State of Renal Blood Flow in Premature Children with Hemodynamically Significant Patent Ductus Arteriosus

Abstract: Introduction: Hemodynamically significant patent ductus arteriosus (HSPDA) lowers the renal circulation because of the "ductal stealing phenomenon," which can change the renal blood flow. The aim: To study the state of blood flow in the main renal artery and interlobar renal artery in premature infants with HSPDA. Materials and methods: 74 preterm newborns (gestational age 29-36 weeks) were divided into three groups: І - 40 children with HSPDA, ІІ - 17 children with patent ductus arteriosus (PDA) without hemodynamic disorders, ІІІ - 17 children with closed ductus arteriosus. Color ultrasound Doppler scan of the vascular bed of the kidneys was performed using a microconvex sensor with a frequency of 5-8 MHz ("TOSHIBA" Nemso XG model SSA-580A (Japan) from the main renal artery to the interlobar renal arteries of the right kidney. The following parameters of renal blood flow were studied: peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI). Results: Peak systolic velocity (PSV) in the main renal artery and interlobar renal arteries did not differ significantly between groups. On the first, third, and tenth days of life, there was a significant decrease in the EDV of blood flow and increased RI in the main renal artery. The EDV of blood flow and RI in the interlobar renal artery on the first day of life did not differ depending on PDA's presence and its hemodynamic significance. On the third and tenth days of life and in the interlobar renal artery, a significant decrease in EDV of blood flow and increased RI were noted. These renal blood flow characteristics were closely related to the size of the PDA on the first day of life. Conclusion: A feature of renal hemodynamics in HSPDA in premature infants is a decrease in the EDV of blood flow in the main renal artery and interlobar renal artery, as well as an increase in the RI of these vessels, directly correlating with the size of the PDA in the first day of life. During the first ten days of life, dynamic control revealed a slowed process of restoration of renal blood flow in babies with HSPDA, despite the PDA's closure.

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Features of renal blood flow in acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

Modern pediatrics. Ukraine ◽

10.15574/sp.2021.119.14 ◽

2021 ◽

pp. 14-18

Author(s):

T.P. Borysova ◽

◽

O.Yu. Obolonska ◽

Т.К. Мavropulo ◽

L.P. Badogina ◽

...

Keyword(s):

Acute Kidney Injury ◽

Blood Flow ◽

Patent Ductus Arteriosus ◽

Renal Artery ◽

Renal Blood Flow ◽

Premature Infants ◽

Ductus Arteriosus ◽

Kidney Injury ◽

The Third ◽

Patent Ductus

Hemodynamically significant patent ductus arteriosus (HSPDA) in premature infants leads to renal hypoperfusion due to the phenomenon of «stealing» of the systemic circulation, which can contribute to the development of acute kidney injury (AKI). The use of ultrasound Doppler sonography of the renal vessels can be effective in assessing renal blood flow and in the early diagnosis of acute renal failure. Purpose — to assess the prognostic significance of the state of renal blood flow in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 40 preterm infants (gestational age 29–36 weeks) with HSPDA. Distribution of the examined patients: the group with AKI — 23 children, the group without AKI — 17 children. The observation period was 10 days. The patients underwent echocardiography with Doppler analysis using a broadband microconvex probe with a frequency of 5–8 MHz (TOSHIBA Nemso XG) at 5–11 hours of life. Color Doppler ultrasound scanning of renal vessels was performed on the first, third and tenth days of life. The parameters of blood flow in the main renal and interlobar renal arteries were studied: peak systolic velocity (PSV) and end diastolic velocity (EDV) of blood flow, resistance index (RI). Diagnosis and stratification of AKI severity met the KDIGO neonatal modification criteria. Results. On the third to fifth day of life, AKI was diagnosed in 23 (57.5%) children, but already in the first day of life, compared with patients without AKI, a significant decrease in PSV parameters of blood flow in the main renal artery was noted (20.6±5.87 cm/sec versus 25.4±6.17 cm/sec in children without AKI, p<0.02). In addition, the main changes in the first day of life in patients with AKI were revealed at the level of the interlobar renal artery, namely: a decrease in PSV blood flow (11.10±3.329 cm/sec versus 18.48±3.014 cm/sec in children without AKI, p<0.001) and EDV of blood flow (2.83±2.063 cm/sec versus 6.16±2.447 cm/sec in children without AKI, p<0.001), increased RI (0.758±0.137 versus 0.666±0.1216 in children without AKI, p<0.02). On the third day of life at AKI, there was a disorder in the parameters of blood flow in the interlobaric renal artery, the value of which on the tenth day of life did not differ from the parameters of children without AKI. Conclusions. In premature infants with HSPDA, who were diagnosed with AKI on the third to fifth day of life, in the first day of life, there is a decrease in PSV blood flow parameters in the main renal artery, changes in blood flow in the interlobar renal artery, namely: a decrease in PSV and EDV blood flow, an increase in RI. Thus, the assessment of the state of blood flow in the interlobar renal artery on the first day of life in premature infants with HSPDA is of diagnostic value for the timely determination of the risk group for AKI. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature infants, patent ductus arteriosus, renal blood flow, acute kidney injury.

