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Non-invasive measurements of ductus arteriosus flow directly after birth
  1. Jeroen J van Vonderen1,
  2. Arjan B te Pas1,
  3. Clara Kolster-Bijdevaate2,
  4. Jan M van Lith2,
  5. Nico A Blom3,
  6. Stuart B Hooper4,
  7. Arno A W Roest3
  1. 1Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
  4. 4The Ritchie Centre, Monash Institute for Medical Research, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Jeroen J van Vonderen, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, Leiden 2300 RC, The Netherlands; j.j.van_vonderen{at}


Objective To assess ductus arteriosus (DA) blood flow directly after birth in healthy term infants after elective caesarean section.

Design In healthy term newborns, echocardiography was performed at 2, 5 and 10 min after birth to monitor cardiac output and DA blood flow. Heart rate (HR) was assessed using ECG.

Setting The delivery rooms of the Leiden University Medical Center.

Patients 24 healthy term infants born after a caesarean section were included in this study.

Results Mean (SD) HR did not change (158 (18) beats per minute (bpm), 5 min (159 (23) bpm) and 10 min (156 (19) bpm). DA diameter decreased from 5.2 (1.3) mm at 2 min to 4.6 (1.3) mm at 5 min (p=0.01) to (3.9 (1.2) mm) (p=0.01) at 10 min. Right-to-left DA shunting was unaltered (median (IQR) 95 (64–154) mL/kg/min to 90 (56–168) mL/kg/min and 80 (64–120) mL/kg/min, respectively (ns)), whereas left-to-right shunting significantly increased between 2 and 5 min (41 (31–70) mL/kg/min vs 67 (37–102) mL/kg/min (p=0.01)) and increased significantly between 2 and 10 min (93 (67–125)) mL/kg/min (p<0.001). Right-to-left/left-to-right shunting ratio decreased significantly from 2.1 (1.4–3.1) at 2 min to 1.4 (1.0–1.8) at 5 min (p<0.0001) and to 0.9 (0.6–1.1) at 10 min (p<0.0001).

Conclusions DA shunting changes swiftly from predominantly right-to-left shunting to predominantly left-to-right shunting at 10 min after birth, reflecting differential changes in pulmonary and systemic vascular resistance.

  • Neonatology
  • neonatal transition
  • ductus arteriosus
  • left ventricular output
  • right ventricular output

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