Precision and Accuracy of Clinical and Radiological Signs in Premature Infants at Risk of Patent Ductus Arteriosus

Davis, Peter G; Turner-Gomes, Sophronia O.; Cunningham, Kathryn; Way, Clifton; Roberts, Robin S.; Schmidt, Barbara

doi:10.1001/archpedi.1995.02170230090013

Cited by 94 publications

(41 citation statements)

References 24 publications

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“…Clinical assessment for the diagnosis of PDA has been shown to be specific, but not sensitive. [12][13][14] Echocardiography is used to detect PDA and to assess the degree of shunting through various cardiac indices, for example, left atrium to aortic root ratio (LA/Ao ratio), left ventricular size or left ventricular output. 15 However, its availability is limited, particularly in developing countries.…”

Section: Introductionmentioning

confidence: 99%

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

Nuntnarumit

Khositseth

2008

J Perinatol

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Objective: To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting.Study Design: An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus X2 clinical features of PDA.Result: Plasma NT-proNBP levels on day 2 in the HsPDA group (n ¼ 12) were significantly higher than in non-HsPDA group (n ¼ 23) with a median of 16 353 pg ml À1 (interquartile range (IQR), 12 360-33 459; range, 10 316-104 998) vs 3914 pg ml À1 (IQR, 2601-5782; range, 1535-19 516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P ¼ 0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10 180 pg ml À1 offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%.Conclusion: Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP. Journal of Perinatology (2009) 29, 137-142; doi:10.1038/jp.2008 published online 20 November 2008 Keywords: preterm infant; patent ductus arteriosus; NT-proBNP Introduction It is of vital importance to recognize and properly treat hemodynamically significant patent ductus arteriosus (HsPDA) 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. 9,10 Recent studies have shown that only one-third of very low birth weight infants develops significant PDA. 10,11 Therefore, a number of infants, whose PDA would otherwise close spontaneously, will be exposed to the treatment unnecessarily if prophylaxis strategy is used. Clinical assessment for the diagnosis of PDA has been shown to be specific, but not sensitive. [12][13][14] Echocardiography is used to detect PDA and to assess the degree of shunting through vario...

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Section: Introductionmentioning

confidence: 99%

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

Nuntnarumit

Khositseth

2008

J Perinatol

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“…[1][2][3] The currently used tools, such as the clinical findings, which include heart failure and the typical echocardiographic features of hsPDA, have unsatisfactory sensitivities and/or specificities. [4][5][6][7][8] A simple blood test that could easily, rapidly, and accurately help in diagnosing hsPDA would be of great use, especially in low birth weight infants. However, currently no accepted blood test is available to aid in the diagnosis and management of preterm infants with PDA.…”

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confidence: 99%

Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants

et al. 2005

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ABSTRACT. Objective. In preterm infants, the rapid and accurate determination of the presence of a hemodynamically significant patent ductus arteriosus (PDA) is extremely important, but this is often difficult. Plasma B-type natriuretic peptide (BNP) measurement has been reported to be a helpful aid in the diagnosis of hemodynamically significant PDA in preterm infants. The aim of our study was to investigate the usefulness of a rapid BNP assay as a diagnostic marker of symptomatic PDA (sPDA) in preterm infants.Methods. Sixty-six preterm infants, ranging from 25 to 34 gestational weeks of age, underwent clinical and echocardiographic examinations for PDA every other day from the third day of life until the disappearance of ductal flow. Blood samples were collected and plasma BNP concentrations were measured simultaneously using a commercial kit, (Triage BNP test kit; Biosite Diagnositics, San Diego, CA). When >2 clinically significant features of PDA were noted, and a large ductal flow was confirmed by color Doppler echocardiography, sPDA was diagnosed and treated with indomethacin.Results. On the third day after birth, the mean BNP concentration in the sPDA group (n ‫؍‬ 23) was significantly higher than in the control group (n ‫؍‬ 43) (2896 ؎ 1627 vs 208 ؎ 313 pg/mL). Seventeen infants (74%) in the sPDA group became asymptomatic after an initial course of indomethacin and their BNP levels concomitantly decreased. Moreover, BNP concentrations were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery (r ‫؍‬ 0.726 and 0.877). The area under the receiver operator characteristic curve for the detection of sPDA was high: 0.997 (95% confidence interval: 0.991-1.004). The best cutoff of BNP concentration for the diagnosis of sPDA was determined to be 1110 pg/mL (sensitivity: 100%; specificity: 95.3%).Conclusion. In preterm infants, the circulating BNP levels correlated well with the clinical and echocardiographic assessments of PDA. Although not a stand-alone test, the rapid BNP assay provides valuable information for the detection of infants with sPDA that require treatment. Moreover, serial BNP measurements may be of value in determining the clinical course of PDA in preterm infants. ABBREVIATIONS. PDA, patent ductus arteriosus; hsPDA; hemodynamically significant patent ductus arteriosus; BNP, B-type natriuretic peptide; sPDA, symptomatic patent ductus arteriosus; LA/AO, a ratio of left atrium to the aortic root diameter; DFLPA, diastolic flow velocity of the left pulmonary artery; ROC, receiver operator characteristic; asPDA, asymptomatic patent ductus arteriosus. R apidly and accurately determining the indications of therapeutic closure of a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is extremely important. [1][2][3] The currently used tools, such as the clinical findings, which include heart failure and the typical echocardiographic features of hsPD...

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“…İlk günlerde açık olabilen duktusun kapanmaması veya tekrar açılması hemodinamiyi bozmakta ve organların perfüzyonunu etkilemektedir. Bebeğin doğum haftası ne kadar küçük ise PDA görülme oranı da o kadar artmaktadır (11).…”

Section: Discussionunclassified

A Retrospective Evaluation of Causes of Morbidity, and Mortality among Babies Delivered in the Haseki Training and Research Hospital Within the Three Years

Alkan¹,

Elevli²,

Ataoğlu³

et al. 2016

Haseki

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AnahtarSözcükler:Yenidoğan, yoğun bakım, mortalite, morbidite Aim: Our aim was to evaluate morbidity and mortality rates, and relevant effective factors among babies delivered in our hospital between January 2009 and December 2011. Methods:We evaluated the neonatal care unit data on mortality and morbidity among babies delivered between January 1 st 2009 and December 31 st 2011, and analyzed epidemiological data of these babies born at gestational age of >22 weeks with a birth weight above 500 gr. Results:One thousand nine hundred five live babies and 32 stillbirths were delivered in the year 2011. Twelve babies died during early neonatal period. The rates of perinatal and early neonatal mortality, and stillbirth were found to be 2.27‰, 0.61‰, and 1.65‰, respectively. The causes of perinatal death were stillbirths (68.1%), congenital malformations (11.3%), prematurity-related factors (9%), and other etiologies (11.6%) in order of decreasing frequency.The most frequent indications for hospitalizations were neonatal hyperbilirubinemia (35.3%), and suspected sepsis (13.4%), and other etiologies. Our median mortality rate among babies delivered before the 32 nd weeks of gestation within three years was 14.5%. Conclusion:Providing adequate antenatal care for pregnants, realization of deliveries under optimal conditions, and delivery of sufficient postnatal care will dramatically decrease neonatal mortality rates.

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Precision and Accuracy of Clinical and Radiological Signs in Premature Infants at Risk of Patent Ductus Arteriosus

Cited by 94 publications

References 24 publications

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

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

Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants

A Retrospective Evaluation of Causes of Morbidity, and Mortality among Babies Delivered in the Haseki Training and Research Hospital Within the Three Years

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