Assessing patent ductus arteriosus in preterm infants from standard neonatal intensive care monitoring

AbstractMonitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. The aim of this pilot study was to investigate whether PDA status could be assessed from standard neonatal intensive care monitoring. Electrocardiography (ECG) and blood pressure (BP) waveforms were acquired from extremely preterm infants using standard neonatal monitors. We developed software using MATLAB to analyse ECG and BP waveforms and their interrelationships in terms of pulse transit time (PTT) and pulse wave velocity (PWV). The times from peak systolic BP to diastolic trough (BPFt) and from the diastolic trough to peak systolic BP (BPRt) were also calculated. PTT, BPFt and BPRt were normalised for heart rate (HR) termed NPTT, NBPFt and NBPRt, respectively. ECG, invasive aortic BP monitoring and echocardiography were performed in 14 preterm infants < 29 weeks’ gestation in the first 3 days after birth. The median (range) birth weight of the infants was 0.90 (0.48–1.31) kg, gestation 26.6 (24.0–28.7) weeks, PDA diameter 1.6 (0.8–3.6) mm and mean BP 32 (16–40) mmHg. We found a significant positive correlation between PDA diameter and NPTT (r = 0.69, P = 0.007) as well as NBPFt (r = 0.65, P = 0.012) and NBPRt (r = 0.71, P = 0.005). No relationship was found between PDA diameter and pulse pressure.Conclusions: Interrelationships between ECG and BP traces as well as BP waveform time analysis are straightforward to measure and associated with PDA diameter. The results of this pilot study suggest that this approach may help provide biomarkers for continuous monitoring PDA diameter and function. What is Known:• Patent ductus arteriosus (PDA) in premature infants is associated with increased risk of developing chronic lung disease, necrotising enterocolitis and cerebral injury.• Currently PDA is assessed intermittently using echocardiography which requires considerable expertise and sometimes is not well tolerated by critically ill preterm infants. What is New:• Blood pressure (BP) and ECG waveform interrelation and BP trace time analysis, taking account of heart rate, relate to PDA diameter.• ECG and BP waveform phase difference as well as BP waveform time analysis may be useful in the continuous assessment of PDA function.

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Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-020-00046-8 ◽

2020 ◽

Vol 68 (1) ◽

Author(s):

Reem M. Soliman ◽

Fatma Alzahraah Mostafa ◽

Antoine Abdelmassih ◽

Elham Sultan ◽

Dalia Mosallam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Side Effects ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

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Long-Term Variability of Heart Rate Increases with Successful Closure of Patent Ductus arteriosus in Preterm Infants

Neonatology ◽

10.1159/000243736 ◽

1992 ◽

Vol 61 (3) ◽

pp. 142-149 ◽

Cited By ~ 9

Author(s):

Viola Prietsch ◽

Rolf Maier ◽

Lothar Schmitz ◽

Michael Obladen

Keyword(s):

Heart Rate ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Patent Ductus

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Operative closure of patent ductus arteriosus in premature infants in the neonatal intensive care unit

The American Journal of Surgery ◽

10.1016/0002-9610(86)90453-8 ◽

1986 ◽

Vol 152 (6) ◽

pp. 704-708 ◽

Cited By ~ 24

Author(s):

Robert L. Taylor ◽

Frederick L. Grover ◽

P.Kent Harman ◽

Marilyn K. Escobedo ◽

Rajam S. Ramamurthy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care Unit ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Operative Closure ◽

Patent Ductus

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Change in Blood Pressure and Pulse Pressure in Preterm Infants After Treatment of Patent Ductus Arteriosus With Indomethacin

Korean Circulation Journal ◽

10.4070/kcj.2011.41.4.203 ◽

2011 ◽

Vol 41 (4) ◽

pp. 203 ◽

Cited By ~ 3

Author(s):

Ui Joung Han ◽

Hwa Jin Cho ◽

Young Kuk Cho ◽

Young Youn Choi ◽

Jae Sook Ma

Keyword(s):

Blood Pressure ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Pulse Pressure ◽

Ductus Arteriosus ◽

Patent Ductus

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Management and outcomes of concurrent patent ductus arteriosus and necrotising enterocolitis in preterm infants in a surgical neonatal intensive care unit

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild.2011.300164.31 ◽

2011 ◽

Vol 96 (Supplement 1) ◽

pp. Fa25-Fa26

Author(s):

A. Stewart ◽

A. Heuchan ◽

N. Patel ◽

G. Walker

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Necrotising Enterocolitis ◽

Patent Ductus

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Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus

Pediatric Radiology ◽

10.1007/s00247-016-3615-x ◽

2016 ◽

Vol 46 (9) ◽

pp. 1291-1300 ◽

Cited By ~ 7

Author(s):

Ginette M. Ecury-Goossen ◽

Marlou M. A. Raets ◽

Fleur A. Camfferman ◽

Rik H. J. Vos ◽

Joost van Rosmalen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Cerebral Arteries ◽

Very Preterm Infants ◽

Very Preterm ◽

Patent Ductus

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Safety and Feasibility of Intravenous Paracetamol for Patent Ductus Arteriosus in Indomethacin-/Ibuprofen-Resistant or -Contraindicated Preterm Infants: A Case Series

American Journal of Perinatology Reports ◽

10.1055/s-0040-1702945 ◽

2020 ◽

Vol 10 (01) ◽

pp. e49-e53

Author(s):

Ayumi Oshima ◽

Shun Matsumura ◽

Ayaka Iwatani ◽

Machiko Morita ◽

Sumie Fujinuma ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Premature Infants ◽

Ductus Arteriosus ◽

Case Series ◽

High Plasma ◽

Gastrointestinal Complications ◽

Surgical Closure ◽

Intravenous Paracetamol ◽

Patent Ductus

Abstract Background Although indomethacin and ibuprofen are the standard treatments for hemodynamically significant patent ductus arteriosus (hsPDA), they are associated with renal impairment and gastrointestinal complications. Paracetamol for hsPDA closure does not provoke a peripheral vasoconstrictive effect and seems to have effects similar to those of indomethacin and ibuprofen. We have previously reported the safety of low-dose (7.5 mg/kg) intravenous paracetamol for preterm infants with hsPDA, who were indomethacin-resistant or -contraindicated but did not affect the need for surgical PDA ligation. However, reports considering the use of higher-dose (15 mg/kg) paracetamol for hsPDA have not been published in Japan. Cases In 16 premature infants in whom indomethacin or ibuprofen was contraindicated or ineffective, 15 mg/kg of paracetamol was intravenously administered every 6 hours for 3 days after obtaining parental consent. hsPDA closure or narrowing was observed in 14 infants (88%), with the need for surgical closure totally avoided in nine cases (56%). High plasma paracetamol levels were observed in three cases. No paracetamol-related side effects or adverse events were reported. Conclusion The intravenous administration of higher dose paracetamol was safe and feasible in premature infants with hsPDA. Future clinical trials to explore the optimized dose and timing of administration are needed.

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