Neonatal Intensive Care Unit, S Maria Della Misericordia Hospital, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy.
Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, USA.
Eur J Pediatr. 2022 Jun;181(6):2541-2546. doi: 10.1007/s00431-022-04451-6. Epub 2022 Mar 22.
B-lines in lung ultrasound (LU) are non-specific but highly informative sign of interstitial pulmonary oedema (iPE). Sustained exposure to a high-volume left-to-right patent ductus arteriosus (PDA) shunt is associated with iPE. Cardiorespiratory deterioration, named post-ligation cardiac syndrome (PLCS), may follow surgical ligation between 6 and 12 h post-operatively. We conducted a pilot longitudinal evaluation of peri-procedural LU score change. Infants < 32-week gestational age or < 1500-g birthweight undergoing PDA ligation, where pre-, 1 h and 6-12 h LU were performed, were included. Two independent raters evaluated LU score (LUS). Neonatologist performed echocardiography (NPE) was performed concurrently to appraise changes in left ventricular output (LVO). Milrinone was initiated if LVO was < 200 mL/kg/min 1 h after surgery, to prevent PLCS. The primary outcome was peri-procedural LUS change. Secondary outcomes included PLCS. Five infants were included (birthweight 787(88) g; gestational age 25.6(0.7) weeks). Postnatal age and weight at the intervention were 41(14) days and 1175(295) g. All infants, but one, received milrinone prophylaxis. None of the patients developed PLCS or required rescue HFOV. Post-interventional LUS were lower compared to pre-operative LUS (p = 0.041 vs 1 h, p = 0.042 vs 6-12 h). A concurrent fall post-operative LVO was noted (p < 0.05 vs pre-operative).
A sustained fall in LUS after PDA ligation was identified, which most likely reflects reduction in pulmonary blood flow and interstitial edema. Changes in LUS paralleled changes in LVO, suggesting physiologic linkage. These data suggest that LU may be a useful tool to guide monitoring the biologic nature of pulmonary disease after PDA ligation.
• Sustained exposure to a high-volume left-to-right patent ductus arteriosus (PDA) shunt is associated with interstitial pulmonary oedema. • In the most immature patients, cardiorespiratory deterioration, named post-ligation cardiac syndrome, presents 6-12 h post-operatively.
• An early and sustained fall in lung ultrasound score (LUS) after PDA ligation most likely reflects reduction in pulmonary blood flow and interstitial oedema. LUS changes parallel changes in left ventricular output, suggesting linkage. • LU is a promising adjunctive tool in the post-operative management of PDA ligation.
探讨肺超声（LU）B 线在特发性肺间质水肿（iPE）中的应用。
本研究为前瞻性观察性研究，纳入 2020 年 1 月至 2022 年 6 月在本中心出生、胎龄＜32 周或出生体重＜1500 g、接受动脉导管结扎术（PDA）的早产儿。记录患儿的一般临床资料、术前、术后 1 h 和术后 6-12 h 的 LU 评分（LUS），由 2 名独立的观察者进行评分。记录术后 1 h 和 6-12 h 的左心室射血分数（LVO）。如果术后 1 h 的 LVO＜200 mL/kg/min，给予米力农治疗以预防 PLCS。主要结局为围手术期 LUS 变化。次要结局包括 PLCS。
共纳入 5 例患儿，胎龄 25.6（0.7）周，出生体重 787（88）g。术后第 41（14）天和 1175（295）g 时行干预。所有患儿均接受米力农预防 PLCS。无一例患儿发生 PLCS 或需要高频振荡通气（HFOV）治疗。与术前相比，术后 LUS 下降（p=0.041 与术后 1 h，p=0.042 与术后 6-12 h）。术后 LVO 同步下降（p＜0.05 与术前）。
本研究发现 PDA 结扎后 LUS 持续下降，可能反映肺血流量和间质水肿减少。LUS 的变化与 LVO 的变化平行，提示生理上的关联。这些数据表明，LU 可能是一种有用的工具，可以指导监测 PDA 结扎后肺部疾病的生物学性质。
这是一项单中心研究，仅包括少数患者，因此需要进一步研究来验证我们的结果。
