Abstract Abstract Objective The objective of this study was to use the Ultrasonic Cardiac Output Monitor
(USCOM) to observe the hemodynamic effects of a hemodynamically significant patent ductus arteriosus
(hsPDA) on the very low birth weight infants, and to identify the hemodynamic changes after using the
ibuprofen to close the hsPDA. To evaluate whether USCOM can be used in screening for hemodynamically
significant patent ductus arteriosus in preterm neonates. Methods This was a prospective study involving
preterm neonates with birth weight < 1500 g, and gestational age 32weeks. Each enrolled neonate
underwent the initial echocardiogram for a clinical suspicion of a hemodynamically significant patent ductus arteriosus (PDA). The definition of a hsPDA include the diameter of the PDA > 1.5 mm, Left atrial/Aortic root (LA/AO)>1.4, and with moderate to severe left to right shunt. Use the USCOM to monitor the hemodynamic parameters of these infants after birth, as well as the PDA diameter, LA/AO, shunt ,and repeat every 24 to 48 hours until completion of ibuprofen treatment. Results A total of 5 preterm infants were included, 3 were male,2 were female,with a median gestation of 30+4 weeks (27 to 32weeks), and a median birth weight of 1.3 Kg750 to1500g. All the infants received echocardiogram in 4 to 6 hours after birth, the median size of the PDA was 2.2 mm, LA/AO was 1.74, with Left to right shunt were found in all the infants.No significant clinical symptoms were found during the first 72 hours, from day 5 to day 7,all the infants developed significant clinical symptoms: elevated heart rate, low blood pressure, shortness of breath, feeding intolerance and so on. All the infants received ibuprofen treatment (10 mg/kg first dose, then second andthird dose after every 24 hours,5mg/kg), on the 10-12 days after birth, hsPDA were found closed in all the infants. The hemodynamics show significant changes from day 5-7 ,with left ventricular cardiac output (LVCO), stroke volume (SV), cardiac index (CI), heart rate (HR) and Smith-Madigan inotropy index (SM), all raised significantly (p<0.01), while systemic vascular resistance index (SVRI) , blood pressure show significantly reduced (p < 0.01). After the use of ibuprofen, on day 10 to 12 ,the total LVCO, SV, CI, HR and SMfall to basic level at birth (p < 0.01), SVRI, blood pressure raised to basic level at birth (p < 0.01).Conclusion The hsPDA had significant effects on the hemodynamics of the very low birth weight infants.Hemodynamic changes mostly developed from day 5 to 7 after birth with significant clinical symptoms, a number of hemodynamic parameters such as LVCOCISVHRSM all raised significantly, while SVRI and blood pressure dropped. After the use of ibuprofen, hsPDA closed, the hemodynamic parameters went back to normal, and the clinical symptoms improved. USCOM can be used in screening for hemodynamically significant patent ductus arteriosus in preterm neonates and in monitoring the efficacy of treatment of hsPDA.
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Received: 18 February 2018
Published: 05 September 2019
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2014, Vol. 2 
