Noninvasive technique for the diagnosis of patent ductus arteriosus in premature infants by analyzing pulse wave phases on photoplethysmography signals measured in the right hand and the left foot.

Sabrina Goudjil,Mahdi Mahmoudzadeh,Fatiha Imestouren,André Leke,Lucie Razafimanantsoa,Aurelie Armougon,Fabrice Wallois,Guy Kongolo,Vincenzo Lionetti

doi:10.1371/journal.pone.0098763

Sabrina Goudjil, Mahdi Mahmoudzadeh + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0098763

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Abstract

ObjectiveTo evaluate the impact of patent ductus arteriosus (PDA) on the pulse phase difference (PPD) between the left foot (postductal region) and the right hand (preductal region).Materials and MethodsPPD was determined from arterial photoplethysmography signals (pulse waves) measured by infrared sensors routinely used for pulse oximetry in 56 premature infants less than 32 weeks gestation. Only infants with significant PDA (sPDA) diagnosed by echocardiography were treated with ibuprofen (for 3 days). Patients were classified according to whether or not they responded (Success/Failure) to this treatment. The Control group was composed of infants in whom ductus had already closed spontaneously at the time of the first echocardiography. The 3 groups were compared in terms of PPD at the beginning (T1) and at the end (T2) of the study. For patients in the Failure (n = 17) and Success groups (n = 18), T1 corresponded to the first day of treatment and T2 to the day after completion of the course of ibuprofen. In the Control group (n = 21), T1 corresponded to 1 to 3 days of life (DOL), and T2 to 4–6 DOL.ResultsCompared to the Control group, PPD was higher in the Failure (at T1 and T2) and Success (at T1) groups characterized by sPDA. After ibuprofen therapy, PPD in the Success group decreased to about the level observed in the Control group. The area under the ROC curve of PPD for the diagnosis of sPDA was 0.98 (95% CI 0.96–1); for an optimal cut-off of PPD ≥1.65 deg/cm, the sensitivity was 94.2% and the specificity was 98.3%.ConclusionIn this study, PPD was correlated with ductus arteriosus status evaluated by echocardiography, indicating involvement of the ductal shunt in the mechanism of redistribution in systemic vascular territories. PPD can be considered for the diagnosis of hemodynamically significant PDA.

Highlights

Patent ductus arteriosus is common in premature infants born before 32 weeks and is associated with high morbidity and mortality, especially in neonates with a birthweight less than 1000 g [1], [2]
Compared to the Control group, pulse wave phase difference (PPD) was higher in the Failure and Success groups characterized by significant PDA (sPDA)
In this study, PPD was correlated with ductus arteriosus status evaluated by echocardiography, indicating involvement of the ductal shunt in the mechanism of redistribution in systemic vascular territories

Summary

Introduction

Patent ductus arteriosus is common in premature infants born before 32 weeks and is associated with high morbidity (i.e., pulmonary hemorrhage, necrotizing enterocolitis, acute renal failure, intraventricular hemorrhage, etc.) and mortality, especially in neonates with a birthweight less than 1000 g [1], [2]. This condition is characterized by a ductal shunt that diverts part of the aortic blood flow towards the pulmonary circulation, resulting in pulmonary vascular overload and decreased blood flow to systemic organs. The fact that local hemodynamic conditions have an influence on blood vessel mechanics suggests that, in the presence of significant patent ductus arteriosus, pulse wave propagation properties would probably be impacted to varying degrees on preductal and postductal vessels [5], [6]

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