medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2013, Number 1

<< Back Next >>

Rev Invest Clin 2013; 65 (1)

Un índice del diámetro interno del conducto arterioso/superficie corporal como necesidad de cierre del conducto en el recién nacido de pretérmino

Tapia-Rombo CA, González-Arenas M, Carpio-Hernández JC, Santiago-Romo JE

Language: Spanish
References: 36
Page: 12-23
PDF size: 174.28 Kb.


ABSTRACT

Objective. To determine a rate of internal diameter (ID), the narrowest, the ductus arteriosus (DA)/body surface area (BSA) in preterm newborns (PTNB) for need for closure of DA either medically or surgically. Material and methods. Prospective (cohort), held in a Neonatology Service in February 2010 to January 2011. Inclusion criteria were PTNB from 28 to 36 weeks of gestation from 0 to 28 days after birth, which confirmed diagnosis of patent ductus arteriosus (PDA) by echocardiogram, taking the narrowest ID, who did not present heart complex congenital or other major malformations in other systems without pulmonary arterial hypertension, that had not received drug treatment with prostaglandin inhibitors to close the DA. The exclusion criteria for complications of mechanical ventilation (air leaks, atelectasis, etc.) before measurements. BSA was determined based on their weight and height. There were two comparison groups during its evolution, those who finally merited either closure medical or surgical closure or was indicated but the poor conditions of the patient by the same PDA mainly, the procedure was not carried out (Group A) and Group B and those that are not operated or not medically closed DA not being hemodynamically significant. Statistical analysis was performed using descriptive statistics and inferential. Significance levels were set at p ‹ 0.05. Results. The study population consisted of 32 patients who were divided into two groups: group A of 13 patients and group B with 19 patients. The study population characteristics between the two groups showed significant difference only in the Apgar Score for the Group B. In multivariate analysis found statistically significant as need for closure of DA only a index ID DA/ BSA when it was › 14. Conclusions. It is important to take into account a number of known ways to assess whether the DA is hemodynamically significant and therefore should be closed medically or surgically and according to this study, a parameter to requiring its closure is an index ID DA/BSA with a value › 14.


REFERENCES

  1. Santamaría DH, Gómez GM. Cardiopatías congénitas en: PAC de Neonatologia-1. Libro1. México: Intersistemas; 2003, p. 19-23.

  2. Schneider DJ, Moore JW. Patent Ductus Arteriosus. Circulation 2006; 114: 1873-82.

  3. Park MY. Cardiología Pediátrica. 5a Ed. Madrid: Elsevier; 2008, p. 128-30.

  4. Gien J. Controversies in the management of patent ductus arteriosus. Neo Reviews 2008; 9: e477-e481.

  5. MacDonald MG, Seshia MK, Mullett M. Avery’s Neonatology. 6th Ed. Lippincott Williams & Wilkins; 2005.

  6. Keane JF, Lock JE, Fyler DC, Nadas AS. Nadas’ pediatric cardiology. Saunders 2006.

  7. Yeh TF, Raval D, Luken J, Thalji A, Lilien L, Pildes RS. Clinical evaluation of premature infants with patent ductus arterio sus: a scoring system with echocardiogram, acid-base, and blood gas correlations. Crit Care Med 1981; 9: 655-7.

  8. Evans N. Diagnosis of patent ductus arteriosus in the preterm newborn. Arch Dis Child 1993; 68: 58-61.

  9. Su BH, Watanabe T, Shimizu M, Yanagisawa M. Echocardiographic assessment of patent ductus arteriosus shunt flow in premature infants. Arch Dis Child 1997; 77: F36-F40.

  10. Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr 2009; 168: 907-14.

  11. Forsey JT, Elmasry OA, Martin RP. Patent arterial duct. Orphanet J Rare Dis 2009; 4: 17.

  12. Golombek SG, Sola A, Baquero H, Borbonet D, Cabañas F, Fajardo C, et al. Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeaable en recién nacidos preteérmino. An Pediatr (Barc) 2008; 69: 454-81.

  13. Thomas RL, Parker GC, Van Overmeire B, Aranda JV. A metaanalysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 2005; 164: 135-40.

  14. Ivey KN, Srivastava D. The paradoxical patent ductus arteriosus. J Clin Invest 2006; 116: 2863-66.

  15. Tschuppert S, Doell C, Arlettaz-Mieth, Baenziger O, Rousson V. Balmer C, et al. The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters. J Thorac Cardiovasc Surg 2008; 135: 78-82.

  16. Rangel A, Pérez-Redondo H, Farell J, Basare MN, Zamora C. Division or occlusion of patent ductus arteriosus? Angiology 2003; 54: 695-700.

