Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant☆,☆☆,★
Section snippets
Patient population
We selected 30 patients for the study from the 58 consecutive preterm infants with RDS (birth weight <1500 gm) who were treated with exogenous surfactant within 10 hours of birth at the Iwate Medical University Hospital Neonatal Intensive Care Unit between January 1990 and December 1992. We performed prospective evaluations for ductal patency and hemodynamic function, by use of serial Doppler flow and physical examinations. The infants were selected on the basis of the following criteria: (1)
RESULTS
There were no significant differences between the infants with hsPDA and the matched infants without hsPDA with respect to prenatal factors, gender, mode of delivery, gestational age (28.4 ± 1.9 weeks vs 28.7 ± 1.1 weeks), birth weight (1179 ± 178 gm vs 1197 ± 156 gm), Apgar scores, the severity of initial lung disease, dose of surfactant (124 ± 18 mg vs 132 ± 25 mg phospholipids per kilogram), and age at the time of surfactant therapy (2.5 ± 2.1 hours vs 3.3 ± 2.4 hours). One infant with a
DISCUSSION
The results of this study indicate that the surfactant-treated preterm infant with a large left-to-right ductal shunt during the first postnatal days is able to mount a compensatory increase in cardiac output sufficient to sustain unchanged cerebral blood flow, but is unable to sustain effective blood flow to the postductal organs. After pharmacologic closure of the PDA, both LVO and individual organ blood flows return to normal. These findings are consistent with the description by Clyman et
References (31)
- et al.
Cardiovascular effects of patent ductus arteriosus in preterm lambs with respiratory distress
J PEDIATR
(1987) - et al.
Real-time Doppler color flow mapping for detection of patent ductus arteriosus
J Am Coll Cardiol
(1986) - et al.
Effect of patent ductus arteriosus on left ventricular output in premature infants
Pediatrics
(1983) - et al.
Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound
J PEDIATR
(1979) - et al.
The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant
J PEDIATR
(1981) - et al.
The contractility and performance of the preterm left ventricle before and after early patent ductus arteriosus occlusion in surfactant-treated lambs
Pediatr Res
(1985) - et al.
Left ventricular performance and regional blood flows before and after ductus arteriosus occlusion in premature lambs treated with surfactant
Circulation
(1983) - et al.
Maturity of fetal lungs tested by production of stable microbubbles in amniotic fluid
Br J Obstet Gynaecol
(1979) - et al.
Stable microbubble test for predicting the risk of respiratory distress syndrome. II. Prospective evaluation of the test on amniotic fluid and gastric aspirate
Eur J Pediatr
(1993) - et al.
Surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonate with respiratory distress syndrome: final analysis of multicenter, double-blind, randomized trial and comparison with similar trial
Pediatrics
(1990)
Surfactant replacement in neonatal RDS
Echocardiographic characteristics of premature infants with patent ductus arteriosus
Pediatrics
Diagnosis of patent ductus arteriosus in the preterm newborn
Arch Dis Child
Closure of patent ductus arteriosus in preterm infants with mefenamic acid [in Japanese]
Igaku No Ayumi
Pediatric echocardiography
Cited by (0)
- ☆
From the Department of Pediatrics, Iwate Medical University, Morioka, Iwate, Japan
- ☆☆
Reprint requests: Senji Shimada, MD, Department of Pediatrics, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020 Japan.
- ★
0022-3476/94/$3.00 + 0 9/23/55484