Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants.

Abstract

We have shown that an assessment of both atrial and PDA shunt size can be derived from the respective colour Doppler shunt diameter.89 We used this and other echocardiographic measures to highlight the complexity of early preterm cardiac haemodynamics in a cohort of 120 ventilated preterm infants.10 Low ventricular outputs are a common early finding and are associated with high ventilatory pressures and large left to right PDA and atrial shunts which "steal" blood from the systemic circulation, even in the early postnatal period. 10 We hypothesised that there is an association between these early cardiovascular changes and IVH. The aim of this analysis was to examine if there were any significant associations, in this same group of preterm infants, between our early echocardiographic measures, other perinatal variables, and the occurrence of IVH. MethodsPreterm infants with a birthweight of less than 1500 g and respiratory problems likely to require mechanical ventilation for more than 24 hours were selected for echocardiographic study. The infants were studied over two 12 month periods which began, respectively, in February 1992 and June 1993. Echocardiography was performed at a mean of 19 hours of age (range 7-31 hours).Echocardiographic data collection was done using an Acuson 128/XP10 ultrasound machine with a 7 MHz transducer incorporating colour flow, pulsed wave, and continuous wave Doppler. Structural normality of the heart was established on the initial scan. A videotape of the scan was made and measurements were done later. Echocardiographic measures included: right ventricular output (RVO); colour Doppler diameter and pulsed Doppler direction of any ductus arteriosus shunt; left ventricular output (LVO); colour Doppler diameter and pulsed Doppler direction of any interatrial shunt. The echocardiographic procedure and measurement protocol have been described before.'0 Cerebral ultrasound scans were performed with a 7 MHz transducer. All infants were scanned between the fourth and seventh postnatal day and then again on day 28. These scans were recorded on to x-ray film and reported by a paediatric radiologist who was unaware of either the echocardiographic or clinical findings. These scans were used as the

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

“…A significant PDA also affects the cerebral blood flow, mostly during diastole, a possible pathway for IVH and PVL [42,46]. A link between PDA and IVH has been reported in many studies, as in the current report where there was an increased risk for IVH in Group 1 compared to Group 2 [20,40,46,47,68] (Table 4).…”

“…A link between PDA and IVH has been reported in many studies, as in the current report where there was an increased risk for IVH in Group 1 compared to Group 2 [20,40,46,47,68] (Table 4).…”

“…In the short term, PDA is associated with decreased blood pressure [5,8], decreased renal function [5], cardiac congestive failure [18,37,38], pulmonary haemorrhage [8,39], apnea and ventilator-dependency [6,38], bronchopulmonary dysplasia (BPD) [5,14,20,21,25,34,41,42], necrotizing enterocolitis (NEC) [8,9,11,19,20,34,39,43,44], intraventricular hemorrhage (IVH) [5,19,20,39,42,45,46], periventricular leukomalacia (PVL) [5], retinopathy of prematurity (ROP), cerebral palsy [24], delayed growth [11], and increased mortality rate [6,34,45,[47][48][49][50].…”

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

“…PDA has been reported to be associated with morbidities in preterm infants as a result of ductal steal from systemic circulation, for example, pulmonary congestion, pulmonary hemorrhage, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing enterocolitis. [1][2][3][4] Strategies for PDA closure involve prophylactic treatment, presymptomatic treatment for non-HsPDA, and treatment for HsPDA. 5,6 Although prophylactic treatment with indomethacin reduces incidence of PDA and severe intraventricular hemorrhage in preterm infants, 7,8 there are no differences in mortality and long-term neurodevelopment.…”

Diagnosis of patent ductus arteriosus by a neonatologist with a compact, portable ultrasound machine

“…[1][2][3][4][5] In a review of periventricular leukomalacia in preterm infants, PDA was associated with decreased cerebellar volume, area of the vermis and diameter of the pons. 6 The frequency of PDA is high in premature infants, ranging from 53% in infants born before 34-weeks gestation, up to 65% in infants born before 26-weeks gestation.…”