Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California.
Department of Pediatric Cardiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
Am J Perinatol. 2024 Sep;41(12):1673-1679. doi: 10.1055/a-2249-1671. Epub 2024 Jan 18.
Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA.
Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. -tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values.
Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (-values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively).
Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities.
· Early diagnosis of hsPDA may prevent severe morbidity and death.. · There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis.. · Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA..
早产儿血流动力学显著的动脉导管未闭（hsPDA）与终末器官损伤有关，包括脑室出血。早期治疗可能会降低发病率，但可能导致过度治疗。本研究旨在探讨出生后 12 小时内获得的常见超声心动图指标与 hsPDA 最终治疗之间的关系。
患有<32 周胎龄的患者在出生后 12 小时内进行了盲法超声心动图检查，作为研究方案的一部分。动脉导管未闭（PDA）的后续治疗由临床团队独立于超声心动图结果决定。对于连续数据和分类结果，进行了 t 检验和卡方检验。创建了接收器工作曲线以优化截断值。
在研究的 199 名新生儿中（超声心动图检查的平均时间为出生后 6.7 小时），需要 PDA 治疗的新生儿左心室输出（LVO）、右心室输出（RVO）和上腔静脉（SVC）流量更高（t 值分别为 0.007、0.044 和 0.012）。预测 PDA 治疗的截断值为 LVO>204 mL/kg/min（63%敏感性，66%特异性）、RVO>221 mL/kg/min 或 SVC 流量>99 mL/kg/min（敏感性分别为 70%和 43%，特异性分别为 48%和 73%）。
出生后 12 小时内心脏输出标志物较高的早产儿后来需要 PDA 治疗。这些数据是首次使用出生后 12 小时内的标准心输出量测量值来预测未来 PDA 治疗的需求。需要进一步进行前瞻性研究来证实这些超声心动图标志物与临床结局/发病率之间的关联。
· hsPDA 的早期诊断可能预防严重的发病率和死亡。
· 除了导管大小和血流方向之外，还有其他超声心动图标志物可以帮助早期诊断。
· 出生后 12 小时内的心脏输出标志物可能预测 hsPDA 治疗的需求。
Zotero 插件