Abstract
Objective: This study was conducted in order to compare the strength of correlation between echocardiographic markers of shunt volume and patent ductus arteriosus (PDA) diameter based on postnatal age.Methods: This retrospective study focused on preterm infants (aged <32 weeks of gestation) admitted to the Neonatal Intensive Care Unit of Korea University Ansan Hospital, between April 2014 and December 2017, who studied serial targeted neonatal echocardiography (TNE) for PDA during hospitalization. The association between echocardiographic characteristics and duct size was divided into the following days: within 3 days (very early, VE), 4–7 days after birth (early, E), and after 8 days of birth (late, L).Results: We found 113 assessments conducted on 57 infants in the VE period, 92 assessments on 40 infants in the E period, and 342 assessments on 37 infants in the L period. Median gestational age and birth weight were 28+2 weeks of gestation and 1,115 g, respectively. In the univariate regression analysis, we found a statistically significant correlation between PDA diameter and all TNE markers in the E and L days, but not in the VE period. Only ductal velocity [coefficient of determination (R2) = 0.224], antegrade left pulmonary artery diastolic flow velocity (R2 = 0.165), left ventricular output (LVO)/superior vena cava (SVC) flow ratio (R2 = 0.048), and E/A wave ratio (R2 = 0.092) showed weak correlations with PDA diameter in the VE period. The slopes of the regressions showed significant changes based on postnatal age in the maximum ductal velocity, left atrium/aorta ratio, LVO/SVC flow ratio, and LVO.Conclusions: It is difficult to predict the echocardiographic markers of shunt volume based on the PDA diameter in preterm infants younger than 4 days. A better understanding of the changes in the hemodynamic consequences of PDA based on postnatal age is needed when considering treatment.
Highlights
Echocardiography is currently the preferred tool to screen neonates with hemodynamically significant patent ductus arteriosus in the early postnatal period, owing to its potential benefits in the prevention of pulmonary hemorrhage or intra ventricular hemorrhage [1]
Since hemodynamically significant patent ductus arteriosus (hsPDA) is determined by both ductal size and shunt volume markers of pulmonary over circulation and systemic hypoperfusion in targeted neonatal echocardiography (TNE), the most common definition of hsPDA is based on the transductal diameter [2, 8, 9]
We found 113 assessments conducted on 57 infants in the VE period, 92 assessments on 40 infants in the E period, and 342 assessments on 37 infants in the L period (Figure 1)
Summary
Echocardiography is currently the preferred tool to screen neonates with hemodynamically significant patent ductus arteriosus (hsPDA) in the early postnatal period, owing to its potential benefits in the prevention of pulmonary hemorrhage or intra ventricular hemorrhage [1]. The investigation is indicated for clinically suspected PDA, especially in very low birth weight neonates during the initial 24 to 72 h immediately following birth [2,3,4]. This transitional period is more complicated in preterm infants who have immature organ systems, thereby necessitating surfactant administration, ventilatory support, and vasoactive medications. Since hsPDA is determined by both ductal size and shunt volume markers of pulmonary over circulation and systemic hypoperfusion in targeted neonatal echocardiography (TNE), the most common definition of hsPDA is based on the transductal diameter [2, 8, 9]. There is lack of information regarding differences in the association between PDA diameter and shunt volume markers in the early postnatal period
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