生后早期床旁心脏超声预测极低出生体重儿动脉导管持续开放的研究

doi:10.7499/j.issn.1008-8830.2109087

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Abstract Objective To study the value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight (VLBW) infants. Methods A retrospective analysis was performed for 51 VLBW infants who were admitted from March 2020 to June 2021, with an age of ≤3 days and a length of hospital stay of ≥14 days. According to the diameter of patent ductus arteriosus (PDA) on days 14 and 28 after birth, the infants were divided into three groups: large PDA group (PDA diameter ≥2 mm), small PDA group (PDA diameter <2 mm), and PDA closure group (PDA diameter =0 mm). The echocardiographic parameters measured at 72 hours after birth were compared among the three groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the echocardiographic parameters in predicting persistent patency of the ductus arteriosus (PDA≥2 mm) at the ages of 14 and 28 days. Results On day 14 after birth, there were 17 infants in the large PDA group, 11 in the small PDA group, and 23 in the PDA closure group. On day 28 after birth, there were 14 infants in the large PDA group, 9 in the small PDA group, and 26 in the PDA closure group. There were significant differences in gestational age, birth weight, rate of pulmonary surfactant use, and incidence rate of hypotension among the three groups (P<0.05). PDA diameter, end-diastolic velocity of the left pulmonary artery, left ventricular output, and left ventricular output/superior vena cava flow ratio measured at 72 hours after birth were associated with persistent patency of the ductus arteriosus at the ages of 14 and 28 days (P<0.05), and the ratio of the left atrium to aorta diameter was associated with persistent patency of the ductus arteriosus at the age of 28 days (P<0.05). The ROC curve analysis showed that the area under the curve that the PDA diameter measured at 72 hours after birth predicting the persistent patency of the ductus arteriosus at the ages of 14 and 28 days was the largest (0.841 and 0.927 respectively), followed by end-diastolic velocity of the left pulmonary artery, with the area under the curve of 0.793 and 0.833 respectively. Conclusions The indicators obtained by beside echocardiography at 72 hours after birth, especially PDA diameter and end-diastolic velocity of the left pulmonary artery, can predict persistent patency of the ductus arteriosus at the ages of 14 and 28 days in VLBW infants, which provides a basis for the implementation of early targeted treatment strategy for PDA.

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	Articles by authors
	LIU Tai-Xiang
	MA Xiao-Lu
	CHEN Jun-Jin
	LIN Hui-Jia
	WANG Chen-Hong
	CHEN Ming-Yan
	GE Jia-Jing
	SHI Li-Ping

Key words： Patent ductus arteriosus Bedside echocardiography Very low birth weight infant Preterm infant

Received: 15 September 2021

Cite this article:

LIU Tai-Xiang,MA Xiao-Lu,CHEN Jun-Jin et al. Value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight infants[J]. CJCP, 2022, 24(1): 26-32.

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http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2109087 OR http://www.zgddek.com/EN/Y2022/V24/I1/26

