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Am J Perinatol 2015; 32(13): 1217-1224
DOI: 10.1055/s-0035-1554795
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association of Antegrade Pulmonary Artery Diastolic Velocity with Spontaneous Closure of the Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants

Dawn M. Weiss
1   Division of Neonatology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Jeffrey R. Kaiser
2   Division of Neonatology, Departments of Pediatrics and Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
,
Christopher Swearingen
3   Division of Biostatistics, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Sadia Malik
4   Division of Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Ritu Sachdeva
5   Division of Pediatric Cardiology, Department of Pediatrics, Emory School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

11 November 2014

01 April 2015

Publication Date:
09 June 2015 (online)

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Abstract

Objective This study aims to determine echocardiographic parameters associated with spontaneous patent ductus arteriosus (PDA) closure in extremely low-birth-weight (ELBW) infants.

Study Design Retrospective demographic review and analysis of echocardiograms from 189 ELBW infants with suspected and confirmed hemodynamically significant PDA identified on an initial echocardiogram was performed. Comparison of echocardiographic parameters was made between infants with spontaneous closure versus those who received treatment.

Results The mean birth weight (787 ± 142 vs. 724 ± 141 g, p = 0.04) and gestational age (27.4 ± 2.8 vs. 26.2 ± 1.6 weeks, p = 0.03) were higher in the spontaneous closure versus the treatment group. Antegrade pulmonary artery (PA) diastolic velocity was lower in infants with spontaneous PDA closure versus those who received treatment (0.15 ± 0.06 vs. 0.22 ± 0.12 m/s, p = 0.009).

Conclusion Heavier and more mature ELBW infants with a lower antegrade PA diastolic velocity were likely to have spontaneous closure of the PDA.