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Prediction of early diagnosis of acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

Modern pediatrics. Ukraine ◽

10.15574/sp.2020.112.5 ◽

2020 ◽

pp. 5-11

Author(s):

T.P. Borysova ◽

◽

O.U. Obolonska ◽

O.E. Khudyakov ◽

◽

...

Keyword(s):

Blood Flow ◽

Patent Ductus Arteriosus ◽

Serum Creatinine ◽

Renal Artery ◽

Flow Velocity ◽

Premature Infants ◽

Blood Flow Velocity ◽

Ductus Arteriosus ◽

Kidney Injury ◽

Patent Ductus

The development of acute kidney injury (AKI) in preterm infants with hemodynamically significant patent ductus arteriosus (HSPDA) is an additional burden on homeostatic mechanisms, leading to loss of fluid, electrolyte balance, and acid-base disturbance and increasing the risk of mortality by 50%. Therefore, early detection of AKI in preterm infants with HSPDA is extremely important in terms of improving treatment outcomes. Purpose — to create, evaluate and further analyze the binary logistic regression model of AKI on the background of HSPDA in premature infants. Materials and methods. The group of study participants consisted of 40 premature babies with HSPDA, who were admitted for treatment on the first day of life to the Department of Anesthesiology and Neonatal Intensive Care at MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council». On the third to fifth day of life, 23 (57.5%) patients were diagnosed with AKI. Clinical and laboratory examination included obstetric history, gestational age, weight, physical examination, clinical analysis of blood and urine, arterial blood oxygen saturation, biochemical methods — examination of urea, serum and urine creatinine, serum and urine sodium, serum potassium. The concentration index of creatinine, fractional excretion of sodium, glomerular filtration rate (GFR) according to the Schwartz formula were calculated. Instrumental methods of examination included echocardiography with Doppler, ultrasound Doppler of renal vessels, renal spectroscopy in the near infrared region. In order to preliminarily determine the diagnostic potential of some clinical'anamnestic and laboratory data, the parameters of the sample with AKI and the sample without this pathology were compared: in the case of interval scale the Mann–Whitney U-test was used, in the case of categorical scale — χ2-test or Fisher's exact test. Spearman's rank correlation was used to form the optimal set of input variables for regression modeling. The method of binary logistic regression was used to develop a diagnostic model of AKI development on the background of HSPDA in premature infants. Results. At the stage of exploratory data analysis (several dozen parameters of clinical and biochemical analysis of blood and urine, renal hemodynamics, renal oxygenation and therapeutic measures on the first day), as well as clinical and anamnestic data, it was found that AKI has a significant relationship with 14 interval ( maximum blood flow velocity in the interlobar renal artery, minimum blood flow velocity in the interlobar renal artery, resistance index in the interlobar renal artery, maximum blood flow velocity in the main renal artery, diameter of the open arterial duct, renal oxygenation, fractional renal tissue extraction of oxygen, serum creatinine, GFR, creatinine concentration index, urinary sodium, fractional sodium excretion, urine protein, diastolic blood pressure) and 9 nominal values (the size of the patent ductus arteriosus on the first day of more than 2 mm, ibuprofen therapy at a dose of 20 mg/kg on the first day, ibuprofen therapy on the first day of life, furosemide treatment, history of renal disease in the mother, chronic foci of infection in the mother, hypertension of pregnancy, threat of abortion, necrotizing enterocolitis in the patient on the first day of life). Conclusions. The most significant predictors of AKI development in premature infants with HSPDA are the parameter of maximum blood flow velocity in the interlobar renal artery, HSPDA diameter greater than 2 mm and serum creatinine level on the first day of life. The sensitivity of the AKI logistic regression model, in which HSPDA diameter and serum creatinine level are used as explanatory variables, is 91%, specificity — 88%, overall accuracy — 90%. Replacement of serum creatinine in the logit function for the maximum blood flow velocity in the interlobar renal artery allows to increase the sensitivity of the model up to 96%, and the overall accuracy up to 93%. The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents of children was obtained for the research. The authors were declare no conflict of interest. Key words: hemodynamically significant patent ductus arteriosus, premature infants, acute kidney injury, prediction of early diagnosis.