	Su BH, Lin HY, Huang FK, et al. Circulatory management focusing on preventing intraventricular hemorrhage and pulmonary hemorrhage in preterm infants[J]. Pediatr Neonatol, 2016, 57(6): 453-462. PMID: 26993561. DOI: 10.1016/j.pedneo.2016.01.001.
	Bancalari E, Claure N, Gonzalez A. Patent ductus arteriosus and respiratory outcome in premature infants[J]. Biol Neonate, 2005, 88(3): 192-201. PMID: 16210841. DOI: 10.1159/000087582.
	Ognean ML, Boant? O, Kovacs S, et al. Persistent ductus arteriosus in critically ill preterm infants[J]. J Crit Care Med (Targu Mures), 2016, 2(4): 175-184. PMID: 29967857. PMCID: PMC5953255. DOI: 10.1515/jccm-2016-0026.
	Hagadorn JI, Brownell EA, Trzaski JM, et al. Trends and variation in management and outcomes of very low-birth-weight infants with patent ductus arteriosus[J]. Pediatr Res, 2016, 80(6): 785-792. PMID: 27509008. DOI: 10.1038/pr.2016.166.
	Gillam-Krakauer M, Reese J. Diagnosis and management of patent ductus arteriosus[J]. Neoreviews, 2018, 19(7): e394-e402. PMID: 30505242. PMCID: PMC6269146. DOI: 10.1542/neo.19-7-e394.
	Su BH, Lin HY, Chiu HY, et al. Therapeutic strategy of patent ductus arteriosus in extremely preterm infants[J]. Pediatr Neonatol, 2020, 61(2): 133-141. PMID: 31740267. DOI: 10.1016/j.pedneo.2019.10.002.
	Hundscheid T, Onland W, van Overmeire B, et al. Early treatment versus expectative management of patent ductus arteriosus in preterm infants: a multicentre, randomised, non-inferiority trial in Europe (BeNeDuctus trial)[J]. BMC Pediatr, 2018, 18(1): 262. PMID: 30077184. PMCID: PMC6090763. DOI: 10.1186/s12887-018-1215-7.
	EL-Khuffash A, Bussmann N, Breatnach CR, et al. A pilot randomized controlled trial of early targeted patent ductus arteriosus treatment using a risk based severity score (the PDA RCT)[J]. J Pediatr, 2021, 229: 127-133. PMID: 33069668. DOI: 10.1016/j.jpeds.2020.10.024.
	Smith A, Maguire M, Livingstone V, et al. Peak systolic to end diastolic flow velocity ratio is associated with ductal patency in infants below 32 weeks of gestation[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(2): F132-F136. PMID: 25406463. DOI: 10.1136/archdischild-2014-306439.
	de Waal K, Phad N, Stubbs M, et al. A randomized placebo-controlled pilot trial of early targeted nonsteroidal anti-inflammatory drugs in preterm infants with a patent ductus arteriosus[J]. J Pediatr, 2021, 228: 82-86.e2. PMID: 32858033. DOI: 10.1016/j.jpeds.2020.08.062.
	Terrin G, Di Chiara M, Boscarino G, et al. Echocardiography-guided management of preterms with patent ductus arteriosus influences the outcome: a cohort study[J]. Front Pediatr, 2020, 8: 582735. PMID: 33409261. PMCID: PMC7779760. DOI: 10.3389/fped.2020.582735.
	Wu TW, Azhibekov T, Seri I. Transitional hemodynamics in preterm neonates: clinical relevance[J]. Pediatr Neonatol, 2016, 57(1): 7-18. PMID: 26482579. DOI: 10.1016/j.pedneo.2015.07.002.
	Kluckow M. The pathophysiology of low systemic blood flow in the preterm infant[J]. Front Pediatr, 2018, 6: 29. PMID: 29503814. PMCID: PMC5820306. DOI: 10.3389/fped.2018.00029.
	Hamrick SEG, Sallmon H, Rose AT, et al. Patent ductus arteriosus of the preterm infant[J]. Pediatrics, 2020, 146(5): e20201209. PMID: 33093140. PMCID: PMC7605084. DOI: 10.1542/peds.2020-1209.
	Deshpande P, Baczynski M, McNamara PJ, et al. Patent ductus arteriosus: the physiology of transition[J]. Semin Fetal Neonatal Med, 2018, 23(4): 225-231. PMID: 29779927. DOI: 10.1016/j.siny.2018.05.001.
	Koch J, Hensley G, Roy L, et al. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less[J]. Pediatrics, 2006, 117(4): 1113-1121. PMID: 16585305. DOI: 10.1542/peds.2005-1528.
	Dice JE, Bhatia J. Patent ductus arteriosus: an overview[J]. J Pediatr Pharmacol Ther, 2007, 12(3): 138-146. PMID: 23055849. PMCID: PMC3462096. DOI: 10.5863/1551-6776-12.3.138.
	Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?[J]. Semin Perinatol, 2012, 36(2): 123-129. PMID: 22414883. PMCID: PMC3305915. DOI: 10.1053/j.semperi.2011.09.022.
	Tissot C, Singh Y. Neonatal functional echocardiography[J]. Curr Opin Pediatr, 2020, 32(2): 235-244. PMID: 32068595. DOI: 10.1097/MOP.0000000000000887.
	van Laere D, van Overmeire B, Gupta S, et al. Application of NPE in the assessment of a patent ductus arteriosus[J]. Pediatr Res, 2018, 84(Suppl 1): 46-56. PMID: 30072803. PMCID: PMC6257219. DOI: 10.1038/s41390-018-0077-x.
	Kwinta P, Rudziński A, Kruczek P, et al. Can early echocardiographic findings predict patent ductus arteriosus?[J]. Neonatology, 2009, 95(2): 141-148. PMID: 18776728. DOI: 10.1159/000153098.
	Toyoshima K, Isayama T, Kobayashi T, et al. What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study[J]. J Cardiol, 2019, 74(6): 512-518. PMID: 31256929. DOI: 10.1016/j.jjcc.2019.05.004.
	Hsu KH, Nguyen J, Dekom S, et al. Effects of patent ductus arteriosus on organ blood flow in infants born very preterm: a prospective study with serial echocardiography[J]. J Pediatr, 2020, 216: 95-100.e2. PMID: 31610928. DOI: 10.1016/j.jpeds.2019.08.057.
	Masutani S, Isayama T, Kobayashi T, et al. Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: a post-hoc analysis of a prospective multicenter study[J]. J Cardiol, 2021, 78(6): 487-492. PMID: 34481720. DOI: 10.1016/j.jjcc.2021.08.007.
	Suzumura H, Nitta A, Tanaka G, et al. Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants[J]. Pediatr Int, 2001, 43(2): 146-151. PMID: 11285066. DOI: 10.1046/j.1442-200x.2001.01365.x.
	El Hajjar M, Vaksmann G, Rakza T, et al. Severity of the ductal shunt: a comparison of different markers[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(5): F419-F422. PMID: 16113155. PMCID: PMC1721944. DOI: 10.1136/adc.2003.027698.