Abstract
Background: Cardiovascular changes during the transition from intra- to extrauterine life, alters the pressure gradient across the ductus arteriosus (DA). DA flow ratio (R-L/L-R) has been suggested to reflect the infant's transitional status and could potentially predict neonatal outcomes after preterm birth.Aim: Determine whether DA flow ratio correlates with oxygenation parameters in preterm infants at 1 h after birth.Methods: Echocardiography was performed in preterm infants born <32 weeks gestational age (GA), as part of an ancillary study. DA flow was measured at 1 h after birth. DA flow ratio was correlated with FiO2, SpO2, and SpO2/FiO2 (SF) ratio. The DA flow ratio of infants receiving physiological-based cord clamping (PBCC) or time-based cord clamping (TBCC) were compared.Results: Measurements from 16 infants were analysed (median [IQR] GA 29 [27–30] weeks; birthweight 1,176 [951–1,409] grams). R-L DA shunting was 16 [17–27] ml/kg/min and L-R was 110 [81–124] ml/kg/min. The DA flow ratio was 0.18 [0.11–0.28], SpO2 94 [93–96]%, FiO2 was 23 [21–28]% and SF ratio 4.1 [3.3–4.5]. There was a moderate correlation between DA flow ratio and SpO2 [correlation coefficient (CC) −0.415; p = 0.110], FiO2 (CC 0.384; p = 0.142) and SF ratio (CC −0.356; p = 0.175). There were no differences in DA flow measurements between infants where PBBC or TBCC was performed.Conclusion: In this pilot study we observed a non-significant positive correlation between DA flow ratio at 1 h after birth and oxygenation parameters in preterm infants.
Highlights
After birth, major cardiovascular changes occur during transition from intra-uterine to extra-uterine life
There was a moderate correlation between ductus arteriosus (DA) flow ratio and SpO2 [correlation coefficient (CC) −0.415; p = 0.110], FiO2 (CC 0.384; p = 0.142) and SF ratio (CC −0.356; p = 0.175)
There were no differences in DA flow measurements between infants where PBBC or time-based cord clamping (TBCC) was performed
Summary
Major cardiovascular changes occur during transition from intra-uterine to extra-uterine life These cardiovascular changes are triggered by lung aeration and umbilical cord clamping. The pressure changes in both the pulmonary and systemic circulation that accompany transition are reflected in the ductus arteriosus (DA) flow Both clinical and preclinical studies have evaluated DA flow to entirely flow from right-to-left (R-L) prior to birth, due a high PVR. DA flow ratio is likely to be influenced by the increase in SVR after cord clamping as well as the degree of lung aeration and decrease in PVR (4) As such, this measurement could theoretically be used to indicate a successful or disturbed neonatal transition, and even potentially predict (adverse) neonatal outcomes. DA flow ratio (R-L/L-R) has been suggested to reflect the infant’s transitional status and could potentially predict neonatal outcomes after preterm birth
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