Abstract
Objective: The purpose of our study was to compare clinical criteria with echocardiographic findings in diagnosing hemodynamically significant patent ductus arteriosus (PDA) in preterm infants.
Methods: We evaluated 25 preterm infants born at 24–32 weeks of gestation with birth weight from 500 to 1700 g for tachycardia, heart murmur, hyperdynamic chest, presence of dorsalis pedis pulse, hypotension, and worsening of the respiratory status at 48–72 h of life. A pediatric cardiologist blinded to clinical findings performed the echocardiograms. Infants with congenital anomalies and conditions, sepsis, IVH, and necrotizing enterocolitis were excluded.
Results: Out of 25 preterm infants, 12 infants had hemodynamically significant PDA with left-to-right shunt. Two infants had small PDA and in 11 infants the ductus arteriosus was not patent. PDA infants had lower gestational age (P=0.02) and birth weight (P=0.03). Their Apgar scores (1 min) were lower (P=0.03). The heart rate between the two groups differed, but was clinically within normal limits. Systolic (P=0.05) and mean blood pressures (P=0.04) were lower in the PDA group. A poor association between heart murmur, hyperdynamic chest and dorsalis pedis pulse, and the presence of PDA was revealed.
Conclusion: Echocardiogram is required for early diagnosis of PDA in preterm infants, as clinical signs are not reliable in the first few days of life.
References
1 Behrman RE, RM Kliegman, HB Jensen (eds): Nelson Textbook of Pediatrics. 17th edition. Saunders, Philadelphia 2004, pp 579Search in Google Scholar
2 Davis P, S Turner-Gomes, K Cunningham, C Way, R Roberts, B Schmid: Precision and accuracy of clinical and radiological signs in premature infants at risk of patent ductus arteriosus. Arch Pediatr Adolesc Med149 (1995) 1136Search in Google Scholar
3 Evans N, J Moorcraft: Effect of patency of the ductus arteriosus on blood pressure in very preterm infants. Arch Dis Child67 (1992) 1169Search in Google Scholar
4 Kluckow M, N Evans: Ductal shunting, high pulmonary blood flow and pulmonary hemorrhage. J Pediatr137 (2000) 68Search in Google Scholar
5 Kluckow M, N Evans: Low superior vena cava flow and intraventricular hemorrhage in preterm infants. Arch Dis Child Neonatal Ed82 (2000) f18810.1136/fn.82.3.F188Search in Google Scholar
6 Kupferschmid C, D Lang, F Pohlandt: Sensitivity, specificity and predictive value of clinical findings, m-mode echocardiography and continuous-wave Doppler sonography in the diagnosis of symptomatic patent ductus arteriosus in preterm infants. Eur J Pediatr147 (1988) 279Search in Google Scholar
7 Lindner W, M Seidel, H Versmold, C Dohlemann, K Riegel: Stroke volume and left ventricular output in preterm infants with PDA. Pediatr Res27 (1990) 278Search in Google Scholar
8 Morales WJ, JL Angel, WF O'Brien: Use of ampicillin and corticosteroids in premature rupture of membranes: a randomized control study. Obstet Gynecol73 (1989) 721Search in Google Scholar
9 Reller MD, ML Ziegler, MJ Rice, RC Solin, RW McDonald: Duration of ductal shunting in healthy preterm infants: an echocardiographic color flow Doppler study. J Pediatr112 (1988) 441Search in Google Scholar
10 Skelton R, N Evans, J Smythe: A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for PDA. J Pediatr Child Health30 (1994) 406Search in Google Scholar
11 Skinner J: Diagnosis of patent ductus arteriosus. Semin Neonatol6 (2001) 4910.1053/siny.2000.0037Search in Google Scholar PubMed
12 Skinner J, RJ Boys, S Hunter, EN Hey: Pulmonary and systemic pressure in hyaline membrane disease. Arch Dis Child67 (1992) 366Search in Google Scholar
©2005 by Walter de Gruyter Berlin New York
