Early Role of the Atrial-Level Communication in Premature Infants with Patent Ductus Arteriosus - 31/03/21
Abstract |
Background |
High-volume systemic-to-pulmonary ductus arteriosus shunts in premature infants are associated with adverse neonatal outcomes. The role of an atrial communication (AC) in modulating the effects of a presumed hemodynamically significant patent ductus arteriosus (PDA) is poorly studied. The objective of this study was to characterize the relationship between early AC and echocardiographic indices of PDA shunt volume and clinical neonatal outcomes.
Methods |
A retrospective review of preterm infants (born at <32 weeks’ gestation) who underwent echocardiography in the first postnatal week was performed. The cohort was divided into four groups on the basis of presence of a presumed hemodynamically significant PDA (≥1.5 vs <1.5 mm) and AC size (≤1 vs >1 mm), and echocardiographic measures of PDA shunt volume were then compared. Clinical outcomes, including chronic lung disease and intraventricular hemorrhage, were also compared among all four groups.
Results |
A total of 199 preterm infants (mean birth weight, 928 ± 632 g; mean gestational age, 26.6 ± 1.5 weeks) were identified; 159 infants had PDAs ≥ 1.5 mm, of whom 52 had ACs ≤ 1 mm and 107 had ACs > 1 mm. The remaining 40 infants had PDAs < 1.5 mm, of whom 23 had ACs ≤ 1 mm and 17 had ACs > 1 mm. Infants with PDAs ≥ 1.5 mm and ACs > 1 mm had higher pulmonary vein D-wave velocities (P < .05), higher left ventricular output (P < .005), higher PDA scores (P < .001), and increased rates of reversed diastolic flow in the descending aorta (P < .001), celiac artery (P < .001), and middle cerebral artery (P < .001) than infants with either PDAs < 1.5 mm or PDAs ≥ 1.5 mm and ACs ≤ 1 mm. There was no difference in the incidence of intraventricular hemorrhage, but infants with PDAs ≥ 1.5 mm and ACs > 1 mm had a higher risk for a composite outcome of chronic lung disease or death before hospital discharge (P < .05).
Conclusions |
Echocardiographic evidence of ACs > 1 mm in patients with PDAs ≥ 1.5 mm during the first postnatal week may be a marker of a more pathologic hemodynamically significant PDA in premature infants. Future investigations should evaluate if early identification and treatment of patients with both high-volume PDAs and larger atrial-level communications may help mitigate adverse outcomes, such as chronic lung disease or death, in this high-risk patient population.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Relationship of early atrial communication in preemies to PDA shunt poorly studied |
• | A larger atrial communication meant more echoc markers of high-volume PDA shunt |
• | Higher risk of either death of CLD wtih hsPDA and large early atrial communication |
• | Larger early atrial communication suggestive of higher volume PDA shunt in preemies |
Keywords : Patent ductus arteriosus, Atrial septal defect, Shunt volume, Chronic lung disease, Hemodynamics, Prematurity, Echocardiography
Abbreviations : AC, CBF, CLD, hsPDA, IVH, LVO, NICU, PDA, TnECHO
Plan
Dr. Rios is supported by the National Institutes of Health (grant 1K23HLI130522), which was not involved in the study. |
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Conflicts of interest: None. |
Vol 34 - N° 4
P. 423 - avril 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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