Navarro-Guzmán Eduardo A, Ledezma-Bautista Iván, Rubio-Hernández Martha E, Escalante-Padrón Francisco J, Lima-Roguel Victoria, Pierdant-Perez Mauricio
Department of Neonatology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico.
Department of Clinical Epidemiology, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
Arch Cardiol Mex. 2019;89(1):111-117. doi: 10.24875/ACME.M19000033.
The ductus arteriosus is a necessary structure in fetal circulation, and its patency can produce hemodynamic alterations. The diagnostic gold standard is echocardiography, not always available. In the neonatal intensive care unit (NICU), they have pulse oximetry that measures perfusion index (PI), which could be used as a diagnostic tool in hemodynamically significant patent ductus arteriosus (HSPDA).
The objective of the study was to correlate the PI increment (ΔPI) in 24 and 72 h after birth with HSPDA in premature newborns of NICU in a second-level hospital.
This is an analytic prospective study which included neonates of 26-34 weeks of gestational age, without comorbidities, who underwent echocardiography and measurement of PI in arm and leg, 24 and 72 h after birth. We did bivariate analysis with X2/exact Fisher's test and Student's t-test/Mann-Whitney U-test, besides Spearman correlation and linear regression for value prediction.
We included 39 premature newborns. We did not find significant differences between patients without and with HSPDA (median: 0.22 [0.06-0.58] vs. 0.03 [-0.27-0.2]; p = 0.09) at 24 h neither 72 h after birth (median: 0.2 [0-0.47] vs. 0.45 [-0.37-0.76]; p = 0.47). We found a positive correlation between ductus arteriosus diameter (DAD) and ΔPI (r: 0.78; confidence interval 95%: 0.6-0.88; p = 0.01). The prediction formula with linear regression is expressed this way: DAD = 1.31 + (2.05 × ΔIP).
The PI does not allow us to discriminate between patient without and with HSPDA. The ΔPI could be a tool for the monitorization of DAD in neonates 72 h after birth.
动脉导管是胎儿循环中的一个必要结构，其通畅可导致血流动力学改变。诊断的金标准是超声心动图，但并非总是可用。在新生儿重症监护病房（NICU），可通过脉搏血氧饱和度仪测量灌注指数（PI），其可作为诊断血流动力学显著的动脉导管未闭（HSPDA）的一种工具。
本研究的目的是将出生后24小时和72小时的PI增量（ΔPI）与二级医院NICU早产新生儿的HSPDA进行关联。
这是一项分析性前瞻性研究，纳入了胎龄为26 - 34周、无合并症的新生儿，在出生后24小时和72小时进行了超声心动图检查以及手臂和腿部PI的测量。除了进行Spearman相关性分析和线性回归以进行值预测外，我们还使用X2/确切Fisher检验以及Student t检验/ Mann-Whitney U检验进行了双变量分析。
我们纳入了39例早产新生儿。出生后24小时和72小时，未患HSPDA和患HSPDA的患者之间均未发现显著差异（中位数：0.22 [0.06 - 0.58] 对比 0.03 [-0.27 - 0.2]；p = 0.09）以及（中位数：0.2 [0 - 0.47] 对比 0.45 [-0.37 - 0.76]；p = 0.47）。我们发现动脉导管直径（DAD）与ΔPI之间存在正相关（r：0.78；95%置信区间：0.6 - 0.88；p = 0.01）。线性回归的预测公式如下：DAD = 1.31 + (2.05 × ΔIP)。
PI无法使我们区分未患和患HSPDA的患者。ΔPI可能是出生后72小时新生儿DAD监测的一种工具。
