Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
Physiol Meas. 2021 Feb 6;42(1):015005. doi: 10.1088/1361-6579/abd5aa.
Presence of a patent ductus arteriosus (PDA) in neonates is assessed by echocardiography. Echocardiographic assessment has disadvantages, primarily its discontinuous nature. We hypothesize that the continuously measured ratio of arterial blood pressures (ABP) at the borders of a window surrounding the systolic peak ratio discriminates non-PDA from PDA patients.
Preterm infants (gestational age <32 weeks) with and without PDA were included. Patients were divided into controls (n = 8) and PDA patients (n = 22), the latter with a subset of patients with closed PDA after three doses Ibuprofen (n = 10). For each patient, a six-hour ABP segment from 12 AM to 6 AM on the day of echocardiographic assessment patency or closure of the DA was selected. The mean ratio of the ABP values a samples before and p samples after the systolic peak (R ) was calculated for each segment. If R < 1, the patient was predicted to have a PDA. The a and p with the least misclassifications were selected (-64 and +104 ms).
R was significantly lower in PDA patients (median 0.95, IQR 0.06) compared to controls (median 1.05, IQR 0.10; p = 0.0024). R correctly predicted 19 out of 22 patients (86.4%) and six out of eight controls (75%). R increased after closure in nine out of 10 patients (median 1.01, IQR 0.04; p = 0. 0182).
R may discriminate preterm PDA patients from non-PDA patients and can be calculated continuously from clinical data measured during standard of care.
通过超声心动图评估新生儿动脉导管未闭（PDA）的存在。超声心动图评估存在缺点，主要是其非连续性。我们假设，在围绕收缩峰的窗口边界处连续测量的动脉血压（ABP）比值可以区分非 PDA 与 PDA 患者。
纳入有和无 PDA 的早产儿（胎龄<32 周）。患者分为对照组（n=8）和 PDA 患者（n=22），后者有三剂布洛芬后关闭 PDA 的亚组患者（n=10）。对于每位患者，从超声心动图评估开放或关闭 PDA 的当天 12 点到 6 点选择 6 小时的 ABP 段。对于每个段，计算在收缩峰前 a 个样本和收缩峰后 p 个样本的 ABP 值的平均比值（R）。如果 R<1，则预测患者存在 PDA。选择最少误分类的 a 和 p（-64 和+104 ms）。
与对照组相比（中位数 1.05，IQR 0.10；p=0.0024），PDA 患者的 R 明显较低（中位数 0.95，IQR 0.06）。R 正确预测了 22 例患者中的 19 例（86.4%）和 8 例对照中的 6 例（75%）。在 10 例患者中的 9 例中，R 在关闭后增加（中位数 1.01，IQR 0.04；p=0.0182）。
R 可以区分早产儿 PDA 患者与非 PDA 患者，并且可以从标准护理期间测量的临床数据中连续计算。