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Indomethacin and cerebral blood flow in premature infants treated for patent ductus arteriosus

European Journal of Pediatrics ◽

10.1007/bf00442705 ◽

1988 ◽

Vol 147 (3) ◽

pp. 315-316 ◽

Cited By ~ 64

Author(s):

O. Pryds ◽

G. Greisen ◽

K. H. Johansen

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Patent Ductus Arteriosus ◽

Premature Infants ◽

Ductus Arteriosus ◽

Patent Ductus

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The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study

Journal of Perinatology ◽

10.1038/s41372-020-0622-4 ◽

2020 ◽

Vol 40 (9) ◽

pp. 1366-1374 ◽

Cited By ~ 2

Author(s):

Yulia Vaisbourd ◽

Dawod Sharif ◽

Arieh Riskin ◽

Liat Yaniv ◽

Gil Dinur ◽

...

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Pilot Study ◽

Patent Ductus Arteriosus ◽

Premature Infants ◽

Ductus Arteriosus ◽

Artery Blood Flow ◽

Patent Ductus

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Clinical Considerations for the Pharmacologic Management of Patent Ductus Arteriosus with Cyclooxygenase Inhibitors in Premature Infants

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-12.3.147 ◽

2007 ◽

Vol 12 (3) ◽

pp. 147-157

Author(s):

Karen E. Corff ◽

Kris C. Sekar

Keyword(s):

Clinical Trials ◽

Blood Flow ◽

Patent Ductus Arteriosus ◽

Premature Infants ◽

Ductus Arteriosus ◽

Arterial Blood Flow ◽

Medical Decision ◽

Cox Inhibitors ◽

Clinical Considerations ◽

Patent Ductus

When medical management is warranted for closure of a persistent patent ductus arteriosus (PDA) in premature infants, treatment with a cyclooxygenase (COX) inhibitor is indicated. Indomethacin, available since 1976, has been the conventional pharmacologic treatment for PDA, but its use is associated with vasoconstrictive effects that impair renal, mesenteric and cerebral blood flow. Intravenous (IV) ibuprofen lysine, approved in the United States in 2006, has less severe vasoconstrictive effects on these vital organs than IV indomethacin. Clinical trials have shown both of these COX inhibitors to be equally effective in closing the PDA in approximately 70%–80% of treated infants, with less vasoconstrictive and adverse renal effects occurring with IV ibuprofen lysine.12 Several clinical considerations are important in the process of medical decision-making when faced with the need for PDA treatment with one of these pharmacologic agents in the premature infant. This paper focuses on these clinical considerations, including cerebral, renal and mesenteric blood flow, renal function, pulmonary effects, protein-binding capacity as it relates to hyperbilirubinemia, and platelet aggregation. No differences in chronic lung disease, pulmonary hypertension, hyperbilirubinemia and coagulopathy were observed in clinical trials when comparing these 2 COX inhibitors; however, significant differences have been observed in arterial blood flow to the cerebral, renal and mesenteric organs, suggesting that IV ibuprofen lysine may be the more favorable agent.

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