Graff Kirsten, Ross Julie R, Morella Kristen, Chowdhury Shahryar M
Department of Pediatrics, Medical University of South Carolina, United States.
J Neonatol. 2023 Dec;37(4):384-389. doi: 10.1177/09732179231178127. Epub 2023 Aug 1.
Preterm neonates often have an echocardiogram performed in the first few days of life for suspicion of pulmonary hypertension and patent ductus arteriosus. The usefulness of this echocardiogram in predicting outcomes in this population are unknown. The objective of this study was to investigate associations between initial echocardiographic assessment and hospital outcomes in preterm neonates with patent ductus arteriosus and clinical suspicion of pulmonary hypertension.
Premature neonates (<37 weeks gestational age) with patent ductus arteriosus and clinical suspicion of pulmonary hypertension born at our institution or transferred within 48 hours of life were included in this single center retrospective study. The primary outcome was in-hospital extracorporeal membrane oxygenation utilization or mortality.
86 patients were included. Median age at echocardiogram was 2 days (interquartile range 1,7), gestational age was 27 weeks (interquartile range 25,32), and birth weight was 878 grams (interquartile range 650,1818). 15 patients (17%) met the primary outcome. Larger patent ductus arteriosus size ( = .03), patent foramen ovale flow that was bidirectional or right to left ( = .047), and right atrial volume ( = .04) were independently associated with the primary outcome.
Larger patent ductus arteriosus size, bidirectional or right to left flow at the patent foramen ovale, and lower right atrial volume are independently associated with in-hospital mortality. These findings on the initial echocardiogram of a preterm neonate can be used to risk stratify these patients for elevated risk for in-hospital extracorporeal membrane oxygenation utilization or mortality.
早产新生儿常在出生后的头几天因怀疑患有肺动脉高压和动脉导管未闭而接受超声心动图检查。这种超声心动图在预测该人群预后方面的作用尚不清楚。本研究的目的是调查动脉导管未闭且临床怀疑有肺动脉高压的早产新生儿的初始超声心动图评估与医院结局之间的关联。
本单中心回顾性研究纳入了在我们机构出生或出生后48小时内转入的胎龄小于37周、患有动脉导管未闭且临床怀疑有肺动脉高压的早产新生儿。主要结局是住院期间体外膜肺氧合的使用情况或死亡率。
共纳入86例患者。超声心动图检查时的中位年龄为2天（四分位间距1,7），胎龄为27周（四分位间距25,32），出生体重为878克（四分位间距650,1818）。15例患者（17%）达到主要结局。动脉导管未闭尺寸较大（P = 0.03）、卵圆孔未闭处双向或右向左分流（P = 0.047）以及右心房容积（P = 0.04）与主要结局独立相关。
动脉导管未闭尺寸较大、卵圆孔未闭处双向或右向左分流以及右心房容积较小与住院死亡率独立相关。早产新生儿初始超声心动图的这些发现可用于对这些患者进行风险分层，以评估其住院期间体外膜肺氧合使用或死亡风险升高的情况。
