude; Lindemann, Rolf; Liestøl, Knut; Kiserud, Torvid; Langslet, A

doi:10.1136/fn.77.2.f131

Cited by 53 publications

(36 citation statements)

References 18 publications

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“…However, not even in IDM with severe IVSd hypertrophy or high PAPs, we found reverse flow pattern in DV, confirming that these newborns did not reach supra-systemic pulmonary hypertension [22]. In addition, the abnormal cerebral blood flow velocity underlines hemodynamic alterations.…”

Section: Discussionsupporting

confidence: 58%

Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography and peripheral flow study

Schierz

Pinello

Piro

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: Metabolic alterations of intrauterine environment in diabetes mellitus (DM) lead to fetal cardiac dysfunctions that can persist after birth. The aim of the study was to assess the cardiovascular adaptation in infants born to diabetic mothers (IDM) with different degrees of glycometabolic control, in relation to revised guidelines for diagnosis of DM and quality improvements in neonatal care. Materials and methods: An observational case-control study was conducted on IDM with gestational, type 1 and type 2 DM. Relevant maternal and neonatal anamnestic, clinical and laboratory data were analyzed. Electrocardiographic and echocardiographic analyses, including structural and systo-diastolic evaluation, were performed. Results: In 68 IDM enrolled, we observed a lower incidence of negative perinatal outcome than expected. Comparing to non-IDM, they presented larger fetal shunts, higher pulmonary pressures, early and atrial wave velocities. At 72 hours, kinesis and heart rate variability remained low. Cerebral blood flow velocities were higher. The most serious impairment of transition was in pregestational IDM. Conclusion: Maternal DM impaired neonatal transitional hemodynamics also in asymptomatic IDM with good glycometabolic control. These results confirm the need for an early cardiologic and cerebrovascular evaluation, to identify IDM with delayed maturation at risk of worse longterm metabolic, cardiovascular, and neurodevelopmental outcome. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 58%

Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography and peripheral flow study

Schierz

Pinello

Piro

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Human studies, performed using doppler ultrasound, have not been able to directly quantitate the magnitude of the ductus venosus shunt. These studies, however, show patency of the ductus venosus in 88% of infants at day three and 24-68% of infants at day seven, with complete closure by day eighteen (Loberant et al 1992;Fugelseth et al 1997).…”

Section: Neonatal Liver Blood Flowmentioning

confidence: 92%

Neonatal Hepatic Drug Elimination

Gow

Ghabrial

Smallwood

et al. 2001

Pharmacology & Toxicology

104

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After the transition from in utero to newborn life, the neonate becomes solely reliant upon its own drug clearance processes to metabolise xenobiotics. Whilst most studies of neonatal hepatic drug elimination have focussed upon in vitro expression and activities of drug-metabolising enzymes, the rapid physiological changes in the early neonatal period of life also need to be considered. There are dramatic changes in neonatal liver blood flow and hepatic oxygenation due to the loss of the umbilical blood supply, the increasing portal vein blood flow, and the gradual closure of the ductus venosus shunt during the first week of life. These changes which may well affect the capacity of neonatal hepatic drug metabolism. The hepatic expression of cytochromes P450 1A2, 2C, 2D6, 2E1 and 3A4 develop at different rates in the postnatal period, whilst 3A7 expression diminishes. Hepatic glucuronidation in the human neonate is relatively immature at birth, which contrasts with the considerably more mature neonatal hepatic sulfation activity. Limited in vivo studies show that the human neonate can significantly metabolise xenobiotics but clearance is considerably less compared with the older infant and adult. The neonatal population included in pharmacological studies is highly heterogeneous with respect to age, body weight, ductus venosus closure and disease processes, making it difficult to interpret data arising from human neonatal studies. Studies in the perfused foetal and neonatal sheep liver have demonstrated how the oxidative and conjugative hepatic elimination of drugs by the intact organ is significantly increased during the first week of life, highlighting that future studies will need to consider the profound physiological changes that may influence neonatal hepatic drug elimination shortly after birth.The development of clinical pharmacology has resulted in a more rational approach to drug therapy, as well as a deeper understanding of the factors capable of influencing drug disposition, and hence drug effects. Of these factors, age is of great importance. However, substantial differences in drug disposition not only exist between neonates and adults, but also among premature neonates, term neonates, infants and children.During the last two decades drug disposition in the neonatal period has been studied extensively. A major impetus for these studies seems to have been a series of incidents involving illness or death following the administration of drugs at ratios of dose/body weight innocuous in an adult (Craft et al. 1974;Gershanik et al. 1982). These studies have shown that the transition from neonate to childhood is characterised by the ontogeny of all of the processes of drug absorption, distribution, hepatic metabolism and renal excretion, with the development of hepatic drug metabolism being particularly important.The extent to which the neonatal drug-metabolising en-

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“…After birth, the ductus ceases its function and undergoes closure, but the timing of this process varies individually and between species so that the vessel may persist for a certain period as a portocaval shunt (Zink & Van Petten, 1980;Momma et al, 1992;Fugelseth et al, 1997). The issue of whether prenatal patency and postnatal closure are actively or passively determined has been debated through the years, the specific point of contention being the functional significance of a tissue ridge at the junction of the ductus with the portal sinus (Coceani, 1993;Kiserud, 1999;Mavrides et al, 2002;Ailamazyan et al, 2003;Tchirikov et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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

Adeagbo

Kelsey

Coceani

2004

British J Pharmacology

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1 The ductus venosus is actively regulated in the fetus, but questions remain on the presence of a functional sphincter at its inlet. Using fetal sheep (0.6-0.7 gestation onwards), we have examined the morphology of the vessel and have also determined whether endothelin-1 (ET-1) qualifies as a natural constrictor being modulated by prostaglandins (PGs). 2 Masson's staining and a-actin immunohistochemistry showed a muscular, sphincter-like formation at the ductus inlet and a muscle layer within the wall of the vessel proper. This muscle cell component increased with age. 3 ET-1 contracted dose-dependently isolated sphincter and extrasphincter preparations of the ductus from term fetus. This ET-1 effect also occurred in the premature, but its threshold was higher. 4 BQ123 (1 mM) caused a rightward shift in the ET-1 dose-response curve, while indomethacin at a threshold concentration (28 nM) tended to have an opposite effect. 5 Big ET-1 also contracted the ductus sphincter but differed from ET-1 for its lesser potency and inhibition by phosphoramidon (50 mM). 6 The ductus sphincter (term and preterm) and extrasphincter (term) released 6-keto-PGF 1a (hence PGI 2 ) and, to a lesser degree, PGE 2 at rest and their release increased dose-dependently upon ET-1 treatment. Both basal and stimulated release was curtailed by endothelium removal. 7 BQ123 and phosphoramidon reduced slightly the contraction of ductus sphincter to indomethacin (2.8 mM). 8 We conclude that the ductus contains a contractile mechanism in the sphincter and extrasphincter regions. ET-1 lends itself to a role in the generation of contractile tone and its action may be modulated by prostaglandins.

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Ultrasonographic study of ductus venosus in healthy neonates

Cited by 53 publications

References 18 publications

Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography and peripheral flow study

Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography and peripheral flow study

Neonatal Hepatic Drug Elimination

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

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