Choi Eui Kyung, Park Kyu Hee, Choi Byung Min
Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea.
Front Pediatr. 2021 Apr 20;9:635616. doi: 10.3389/fped.2021.635616. eCollection 2021.
This study was conducted in order to compare the strength of correlation between echocardiographic markers of shunt volume and patent ductus arteriosus (PDA) diameter based on postnatal age. This retrospective study focused on preterm infants (aged <32 weeks of gestation) admitted to the Neonatal Intensive Care Unit of Korea University Ansan Hospital, between April 2014 and December 2017, who studied serial targeted neonatal echocardiography (TNE) for PDA during hospitalization. The association between echocardiographic characteristics and duct size was divided into the following days: within 3 days (very early, VE), 4-7 days after birth (early, E), and after 8 days of birth (late, L). We found 113 assessments conducted on 57 infants in the VE period, 92 assessments on 40 infants in the E period, and 342 assessments on 37 infants in the L period. Median gestational age and birth weight were 28 weeks of gestation and 1,115 g, respectively. In the univariate regression analysis, we found a statistically significant correlation between PDA diameter and all TNE markers in the E and L days, but not in the VE period. Only ductal velocity [coefficient of determination ( ) = 0.224], antegrade left pulmonary artery diastolic flow velocity ( = 0.165), left ventricular output (LVO)/superior vena cava (SVC) flow ratio ( = 0.048), and E/A wave ratio ( = 0.092) showed weak correlations with PDA diameter in the VE period. The slopes of the regressions showed significant changes based on postnatal age in the maximum ductal velocity, left atrium/aorta ratio, LVO/SVC flow ratio, and LVO. It is difficult to predict the echocardiographic markers of shunt volume based on the PDA diameter in preterm infants younger than 4 days. A better understanding of the changes in the hemodynamic consequences of PDA based on postnatal age is needed when considering treatment.
本研究旨在比较基于出生后年龄的分流体积超声心动图标志物与动脉导管未闭（PDA）直径之间的相关性强度。这项回顾性研究聚焦于2014年4月至2017年12月期间入住韩国大学安山医院新生儿重症监护病房的早产儿（胎龄<32周），这些患儿在住院期间接受了针对PDA的系列靶向新生儿超声心动图（TNE）检查。超声心动图特征与导管大小之间的关联分为以下几个时间段：3天内（极早期，VE）、出生后4 - 7天（早期，E）以及出生后8天以后（晚期，L）。我们发现在极早期对57例婴儿进行了113次评估，在早期对40例婴儿进行了92次评估，在晚期对37例婴儿进行了342次评估。中位胎龄和出生体重分别为28周和1115克。在单变量回归分析中，我们发现PDA直径与E期和L期的所有TNE标志物之间存在统计学显著相关性，但在极早期不存在。在极早期，仅导管速度[决定系数（）= 0.224]、左肺动脉前向舒张期血流速度（ = 0.165）、左心室输出量（LVO）/上腔静脉（SVC）血流比值（ = 0.048）以及E/A波比值（ = 0.092）与PDA直径呈弱相关性。回归斜率显示，最大导管速度、左心房/主动脉比值、LVO/SVC血流比值和LVO基于出生后年龄有显著变化。对于小于4天的早产儿，很难根据PDA直径预测分流体积的超声心动图标志物。在考虑治疗时，需要更好地了解基于出生后年龄的PDA血流动力学后果变化。
