Elsevier

The Journal of Pediatrics

Volume 127, Issue 5, November 1995, Pages 780-785
The Journal of Pediatrics

Hemodynamic prediction of complications in neonatal respiratory distress syndrome,☆☆,,★★

https://doi.org/10.1016/S0022-3476(95)70173-7Get rights and content

Abstract

Objectives. We hypothesized that the absence of an increase in the Doppler-derived aortopulmonary pressure gradient (APPG) across the ductus arteriosus, which reflects pulmonary artery pressure during the first day of life, can predict clinical complications in preterm infants with neonatal respiratory distress syndrome (RDS). Study design. Twenty-nine healthy preterm infants weighing 2210 ± 244 gm (mean ± SEM) and 63 infants with RDS weighing 1645 ± 86 gm were studied with the Doppler ultrasound technique for measurement of the mean APPG at 2, 24, 48, and 72 hours of age. Of infants with RDS, 67% were treated with synthetic surfactant. Results. Spontaneous closure of the ductus arteriosus on the first day of life led to exclusion of 11 infants with RDS and 17 control subjects from the study. Of the remaining 52 infants with RDS, 26 had an increase in the APPG from 2 to 24 hours of age, and APPG values remained low in the other 26 infants. Neonatal complications appeared more frequently (p <0.001) in distressed infants with little change in APPG values (ΔAPPG) (22/26) than in infants with high ΔAPPG (6/26). Six of the infants with high ΔAPPG values (23%) needed medical or surgical closure of the ductus, but no other acute neonatal complications occurred; 14 (54%) of the infants with low ΔAPPG required ductal closure. Between the ages of 24 and 58 hours, five of the latter 26 infants had severe pulmonary hemorrhage, which was fatal in two cases. Severe (grade III or IV) intraventricular hemorrhage was seen in three infants with RDS and a low ΔAPPG; one of these infants also had severe pulmonary bleeding. Pneumothorax occurred in six infants with a low ΔAPPG. Infants without an increase in the APPG value during the first day of life required a significantly higher fraction of inspired oxygen. Conclusions. Noninvasive measurement of the change in APPG during the first day of life may provide a useful method for identifying infants with RDS at high risk of neonatal complications. (J PEDIATR 1995;127:780-5)

Section snippets

METHODS

Twenty-nine healthy preterm control infants and 63 infants with RDS were studied prospectively (Table I). Infants with sepsis, aspiration, and congenital anomalies were excluded from the study. Cardiac Doppler ultrasound examinations were performed in infants at the mean ages of 2, 24, 48, and 72 hours; some of the examinations were unsuccessful because of the unstable condition of some infants. The infants were treated by the attending physicians, who were unaware of the results of the APPG

RESULTS

Spontaneous closure of the ductus arteriosus in 17 control subjects and 11 infants with RDS during the first day of life led to their exclusion from the study. In 12 healthy control subjects, the mean APPG increased on the first day of life from 6.3 ± 0.9 (mean ± SEM) to 18.6 ± 1.7 mm Hg (Figure). Ductal APPG either increased or remained low in infants with RDS, and the criterion described above was used for separating these patients into two groups. In 26 infants with RDS, the ductal pressure

DISCUSSION

This study shows that the mean APPG rapidly increases after birth in healthy preterm infants and in infants with uncomplicated neonatal RDS. On the other hand, infants with RDS who have a minimal increase in mean ductal APPG during the first day of life had most of the acute neonatal complications.

Early prophylactic closure of the PDA, especially in surfactant-treated infants, has been advocated as a way of diminishing the need for ventilatory support and avoiding serious acute and late

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    From the Department of Pediatrics, University of Turku, Turku, Finland

    ☆☆

    Supported by the South-West Finland Fund of Neonatal Research and the Foundation of Turku University.

    Reprint requests: Marko Seppänen, BM, Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland.

    ★★

    0022-3476/95/$5.00 + 0 9/23/67179

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