  17. Flores FJ, Jiménez VA, Ledesma VM, Robledo NR, Sánchez PJL, Zaragoza RG. Cierre transcateterismo del conducto arterioso con dispositivo en espiral (Coil). Experiencia inicial en el Centro Médico Nacional “20 de Noviembre” ISSSTE. Rev Mex Cardiol 1999; 10: 118-22.

  18. Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed 2005; 90: F235-F239.

  19. Tapia-Rombo CA, Calvo-Rangel KM, Saucedo-Zavala VJ, Mora-Fol JR, Santiago-Romo JE. Evolución final de recién nacidos prematuros operados y no operados por persistencia del conducto arterioso. Gac Med Mex 2008; 144: 111-9.

  20. Gordillo PG, Mota HF, Velasquez JL. Diagnóstico y terapéutica de trastornos renales y electrolíticos en niños. 2a. Ed. México: D.F.: Ediciones Médicas del Hospital Infantil de México; 1981: 529.

  21. Siberry GK, Iannone R. The Harriet Lane Hand Book. 5th ed. EU: Mosby; 2000.

  22. Young MJ, Bresnitz EA, Strom BL. Sample size nomograms for interpreting negative clinical studies. Ann Inter Med 1983; 99: 248-51.

  23. Ekici F, Atasay B, Gunlemez A, Nacar N, Tutar E, Atalay S, et al. Management of patent ductus arteriosus in preterm infants. Anadolu Kardiyol Derg 2006; 6: 28-33.

  24. Tapia-Rombo CA, Dominguez-Martínez R, Saucedo-Zavala VJ, Cuevas-Urióstegui ML. Factores de riesgo para la presencia de complicaciones de la asistencia mecánica ventilatoria en el recién nacido. Rev Invest Clin 2004; 700-11.

  25. Jaillard S, Larrue B, Rakza T, Magnenant E, Warembourg H, Storme L. Consequences of delayed surgical closure of patent ductus arteriosus in very premature infants. Ann Thorac Surg 2006; 81: 231-4.

  26. Tapia-Rombo CA, Rodríguez-Jiménez G, Ballesteros-del-Olmo JC, Cuevas-Urióstegui ML. Factores de riesgo asociados a complicaciones de la asistencia mecánica ventilatoria en el recién nacido prematuro. Gac Med Mex 2009; 145: 273-83.

  27. Tapia-Rombo CA, Córdova-Muñiz NE, Ballesteros-del-Olmo JC, Aguilar-Solano AMG, Sánchez -García L, Gutiérrez-González GA, et al. Factores predictores para la producción de displasia broncopulmonar en el recién nacido de pretérmino. Rev Invest Clin 2009; 61: 466-75.

  28. Rojas MA, González A, Bancalari E, Claure U, Poole C, Silva- Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr 1995; 126: 605-10.

  29. Hansen T, Corbert A. Enfermedad pulmonar crónica. En: Taeusch HW, Ballard RA (eds.). Tratado de neonatología de Avery. 7a Ed. Philadelphia: Harcourt; 2000, p. 634-7.

  30. Morales P, Rastogi A, Bez ML, Akintorin SM, Pyati S, Andes SM, Pildes RS. Effect of dexamethasone therapy on the neonatal ductus arteriosus. Pediatr Cardiol 1998; 19: 225-9.

  31. Eronen M, Kari A, Pesonen E, Hallman M. The effect of antenatal dexamethasone administration on the fetal and neonatal ductus arteriosus. Am J Dis Child 1993; 147: 187-92.

  32. Hammerman C. Patent ductus arteriosus. Clinical relevance of prostaglandins and prostaglandins inhibitors in PDA pathophysiology and treatment. Clin Perinatol 1995; 22: 457-77.

  33. Rennie JM, Cooke RW. Prolonged low dose indomethacin for persistent ductus arteriosus of prematurity. Arch Dis Child 1991; 66: 55-58.

  34. Von Overmeire B, Follens I, Hartmann S, Creten WL, Van Acker KJ. Treatment of patent ductus arteriosus with ibuprofen. Arch Dis Child 1997; 76: F179-F184.

  35. Trus T, Winthrop AL, Pipe S, Shah J, langer JC, Lau GY. Optimal management of the patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg 1993; 28: 1137-9.

  36. Pérez CA, Bustorff-Silva JM, Villasenor E, Fonkalsrud EW, Atkinson JB. Surgical ligation of patent ductus arteriosus in very low birth weight infants: is it safe? Am Surg 1998; 64: 1007-09.




2020     |     www.medigraphic.com