Keywords

extremely low-birth-weight infant - ductus arteriosus - echocardiography
 

  • References

  • 1 Fanaroff AA, Stoll BJ, Wright LL , et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196 (2) 147.e1-147.e8
    CrossrefPubMedGoogle Scholar
  • 2 Siassi B, Emmanouilides GC, Cleveland RJ, Hirose F. Patent ductus arteriosus complicating prolonged assisted ventilation in respiratory distress syndrome. J Pediatr 1969; 74 (1) 11-19
    CrossrefPubMedGoogle Scholar
  • 3 Evans N, Kluckow M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 75 (3) F183-F186
    CrossrefPubMedGoogle Scholar
  • 4 Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr 2005; 40 (2) 184-188
    CrossrefPubMedGoogle Scholar
  • 5 Guller B, Bozic C. Right-to-left shunting through a patent ductus arteriosus in a newborn with myocardial infarction. Cardiology 1972; 57 (6) 348-357
    CrossrefPubMedGoogle Scholar
  • 6 Way GL, Pierce JR, Wolfe RR, McGrath R, Wiggins J, Merenstein GB. ST depression suggesting subendocardial ischemia in neonates with respiratory distress syndrome and patent ductus arteriosus. J Pediatr 1979; 95 (4) 609-611
    CrossrefPubMedGoogle Scholar
  • 7 Cotton RB, Stahlman MT, Bender HW, Graham TP, Catterton WZ, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 1978; 93 (4) 647-651
    CrossrefPubMedGoogle Scholar
  • 8 Jones LJ, Craven PD, Attia J, Thakkinstian A, Wright I. Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96 (1) F45-F52
    CrossrefPubMedGoogle Scholar
  • 9 Attridge JT, Clark R, Gordon PV. New insights into spontaneous intestinal perforation using a national data set (3): antenatal steroids have no adverse association with spontaneous intestinal perforation. J Perinatol 2006; 26 (11) 667-670
    CrossrefPubMedGoogle Scholar
  • 10 Edwards AD, Wyatt JS, Richardson C , et al. Effects of indomethacin on cerebral haemodynamics in very preterm infants. Lancet 1990; 335 (8704) 1491-1495
    CrossrefPubMedGoogle Scholar
  • 11 Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr 1983; 102 (6) 895-906
    CrossrefPubMedGoogle Scholar
  • 12 Grosfeld JL, Chaet M, Molinari F , et al. Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin. Ann Surg 1996; 224 (3) 350-355 , discussion 355–357
    CrossrefPubMedGoogle Scholar
  • 13 Palder SB, Schwartz MZ, Tyson KR, Marr CC. Management of patent ductus arteriosus: a comparison of operative v pharmacologic treatment. J Pediatr Surg 1987; 22 (12) 1171-1174
    CrossrefPubMedGoogle Scholar
  • 14 Madan JC, Kendrick D, Hagadorn JI, Frantz III ID ; National Institute of Child Health and Human Development Neonatal Research Network. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 2009; 123 (2) 674-681
    CrossrefPubMedGoogle Scholar
  • 15 Nemerofsky SL, Parravicini E, Bateman D, Kleinman C, Polin RA, Lorenz JM. The ductus arteriosus rarely requires treatment in infants > 1000 grams. Am J Perinatol 2008; 25 (10) 661-666
    Google Scholar
  • 16 Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117 (4) 1113-1121
    CrossrefPubMedGoogle Scholar
  • 17 Thankavel PP, Rosenfeld CR, Christie L, Ramaciotti C. Early echocardiographic prediction of ductal closure in neonates ≤ 30 weeks gestation. J Perinatol 2013; 33 (1) 45-51
    CrossrefPubMedGoogle Scholar
  • 18 Kluckow M, Evans N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 1995; 127 (5) 774-779
    CrossrefPubMedGoogle Scholar
  • 19 Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus?. Eur J Pediatr 2009; 168 (8) 907-914
    CrossrefPubMedGoogle Scholar
  • 20 Carmo KB, Evans N, Paradisis M. Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography. J Pediatr 2009; 155 (6) 819-82 , 2.e1
    CrossrefPubMedGoogle Scholar
  • 21 Su BH, Peng CT, Tsai CH. Echocardiographic flow pattern of patent ductus arteriosus: a guide to indomethacin treatment in premature infants. Arch Dis Child Fetal Neonatal Ed 1999; 81 (3) F197-F200
    CrossrefPubMedGoogle Scholar
  • 22 Su BH, Watanabe T, Shimizu M, Yanagisawa M. Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants. Arch Dis Child Fetal Neonatal Ed 1997; 77 (1) F36-F40
    CrossrefPubMedGoogle Scholar
  • 23 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (2) 377-381
    CrossrefPubMedGoogle Scholar
  • 24 Ramos FG, Rosenfeld CR, Roy L, Koch J, Ramaciotti C. Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates. J Perinatol 2010; 30 (8) 535-539
    Google Scholar
  • 25 Hiraishi S, Horiguchi Y, Misawa H , et al. Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus. Circulation 1987; 75 (6) 1146-1153
    CrossrefPubMedGoogle Scholar
  • 26 Suzumura H, Nitta A, Tanaka G, Arisaka O. Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants. Pediatr Int 2001; 43 (2) 146-151
    CrossrefPubMedGoogle Scholar
  • 27 Pees C, Walch E, Obladen M, Koehne P. Echocardiography predicts closure of patent ductus arteriosus in response to ibuprofen in infants less than 28 week gestational age. Early Hum Dev 2010; 86 (8) 503-508
    CrossrefPubMedGoogle Scholar
  • 28 Olsson KW, Jonzon A, Sindelar R. A high ductal flow velocity is associated with successful pharmacological closure of patent ductus arteriosus in infants 22–27 weeks gestational age. Crit Care Res Pract 2012; 2012: 715265
    PubMedGoogle Scholar
  • 29 Silverman NH, Lewis AB, Heymann MA, Rudolph AM. Echocardiographic assessment of ductus arteriosus shunt in premature infants. Circulation 1974; 50 (4) 821-825
    CrossrefPubMedGoogle Scholar
  • 30 Johnson GL, Breart GL, Gewitz MH , et al. Echocardiographic characteristics of premature infants with patient ductus arteriosus. Pediatrics 1983; 72 (6) 864-871
    PubMedGoogle Scholar
  • 31 Mouzinho AI, Rosenfeld CR, Risser R. Symptomatic patent ductus arteriosus in very-low-birth-weight infants: 1987–1989. Early Hum Dev 1991; 27 (1–2) 65-77
    CrossrefPubMedGoogle Scholar