medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2015, Number 3

<< Back Next >>

An Med Asoc Med Hosp ABC 2015; 60 (3)

Echocardiographic diagnosis of persistence of arterial ductus in neonates hospitalized in the neonatal intensive care unit

Polania RMH, Rodríguez TG, Zamorano JCA, Sánchez VLD

Language: Spanish
References: 17
Page: 185-190
PDF size: 237.38 Kb.


ABSTRACT

Background: The incidence has been reported between 50 and 70% in pre-term newborns being more frequent the lower the gestational age. Objective: To examine the clinical and morphological/physiological characteristics of ductus arteriosus at diagnosis and the relationship between the time of diagnosis and age. Methods: Design observational, descriptive, ambispective and transversal study. Patients: Newborns. Site: Neonatal intensive care unit in a private hospital. Period: 6 years. Variables: Demographic, clinical and sonographic variables. Results: Two-hundred cases were analyzed, 47 (23.5%) newborns at term, 62 (31%) late preterm newborns, 66 (33%) preterm newborns and 25 (12.5%) extreme preterm newborns. Ductus arteriosus was diagnosed in newborns at term in 90% of the cases during the first week. Diagnosis was performed later, between the second and third weeks, in the preterm newborns. Diagnosis was suspected in newborns of more than 33 weeks of gestation with heart murmurs and wider pulses. In newborns of 33 weeks of gestation or less showed hemodynamic and pulmonary compromise. There was a positive correlation between size of ductus arteriosus and gestational age (r=0.16, p=0.02), but not with the gradient (r=0.03, p=0.57). There was a left-right shunt in 79% of cases, right-left shunt in 10.5% and bidirectional in the 10.5% of cases. Conclusions: Diagnosis of ductus arteriosus was performed during the first week in the most of cases, mostly in newborns at term or late preterm newborns. Diagnosis was suspected in presence of tachypnea, tachycardia and heart murmurs. Hemodynamic compromise was more evident in extreme preterm newborns. There was no difference in size, gradient and type of shunt in ductus arteriosus among groups.


REFERENCES

  1. Polin RA, Yoder MC. Workbook in practical neonatology. 4th ed. Saunders Elservier; 2007. pp. 249-60. [Consultado 10 de marzo de 2015]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19591690.

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

  3. Chiruvolu A, Jaleel MA. Pathophysiology of patent ductus arteriosus in premature neonates. Early Hum Dev. 2009; 85 (3): 143-146.

  4. Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate. 2006; 89 (3): 330-335.

  5. John T, Colvin R, Ferrall B. Improving the management and delivery of bedside patent ductus arteriosus ligation. AORN J. 2007; 86 (2): 231-238.

  6. Golombek SG, Sola A, Baquero H, Borbonet D, Cabañas F, Fajardo C et al. First SIBEN clinical consensus: diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns. An Pediatr (Barc). 2008; 69 (5): 454-481.

  7. Ruíz-González MA, Gómez-Guzmán E, Párraga-Quiles MJ et al. Protocolos diagnóstico-terapéuticos de la AEP: Neonatología. Ductus Arterioso Persistente. 2008; 36: 353-361. [Consultado: 10 de marzo de 2015]. Disponible en: http://www.se-neonatal.es/Portal/0/Articulos/36.pdf

  8. Bancalari E. Patent ductus arteriosus. An Pediatr (Barc). 2008; 69 (5); 397-399.

  9. Maroto MC, Camino LM, Girona CJM, Malo CP. Clinical guidelines of the Spanish Society of Cardiology in congenital cardiopathy of the newborn. Rev Esp Cardiol. 2001; 54 (1): 49-66.

  10. Hermes-DeSantis ER, Clyman RI. Patent ductus arteriosus: pathophysiology and management. J Perinatol. 2006; 26 Suppl 1: S14-8.

  11. Diagnosis of patent ductus arteriosus in preterm infants. [Consultado: 10 de marzo de 2015]. Disponible en: http://www.ohsu.edu/xd/health/services/doernbecher/research-education/education/residency/upload/res_lounge_diagnosis-pda.pdf

  12. San Luis R, Arias LG, Peralta ML, Lázaro JL, León JL, Benítez ZM et al. Guía de Práctica Clínica. Persistencia del conducto arterioso. Rev Med Inst Mex Seg Soc. 2012; 50 (4): 453-463.

  13. AEPED. Ductus arterioso persistente y ventana aorto-pulmonar. Protocolos diagnósticos y terapéuticos en Cardiología Pediátrica. [Consultado: 10 de marzo de 2015] Disponible en: https://www.aeped.es/sites/default/files/documentos/7_ductus.pdf.

  14. McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed. 2007; 92 (6): F424-F427.

  15. Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1,000 grams or less. Pediatrics. 2006; 117 (4): 1113-1121.

  16. Bose C, Laughon MM. Patent ductus arterious: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007; 92 (6): F498-502.

  17. Controversies in the management of patent ductus arteriosus. [Consultado: 10 de marzo de 2015] Disponible en: http://neoreviews.aappublications.org/content/9/10/e477.abstract.




2020     |     www.medigraphic.com