Abstract
ABSTRACTObjective:To identify clinical and echocardiographic parameters associated with the evolution of the ductus arteriosus in neonates with birth weight lower than 1,500g.Methods:Retrospective study of 119 neonates in which clinical parameters (Prenatal: maternal age, risk of infection and chorioamnionitis, use of corticosteroid, mode of delivery and gestational age. Perinatal: weight, Apgar score, gender and birth weight/gestational age classification; Postnatal: use of surfactant, sepsis, fluid intake, heart murmur, heart rate, precordial movement and pulses, use of diuretics, oxygenation index, desaturation/apnea, ventilatory support, food intolerance, chest radiography, renal function, hemodynamic instability, and metabolic changes) and echocardiographic parameters (ductus arteriosus diameter, ductus arteriosus/weight ratio, left atrium/ aorta ratio, left ventricular diastolic diameter, and transductal flow direction, pattern and velocity) were analyzed. The clinical and echocardiographic parameters analyzed were considered statistically significant when p<0.05.Results:In the 119 neonates, the incidence of patent ductus arteriosus was 61.3%; 56 received treatment (46 pharmacological and 10 surgical treatment), 11 had spontaneous closure, 4 died, and 2 were discharged with patent ductus arteriosus. A higher incidence of chorioamnionitis, use of surfactant, lower weight and gestational age, sepsis, heart murmur, ventilatory support and worse oxygenation indices were observed in the neonates receiving treatment. The group with spontaneous closure had a smaller ductus arteriosus diameter, lower ductus arteriosus/weight ratio, and higher transductal flow velocity.Conclusion:Based on clinical and echocardiographic parameters, the neonates with spontaneous closure of the ductus arteriosus could be differentiated from those who required treatment.
Highlights
The ductus arteriosus (DA) is a structure that is present in the fetus and connects the aorta and the pulmonary artery, diverting the right ventricular flow into the systemic circulation[1,2].Soon after birth, the process of functional DA closure starts[1]
In preterm neonates (PTN), patent ductus arteriosus (PDA) is common due to increased sensitivity to prostaglandins, a higher incidence of hypoxia and acidosis, and defective migration of the smooth muscle that leads to DA vasoconstriction[3,4,5]
PDA is an anomaly that affects a large number of premature neonates and may lead to significant clinical consequences, with an impact in the morbidity and mortality of these patients
Summary
The ductus arteriosus (DA) is a structure that is present in the fetus and connects the aorta and the pulmonary artery, diverting the right ventricular flow into the systemic circulation[1,2].Soon after birth, the process of functional DA closure starts[1]. With PDA, there is high pulmonary flow and low systemic flow, which may be associated with morbidities in the PTN, such as chronic pulmonary disease, ventricular hemorrhage, leukomalacia, necrotizing enterocolitis, renal failure, congestive heart failure, retinopathy of prematurity, and increased mortality in patients with respiratory distress syndrome[6,7]. The procedures currently available for the treatment of PDA are the use of non-steroidal antiinflammatory drugs and surgical closure. These treatments have been proven effective, their use remains controversial due to their side effects (risk of transient change in brain perfusion and transient decrease in renal function when antiinflammatory drugs are used; and pneumothorax, infection, hemorrhage, chylothorax and vocal cord paralysis when surgery is used), and to the lack of evidence that they improve the patients’ long-term outcome[7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
