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01-07-2020 | Patent Ductus Arteriosus | Original Article

Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus

Authors: Larissa Sobral Cavalcanti, Eduardo Just da Costa e Silva, Ana Rodrigues Falbo, José Natal Figueiroa, Letícia Amorim Bezerra Barreto, Inês Marabuco Lopes, Lívia Lócio Rosado de Oliveira, Thiago Xavier de Barros Correia

Published in: Pediatric Radiology | Issue 8/2020

Abstract

Background

Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions.

Objective

To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultrasonography (US).

Materials and methods

We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2 days to 20 days of age.

Results

All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01).

Conclusion

Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation.

Benitz W (2016) Patent ductus arteriosus in preterm infants. Pediatrics 137:e20153730CrossRef

Noori S, McCoy M, Friedlich P et al (2009) Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 123:138–144CrossRef

Miyague N (2005) Persistência do canal arterial em recém-nascidos prematuros [Preterm neonates with patent ductus arteriosus]. J Pediatr 81:429–430CrossRef

Jain A, Shah PS (2015) Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr 169:863–872CrossRef

Hamrick SE, Hansmann G (2010) Patent ductus arteriosus of the preterm infant. Pediatrics 125:1020–1030CrossRef

Visconti L, Morhy S, Deutsch A et al (2013) Características clínicas e ecocardiográficas associadas à evolução do canal arterial em recém-nascidos com peso de nascimento inferior a 1500g [Clinical and echocardiographic characteristics associated with the evolution of ductus arteriosus in neonates with birth weight lower than 1,500g]. Hosp Isr Albert Einstein 11:317–323

Dominguez G, Leboreiro J, Macías M el al (2015) Pesquisa o diagnóstico sintomático por ecocardiografía en la persistencia del conducto arterioso en prematuros [Echocardiographic screening vs. symptomatic diagnosis for patent ductus arteriosus in preterms]. Rev Med Inst Mex Seguro Soc 53:136–141

Antonucci R, Bassareo P, Zaffanello M et al (2010) Patent ductus arteriosus in the preterm infant: new insights into pathogenesis and clinical management. J Matern Fetal Neonatal Med 23:34–37CrossRef

Hsu KH, Nguyen J, Dekom S et al (2019) Effects of patent ductus arteriosus on organ blood flow in infants born very preterm: a prospective study with serial echocardiography. J Pediatr 216:95–100CrossRef

10.

Wong SN, Lo RN, Hui PW (1990) Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic patent ductus arteriosus. J Ultrasound Med 9:125–130CrossRef

11.

Chock VY, Ramamoorthy C, Van Meurs KP (2012) Cerebral autoregulation in neonates with a hemodynamically significant patent ductus arteriosus. J Pediatr 160:936–942CrossRef

12.

Arvind S, Tran H, Carse E (2011) Doppler manifestations of ductal steal: role in decision making. Eur J Pediatr 170:795–798CrossRef

13.

Martinussen M, Brubakk AM, Vik T, Yao AC (1996) Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants. Pediatr Res 39:275–280CrossRef

14.

Groves AM, Kuschel CA, Knight DB, Skinner JR (2008) Does retrograde diastolic flow in the descending aorta signify impaired systemic perfusion in preterm infants? Pediatr Res 63:89–94CrossRef

15.

Martins FF, Rios DI, Resende MHF et al (2018) Relationship of patent ductus arteriosus size to echocardiographic markers of shunt volume. J Pediatr 202:50–55CrossRef

16.

Ledo A, Aguar M, Nunez-Ramiro A et al (2017) Abdominal near-infrared spectroscopy detects low mesenteric perfusion early in preterm infants with hemodynamic significant ductus arteriosus. Neonatology 112:238–245CrossRef

17.

Maruyama K, Koizumi T, Tomomasa T, Morikawa A (1999) Intestinal blood-flow velocity in uncomplicated preterm infants during the early neonatal period. Pediatr Radiol 29:472–477CrossRef

18.

Meyers RL, Alpan G, Lin E, Clyman RI (1991) Patent ductus arteriosus, indomethacin, and intestinal distension: effects on intestinal blood flow and oxygen consumption. Pediatr Res 29:569–574CrossRef

19.

Shimada S, Kasai T, Konishi M, Fujiwara T (1994) Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr 125:270–277CrossRef

Title: Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus
Authors: Larissa Sobral Cavalcanti
Eduardo Just da Costa e Silva
Ana Rodrigues Falbo
José Natal Figueiroa
Letícia Amorim Bezerra Barreto
Inês Marabuco Lopes
Lívia Lócio Rosado de Oliveira
Thiago Xavier de Barros Correia
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Patent Ductus Arteriosus
Patent Ductus Arteriosus
Patent Ductus Arteriosus
Patent Ductus Arteriosus
Published in: Pediatric Radiology / Issue 8/2020
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-020-04689-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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