Assessment Of Patent Ductus Arteriosus Research Articles

Functional echocardiography and its clinical applications in neonatology.

Functional echocardiography emerges as a clinical tool for the comprehensive clinical evaluation to assess the patient's hemodynamic status, after demonstrating that the clinical methods traditionally used in the Neonatal Intensive Care Unit are limited and often applied late. This allows us to establish a more accurate hemodynamic diagnosis and thus improve neonatal morbidity and mortality, since it allows making recommendations based on physiology, resulting in a rational and individualized treatment plan. There are scenarios where its usefulness has been seen, such as the inadequate transition of the very low birth weight newborn, hemodynamic instability, assessment of Patent Ductus Arteriosus and its hemodynamic repercussion, and pulmonary hypertension. This review updates information on the usefulness of functional echocardiography in the neonatal intensive care unit and the clinical settings where its use is recommended.

Use of feedback and structured reporting improves neonatal provider satisfaction and reduces variation in echocardiogram reports of patent ductus arteriosus

ObjectiveTo evaluate the impact of standardized reporting elements in echocardiogram reports of patent ductus arteriosus in preterm infants on report variability and neonatology provider satisfaction. MethodsStandard echocardiogram reporting elements were implemented for assessment of patent ductus arteriosus in preterm infants based on feedback from neonatology providers. Inclusion of five reporting elements was assessed prior to and after training of sonographers and cardiologists. Electronic survey of neonatology providers was obtained before and after implementation to assess for satisfaction with report quality. ResultsNeonatal provider satisfaction increased from 50% to 87.5% following successful implementation of standard elements of reporting (p = 0.018). No reports included all elements prior to intervention, but after intervention 75% of reports included all five reporting elements (p < 0.001). The median number of elements increased from three to five following intervention (p < 0.001). ConclusionsStandard reporting elements for echocardiograms of patent ductus arteriosus in preterm infants were successfully implemented with increased report completeness. Improvement in neonatal provider satisfaction with reports was achieved through this implementation.

Targeted neonatal echocardiography in neonatal intensive care unit

Purpose: The aim of the study is determining the frequency of use, and the patient characteristics and indications.Materials and Methods: This retrospective cohort study included all neonates who underwent targeted neonatal echocardiography in the neonatal unit of Adana Şehir Training and Research Hospital between September 2016 and September 2018. All newborns who underwent echocardiography according to clinical findings within 24 months were included in the study. Data including gestational age, birth weight, respiratory support, timing and diagnosis of echocardiography were obtained from the review of clinical notes.Results: A total of 355 echocardiographic evaluations were performed in 186 newborns. The most common indications for targeted echocardiography were patent ductus arteriosus (n = 148, 41.7%) followed by evaluation of myocardial performance and systemic blood flow (n = 99, 27.9%) and pulmonary hypertension (n= 72, 20.3%). The median time of echocardiographic evaluation was postnatal 22 (1-178) hours. More than half (59.7%) of the newborns received respiratory support (continuous positive pressure ventilation (21%), conventional mechanical ventilation (27.4%), and high frequency oscillation ventilation (11.3%).Conclusion: Targeted echocardiography is often used and it can be a useful tool in guiding treatment. Assessment of patent ductus arteriosus, myocardial performance and systemic blood flow are the most common indications for use. Large, well-coordinated prospective studies are needed to confirm its usefulness.

Point of care ultrasound (POCUS) in Canadian neonatal intensive care units (NICUs): where are we?

Despite increased evidence that point-of-care ultrasound (POCUS) has the potential to improve patient care in many clinical areas, the extent of use and training in POCUS in Canadian neonatal intensive care units (NICUs) has not been described in the literature. In this study, we aimed to explore the extent to which POCUS is being used and the need for a formal curriculum with defined POCUS competencies in the field of Neonatal-Perinatal Medicine (NPM). We sent a cross-sectional electronic survey to all NPM program directors and fellows in Canada. All 13 Canadian NPM programs were invited to participate. Data were analyzed using descriptive statistics and qualitative content analysis. The response rate was 69% (n = 9) from program directors (PDs) and 29% (n = 25) from NPM fellows. Most respondents indicated regular use of POCUS in clinical practice and ready access to a portable ultrasound machine. The most common use for POCUS was targeted assessment of patent ductus arteriosus (PDA) and persistent pulmonary hypertension (PPHN). Only six PDs reported that POCUS skills are taught to trainees in their centers and only two PDs reported that a structured program existed. Barriers to POCUS structured training include a lack of trained personnel as well as insufficient time in the busy NPM curriculum. POCUS is widely used in Canadian NICUs. However, a formal curriculum and assessment of competencies in this area of neonatal clinical care are lacking.

