Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

Sehgal, Arvind; Coombs, Peter; Tan, Kenneth; McNamara, Patrick J.

doi:10.1038/jp.2010.83

Cited by 22 publications

(18 citation statements)

References 45 publications

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“…The relationship, however, between these echocardiographic markers of ductal steal, actual end-organ tissue oxygen delivery, and adverse outcome remains unclear [19]. Groves et al [13] reported preserved superior vena cava flow but decreased Dao flow in preterm infants with PDA and retrograde diastolic blood flow in the Dao compared with infants with PDA without retrograde diastolic blood flow in the Dao during the first 48 h after birth.…”

Section: Discussionmentioning

confidence: 99%

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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Background: Patent ductus arteriosus (PDA) is common in preterm infants and is associated with significant morbidity. To determine whether the PDA is hemodynamically significant (HSDA), several echocardiographic parameters have been suggested, including retrograde diastolic blood flow in the descending aorta (Dao). Objective: To assess the impact ofan HSDA, including retrograde diastolic flow in the Dao, on regional tissue oxygen saturation (rSO₂) and extraction measured by near-infrared spectroscopy (NIRS). Methods: This is a prospective observational cohort study in which we included preterm infants (GA <32 weeks) who underwent echocardiographic screening because of clinical signs of an HSDA within 2 weeks after birth. We measured cerebral and renal rSO₂ on the day of echocardiography. HSDA was diagnosed if left-to-right shunting through the PDA was accompanied by left atrial-to-aortic root ratio >1.4 and/or left pulmonary artery end-diastolic flow velocity >0.2 m/s and/or retrograde diastolic blood flow in the Dao. Results: Forty-nine infants were included, with a median GA of 27.6 weeks (IQR: 26.1-29.0), birth weight of 980 g (IQR: 800-1,200), and postnatal age of 77 h (IQR: 70-107). Infants with a closed duct (n = 11), a non-HSDA (n = 18), and an HSDA (n = 20) had similar cerebral and renal NIRS measurements. Retrograde diastolic blood flow in the Dao, present in 11 infants with PDA, also did not affect cerebral and renal NIRS measurements. Conclusion: In preterm infants with clinical signs of an HSDA within 2 weeks after birth, cerebral and renal oxygen saturation and extraction are not affected by an HSDA or by retrograde diastolic blood flow in the Dao.

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Section: Discussionmentioning

confidence: 99%

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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“…It has only recently been suggested that a more expectant PDA approach may be superior [2,3] . Although even Doppler waveforms have been used to decide for or against medical/surgical treatment [4,5] , neither echocardiography [6] nor clinical examination can reliably differentiate be-tween hsPDA and the benign variant of a clinically harmless PDA.…”

Section: Introductionmentioning

confidence: 99%

Urinary NT-proBNP, NGAL, and H-FABP May Predict Hemodynamic Relevance of Patent Ductus Arteriosus in Very Low Birth Weight Infants

Tosse¹,

Pillekamp²,

Verde

et al. 2012

Neonatology

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Background: Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common functional cardiovascular disease in preterm infants. The necessity to treat hsPDA can neither be derived solely from clinical nor from echocardiographic criteria. Objective: The aim of this study was to establish non-invasive parameters which can differentiate hsPDA from non-hsPDA. Methods: Urinary protein levels of NT-proBNP, NGAL, and H-FABP were measured and correlated with the necessity of therapy for PDA. In 37 neonates (<1,500 g), urinary protein concentrations were tested on days 0, 2, and 7 by ELISA methodology. Of 37 infants, 12 required therapeutic interventions according to current treatment standards. Results: Infants receiving an intervention for PDA showed significantly higher levels of pro-BNP, NGAL, and H-FABP at all time points except for NT-proBNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples, the concentration of the three proteins correlated positively with each other. Conclusions: The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of PDA on systemic perfusion in preterm infants. Furthermore, NGAL and H-FABP may be used to indicate the necessity of pharmacological or surgical treatment of PDA.

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“…1,4 Methods to close or minimize the effects of a clinically significant PDA include conservative management (eg, fluid restriction, diuretics, ventilation strategies), cyclooxygenase inhibitors (eg, indomethacin or ibuprofen), acetaminophen, or surgical ligation. 5,6 Surgical ligation is usually only considered when medical treatment has either failed or was contraindicated. 7 Several investigators have studied PDA ligation and its association with neonatal mortality, short-term morbidity, and neurodevelopmental impairment (NDI) in early childhood.…”

mentioning

confidence: 99%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks’ gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01–2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98–3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62–3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38–0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58–1.57). CONCLUSIONS: Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.

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Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

Cited by 22 publications

References 45 publications

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Urinary NT-proBNP, NGAL, and H-FABP May Predict Hemodynamic Relevance of Patent Ductus Arteriosus in Very Low Birth Weight Infants

PDA Ligation and Health Outcomes: A Meta-analysis

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