Hemodynamically significant PDA: An echocardiographic and clinical assessment of incidence, natural history, and outcome in very low birth weight infants maintained in negative fluid balance

Abstract

Fifty very low birth weight (VLBW) infants (750-1500 g, 27-33 weeks gestational age) were assigned at random to one of two groups of negative fluid balance and underwent prospective clinical and echocardiographic examinations during the first month of life. The purpose was to determine: the effect of fluid restriction on the incidence of ductal shunting, the reliability of the physical examination in diagnosing significant ductal shunting, and the relationship between significant ductal shunting and outcome in such infants. None of the infants had manipulations to close the ductus during the first week of life. Using routine structural and functional echocardiographic indices as criteria for the diagnosis of hemodynamically significant ductal shunting (hsPDA), we found that the two fluid-balance groups (8%-10% weight loss vs 13%-15% weight loss) did not significantly differ in incidence of hsPDA, duration of ventilation, or development of BPD. These two groups were then combined for further analysis: 32 (64%) of 50 VLBW infants had hsPDA during the first week of life. The group of infants with hsPDA did not differ significantly from that without hsPDA in birth weight or gestational age, but had a significantly lower Apgar score (P less than 0.04) and was significantly more likely to require ventilator support for RDS (P less than 0.01). Although when present a typical ductal murmur was specific for the development of significant ductal shunting, no murmur was heard in 21 (66%) of 32 infants with early hsPDA.(ABSTRACT TRUNCATED AT 250 WORDS)

Patent Ductus Arteriosus: Perinatal Risk Factors

“…Reller et al [13] also found that in VLBW infants, birth asphyxia and severe RDS were significant risk factors for development of an early hemodynamically significant PDA.…”

“…Besides immaturity and severity of illness frequently presented by preterm infants, other parameters, namely, the Apgar score, presence of metabolic acidosis and need for supplemental oxygen are also considered when scoring [14], all contributing to PDA, as noted above [13].…”

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

“…However, oxygen saturations in the range of 83 to 89% do not appear to impact the response of the DA to pharmacological closure as the rate of surgical ligation remained unchanged. Several factors affect the incidence of PDA in preterm neonates including GA, 1 intrauterine growth restriction, 18 antenatal steroids, 19,20 low Apgar scores 21 and the presence of respiratory distress syndrome. 22 When adjusted for these factors using univariate and multivariate logistic regression, the odds of having an hsPDA remained higher with the low oxygen saturation limits.…”

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

“…2,3 In these neonates, the incidence of a persistent patent DA (PDA) increases with decreasing estimated gestational age (EGA) and BW, [2][3][4][5] although not all studies have arrived at this conclusion. 6 As a group, as many as 31% of very low BW neonates develop a clinically and hemodynamically significant PDA (sPDA) with signs of increased left to right shunting, pulmonary edema and an enlarged cardiothymic shadow on chest X-ray. 7 The presence of a sPDA in very low BW preterm neonates has been associated with pulmonary edema and hemorrhage, prolonged mechanical ventilation and oxygen requirement, development of bronchopulmonary dysplasia (BPD) or chronic lung disease, necrotizing enterocolitis, intracranial hemorrhage and retinopathy of prematurity.…”