Echocardiographic assessment of patent ductus arteriosus in very low birthweight infants over time: prospective observational study

Background: We aimed to determine the echocardiographic parameters that can predict the presence of patent ductus arteriosus (PDA) and haemodynamically significant ductus arteriosus (HSDA) at different time points.Methods: Echocardiogram was performed on postnatal days 3 and 7(D3-Echo and D7-Echo, respectively) in 71 very low birthweight infants with a median gestational age of 28.0 weeks. We first assessed the correlation between D3-Echo findings among infants with ductal patency and persistent ductal patency on D7-Echo. We subsequently assessed the correlation between D7-Echo findings and ultimate need for PDA treatment.Results: Forty-nine (69.0%) infants had ductal patency on D3-Echo, and 32(65.3%) of these had persistent PDA on D7-Echo. Twenty of the latter (62.5%) underwent PDA treatment at a median chronological age of 19 days. PDA treatment was significantly correlated with DA size and DA peak-systolic-to-end-diastolic velocity(S/D) ratio on D3- and D7-Echo. Receiver operating characteristic curve analysis revealed that DA size ≥2.040 mm and S/D ratio ≥2.016 had fair sensitivity, specificity, and predictive values for PDA treatment.Conclusion: The significance of different echocardiographic parameters associated with future ductal patency or HSDA depends on the time of assessment. DA size and S/D ratio on day 7 are two reliable indicators of the need for future PDA treatment.

Correlation of B-type natriuretic peptide levels and echocardiographic parameters in preterm infants with patent ductus arteriosus.

PurposeThis study aimed to evaluate the correlation, according to postnatal age, between plasma B-type natriuretic peptide (BNP) levels and echocardiographic parameters for the assessment of patent ductus arteriosus (PDA) in preterm infants with respiratory distress.MethodsWe enrolled 42 preterm infants with respiratory distress who underwent serial echocardiographic evaluation with simultaneous plasma BNP measurements until ductal closure. The correlations between BNP levels and the following 4 representative echocardiographic parameters were studied: diameter of the ductus arteriosus (DA), ratio of the left atrial diameter to the aortic diameter (LA/Ao), ratio of the PDA diameter to the infant's left pulmonary artery diameter (PDA/LPA), and the antegrade diastolic flow of LPA (DFLPA).ResultsBNP levels were significantly correlated to the magnitude of the ductal shunt, comprising the DA diameter, PDA/LPA ratio, LA/Ao ratio, and antegrade DFLPA for the overall study period. The earliest significant correlation, starting from postnatal day 2, was observed between the LA/Ao ratio and BNP levels. The PDA/LPA ratio and the antegrade DFLPA showed significant correlations with BNP levels postnatal day 3 onward, and with the DA diameter, postnatal day 5 onward.ConclusionBNP levels and echocardiographic parameters showed a positive correlation, but the significance of the correlations differed according to the postnatal age, especially during the first few days of life.

Comprehensive assessment of patent ductus arteriosus by echocardiography before transcatheter closure

Background: Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determine the suitability of transcatheter closure (TCC). The purpose of this study is to evaluate whether these PDA features can be obtained by 2-dimensional echocardiography (2DE). Methods: We retrospectively compared PDA measurements and type from 36 patients submitted to TCC between November 1995 and October 2000. Results: The patient age ranged between 2 months to 10.5 years (median = 1.2 years). A significant correlation was found between measurements of PDA minimal diameter ( R 2 = 0.88) and diameter at aortic ostium ( R 2 = 0.72); whereas a poor correlation existed between measurements of the ampulla length. The 2DE and angiographic PDA classification were concordant in 31 of 36 (86%) patients. Conclusion: Our data support the use of 2DE measurements of PDA minimal diameter and PDA diameter at the aortic end to assess suitability for TCC. In the majority of cases, PDA type can be diagnosed by 2DE. (J Am Soc Echocardiogr 2002;15:1154-9.)

Suprasternal assessment of patent ductus arteriosus by two-dimensional echocardiography

Suprasternal assessment of patent ductus arteriosus by two-dimensional echocardiography

Assessment of patent ductus arteriosus in preterm infants by single lateral film aortography.

Differentiation of a hemodynamically significant cardiovascular abnormality from lung disease in the newborn infant may remain problematic after clinical, radiographic, and echocardiographic evaluation. Single-view aortography was performed in 38 preterm and one full term infant in the neonatal special care nursery. Special lateral views were obtained consisting of either a horizontal x-ray beam with oblique angulation of the supine patient or a vertical bean with 30 degree head-up angulation of the patient. These views projected the ductus caudal to the aortic arch and enabled visualization of the entire length of the ductus and focal constrictions of the ductus. The severity of patent ductus arteriosus was judged by anatomic (diameter of the ductus compared to the descending aorta) and physiologic (preferential opacification of the aortic arch or pulmonary circulation) criteria.