Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
J Clin Ultrasound. 2022 Mar;50(3):385-392. doi: 10.1002/jcu.23161. Epub 2022 Feb 26.
The early abnormal pulmonary vasoreactivity observed in babies at risk of Bronchopulmonary dysplasia (BPD) increases the pulmonary vascular resistance. This can be assessed non-invasively using Time to Peak Velocity:Right Ventricular Ejection Time ratio (TPV:RVET) measured from pulmonary artery Doppler waveform obtained using echocardiogram. We postulate that screening for this early can predict BPD in this cohort. The objective of the study was to determine the utility of TPV:RVET in early prediction of BPD in Extremely Low Birth Weight (ELBW) babies born less than 1250grams Birth Weight.
This was a single-center retrospective cohort study of ELBW babies born<29 weeks over 4 year period who had echocardiogram between 7-21 days of life. TPV:RVET ratio was measured from pulmonary artery Doppler waveform obtained using echocardiogram. The main outcome was BPD at 36 weeks corrected gestation. The predictive ability of TPV:RVET (cut off 0.34) for subsequent development of BPD was analyzed using ROC.
Of 589 ELBW<29 weeks, 207 babies were eligible. BPD was found in 60.4%. The TPV:RVET at 0.34 had sensitivity 76.8% (95%CI 68.4-83.9), specificity 85.4% (95%CI 75.8-92.2), positive predictive value 88.9% (95%CI 81.4-94.1), negative predictive value 70.7% (95%CI 60.7-79), and ROC area 0.811 (95%CI 0.757-0.864). Odds ratio of having BPD for TPV:RVET at 0.34 was 19.9 (95%CI 8.19-48.34) and increased by 1.07 (95%CI 1.05-1.09) with every additional days of mechanical ventilation. TPV:RVET ratio had 92.75% inter-observer agreement with kappa 0.83.
TPV:RVET ratio is a good and reliable early screening tool for subsequent development of BPD in ELBW babies with substantial inter-observer agreement.
在患有支气管肺发育不良（BPD）风险的婴儿中，早期观察到的肺血管反应性异常会增加肺血管阻力。这可以通过使用超声心动图获得的肺动脉多普勒波形来测量右心室射血时间（TPV：RVET）比值，从非侵入性方法进行评估。我们推测，对这种早期情况的筛查可以预测该队列中的 BPD。本研究的目的是确定 TPV：RVET 在预测出生体重低于 1250 克的极低出生体重（ELBW）婴儿中早期 BPD 的作用。
这是一项为期 4 年的单中心回顾性队列研究，纳入了 29 周以下出生的 ELBW 婴儿，他们在出生后 7-21 天内进行了超声心动图检查。从超声心动图获得的肺动脉多普勒波形中测量 TPV：RVET 比值。主要结局为校正胎龄 36 周时的 BPD。使用 ROC 分析 TPV：RVET（截断值为 0.34）对随后发生 BPD 的预测能力。
在 589 名 29 周以下的 ELBW 婴儿中，有 207 名婴儿符合条件。发现 60.4%的婴儿患有 BPD。TPV：RVET 为 0.34 时，敏感性为 76.8%（95%CI 68.4-83.9），特异性为 85.4%（95%CI 75.8-92.2），阳性预测值为 88.9%（95%CI 81.4-94.1），阴性预测值为 70.7%（95%CI 60.7-79），ROC 曲线下面积为 0.811（95%CI 0.757-0.864）。TPV：RVET 为 0.34 时，发生 BPD 的比值比为 19.9（95%CI 8.19-48.34），机械通气每增加 1 天，比值比增加 1.07（95%CI 1.05-1.09）。TPV：RVET 比值的观察者间一致性为 92.75%，kappa 值为 0.83。
TPV：RVET 比值是预测 ELBW 婴儿 BPD 的一种良好且可靠的早期筛查工具，具有较高的观察者间一致性。
