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Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants
Author(s) -
Olsson Karl Wilhelm,
Jonzon Anders,
Sindelar Richard
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14752
Subject(s) - ductus arteriosus , medicine , gestational age , mechanical ventilation , observational study , ventilation (architecture) , prospective cohort study , cardiology , continuous positive airway pressure , pediatrics , pregnancy , obstructive sleep apnea , mechanical engineering , genetics , engineering , biology
Aim We assessed whether early haemodynamically significant patent ductus arteriosus (hs PDA ) predicted persistent patent ductus arteriosus ( PDA ) in extremely preterm infants. Methods This prospective observational study of 60 infants born at 22–27 weeks of gestational age (GA) without any major congenital anomalies or heart defects was conducted at Uppsala University Children's Hospital from November 2012 to May 2015. Respiratory and systemic circulatory parameters were continuously recorded, and echocardiographic examinations performed daily during the first three days of life. Pharmacological treatment was initiated if hs PDA was found on days two to seven. Persistent PDA was diagnosed if hs PDA remained after pharmacological treatment or pharmacological treatment was contraindicated. Results The infants (56% male) had a median GA of 25 + 2 weeks and 50% received pharmacological treatment. PDA was persistent in 30% and ultimately closed or insignificant in 70%. hs PDA on days two to seven was not associated with future persistent PDA (p = 1.000). Mechanical ventilation (p = 0.025), high mean airway pressure (p = 0.020) and low ductal maximal flow velocity ( V max ) (p = 0.024) on day two were associated with future persistent PDA . Conclusion Early hs PDA did not predict persistent PDA , but the early need for assisted ventilation and low ductal V max were associated with future persistent PDA in these extremely preterm infants.