Doppler assessment of pulmonary artery pressure in neonates at risk of chronic lung disease

Su, Bai-Horng; Watanabe, T.; Shimizu, Mitsumasa; Yamaguchi, Masayoshi

doi:10.1136/fn.77.1.f23

Cited by 17 publications

(15 citation statements)

References 31 publications

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“…Vascular abnormalities associated with BPD may lead to pulmonary arterial hypertension. 23 We and others have shown that iNO may be used safely in neonates for prevention 27 or treatment of BPD. 24,36 Nitric oxide does not have any adverse effects on surfactant, 37 but evidence for iNO efficacy remains insufficient to recommend its use for BPD.…”

Section: Discussionmentioning

confidence: 97%

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Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

et al. 2016

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IMPORTANCE Although immature neonate survival has improved, there is an increased risk of developing bronchopulmonary dysplasia, leading to significant respiratory morbidity. Measures to reduce bronchopulmonary dysplasia are not always effective or have important adverse effects. OBJECTIVE To evaluate the effect of late surfactant administration in infants with prolonged respiratory distress on ventilation duration, respiratory outcome at 36 weeks' postmenstrual age, and at 1 year postnatal age. DESIGN, SETTING, AND PARTICIPANTS Double-blind randomized clinical trial at 13 level III French perinatal centers. Participants included 118 neonates at less than 33 weeks' gestation who still required mechanical ventilation on day 14 (SD, 2) with fraction of inspired oxygen of more than 0.30. All survivors were eligible for follow-up. We performed an intent-to-treat analysis. INTERVENTIONS Infants received 200 mg/kg of poractant alfa (surfactant) or air after randomization. At 1 year, after parents' interview, infants underwent physical examination by pediatricians not aware of the randomization. MAIN OUTCOMES AND MEASURES The duration of ventilation was the primary outcome. The combined outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age and respiratory morbidity at 1 year of age were the main secondary outcome measures. RESULTS Of the 118 infants who participated in the study, 65 (55%) were male. Fraction of inspired oxygen requirements dropped after surfactant, but not air, for up to 24 hours after instillation (0.36 [0.11] vs 0.43 [0.18]; P < .005). Severe bronchopulmonary dysplasia/death rates at 36 weeks' postmenstrual age were similar (27.1% vs 35.6%; P = .32). Less surfactant-treated infants needed rehospitalization for respiratory problems after discharge (28.3% vs 51.1%; P = .03); 39.5% vs 50% needed respiratory physical therapy (P = .35). No difference was observed for weight (7.8 [1.2] kg vs 7.6 [1.1] kg), height (69 [5] cm vs 69 [3] cm), and head circumference (44.4 [1.7] cm vs 44.2 [1.7] cm) measured at follow-up, nor for neurodevelopment outcome. CONCLUSIONS AND RELEVANCE Late surfactant administration did not alter the early course of bronchopulmonary dysplasia. However, surfactant-treated infants had reduced respiratory morbidity prior to 1 year of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01039285

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Section: Discussionmentioning

confidence: 97%

“…right ventricular ejection time. [23][24][25] To treat associated pulmonary hypertension, 10 ppm inhaled nitric oxide (iNO) were added for 1 to 3 weeks, depending on weekly hemodynamics evaluations.…”

Section: Key Pointsmentioning

confidence: 99%

Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

et al. 2016

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“…A value >40 mm Hg was considered as pulmonary hypertension. 22,23 Doppler echocardiography was only performed at baseline.…”

Section: Methodsmentioning

confidence: 99%

The Use of Sildenafil in Persistent Pulmonary Hypertension of the Newborn

Vargas-Origel¹,

Gómez-Rodríguez²,

Aldana-Valenzuela³

et al. 2009

Amer J Perinatol

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We evaluated the effectiveness of sildenafil in the treatment of neonatal pulmonary hypertension. We performed a double-blind randomized clinical trial in 51 full-term infants with persistent pulmonary hypertension confirmed by Doppler echocardiography. Patients were divided in two groups: 20 infants in group A received placebo when the oxygenation index was >20, and 31 infants in group B received 3 mg/kg of oral sildenafil every 6 hours. Arterial blood gases were taken at 1, 4, 7, 13, 19, and 25 hours after treatment was started. Main outcome measures were oxygenation changes, time on mechanical ventilation, and mortality. Both groups were comparable in general variables as well as in illness severity. We observed better oxygenation parameters after 7 hours of sildenafil treatment, but no significant changes were found in the placebo group. Mortality was higher in the placebo group (40%) than in those infants who received sildenafil (6%; P = 0.004), although no difference was found in time on mechanical ventilation between groups. Our results confirm that sildenafil may be a useful adjuvant therapy for term infants with pulmonary hypertension in centers lacking inhaled nitric oxide and extracorporeal membrane oxygenation.

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“…SVC flow, Doppler measurement of right ventricular output (RVO), left pulmonary artery velocity, colour Doppler diameter of ductus arteriosus shunt and size, and Doppler of the middle cerebral arteries (MCAs) were performed according to previously published methods 9 10. Doppler assessment of pulmonary artery pressure was also performed using the time to peak velocity divided by the right ventricular ejection time (TPV/RVET) 11. All measurements were performed by one investigator (KW).…”

Section: Methodsmentioning

confidence: 99%

Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns

Waal¹,

Evans

Osborn

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Background: Positive pressure ventilation in premature infants can improve oxygenation but may diminish cerebral blood flow and cardiac output. Low superior vena cava (SVC) flow increases risk of intraventricular haemorrhage, and higher mean airway pressure is associated with low SVC flow. Whether this is a direct effect of positive pressure ventilation or a reflection of severity of lung disease is not known. This study aimed to determine if positive end expiratory pressure (PEEP) in ventilated newborns could be increased without clinically relevant cardiorespiratory changes. Method: Ventilated newborns were studied before and 10 min after increasing PEEP (5 cm H 2 O to 8 cmH 2 O) and again when PEEP returned to baseline. Echocardiographic and respiratory function measurements were collected during the intervention. Results: In 50 infants, increased PEEP was associated with a non-significant difference in mean SVC flow of 25 ml/kg/min (95% CI 212 to 3 ml/kg/min) but a significant reduction in right ventricular output of 17 ml/ kg/min (95% CI 5 to 28 ml/kg/min). The increase in lung compliance was non-significant (median difference 0.02 ml/cmH 2 O/kg) and the decrease in lung resistance (18 cmH 2 O/l/s; 95% CI 10 to 26 cm H 2 O/l/s) was significant. Changes (%) in lung compliance and SVC flow, when corrected for PaCO 2 , were positively associated (regression coefficient 0.4%; 95% CI 0.2% to 0.6%). Conclusion: A short-term increase in PEEP does not lead to significant changes in systemic blood flow, although 36% of infants in the present study had clinically important changes in flow (¡25%). The intervention can improve dynamic lung function, especially airway resistance. Improvements in compliance tend to be associated with improvements in blood flow.

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Doppler assessment of pulmonary artery pressure in neonates at risk of chronic lung disease

Cited by 17 publications

References 31 publications

Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

The Use of Sildenafil in Persistent Pulmonary Hypertension of the Newborn

Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns

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