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Cardiac output and ductal reopening during phototherapy in preterm infants
M J Benders1, F Van Bel, M Van de Bor
1Department of Pediatrics, Leiden University Medical Center, The Netherlands.
Insights
Phototherapy for jaundice in preterm infants can affect blood flow. While the ductus arteriosus may reopen, it usually isn't serious, and cardiac output increases during treatment.
Area of Science:
- Neonatal Physiology
- Pediatric Cardiology
- Neonatal Intensive Care
Background:
- Phototherapy is a common treatment for hyperbilirubinemia in preterm infants.
- Potential cardiovascular effects of phototherapy require further investigation.
Purpose of the Study:
- To evaluate the impact of phototherapy on left ventricular output (LVO), left pulmonary artery blood flow (LPA), and patent ductus arteriosus (PDA) in preterm infants.
Main Methods:
- Utilized 2D/pulsed Doppler ultrasound to assess cardiovascular parameters in 27 preterm infants (< or =32 wk gestational age) before, during, and after phototherapy.
- Monitored infants exposed to phototherapy for at least 12 hours for non-haemolytic hyperbilirubinemia.
Main Results:
- The patent ductus arteriosus (PDA) reopened in 52% of infants during phototherapy, but without hemodynamic significance.
- Left ventricular output (LVO) initially decreased in infants without ductal reopening.
- Both LVO and LPA increased from 12 hours into phototherapy until its discontinuation.
- Post-phototherapy, LVO and LPA returned to baseline values.
Conclusions:
- Phototherapy can transiently alter cardiovascular dynamics in preterm infants, including changes in LVO, LPA, and PDA patency.
- These cardiovascular changes during phototherapy appear to be temporary and reversible upon cessation of treatment.
Abstract:
Left ventricular output (LVO), left pulmonary artery blood flow (LPA) and patency of the ductus arteriosus (PDA) were studied with 2D/pulsed Doppler ultrasound before, during and after phototherapy treatment in 27 preterm infants (gestational age < or =32 wk), who were exposed for a minimum of 12 h to phototherapy for non-haemolytic hyperbilirubinemia. In 14 infants (52%) the ductus arteriosus reopened during phototherapy, but ductal patency was not of haemodynamic importance. LVO initially decreased in preterm infants in whom the ductus did not reopen. From 12 h until discontinuation of phototherapy, LVO and LPA were higher than before phototherapy in all infants. After withdrawal of phototherapy, LVO and LPA returned to pre-phototherapy values.