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The silent ductus arteriosus in idiopathic respiratory distress syndrome
Insights
Clinical assessment, especially listening for murmurs, is effective for diagnosing patent ductus arteriosus in premature infants with severe respiratory distress syndrome. This approach rarely misses or delays diagnosis in these vulnerable neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Idiopathic respiratory distress syndrome (IRDS) is a common condition in preterm infants.
- Patent ductus arteriosus (PDA) is a frequent complication in neonates with IRDS.
- Accurate and timely diagnosis of PDA is crucial for appropriate management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clinical criteria, particularly murmurs, for identifying patent ductus arteriosus (PDA) in preterm infants with severe idiopathic respiratory distress syndrome (IRDS).
Main Methods:
- Retrospective review of 425 preterm, low birthweight infants surviving >48 hours.
- Analysis of 130 infants diagnosed with IRDS, including 73 requiring ventilation.
- Correlation of clinical findings (murmurs) with autopsy data and diagnostic outcomes for PDA.
Main Results:
- Of 73 ventilated infants with IRDS, 41 were clinically diagnosed with PDA, predominantly with a murmur.
- Two infants with undiagnosed PDA died, highlighting potential diagnostic limitations.
- Clinical assessment, especially murmur detection, proved reliable in most ventilated infants with IRDS.
Conclusions:
- Clinical evaluation, including auscultation for murmurs, is a highly effective method for diagnosing PDA in preterm infants with severe IRDS.
- Relying on clinical signs rarely leads to missed or significantly delayed PDA diagnoses in this population.
- Prompt identification of PDA facilitates timely intervention and improves outcomes for neonates with IRDS.
Abstract:
Among 425 pre-term low birthweight babies who survived more than 48 hours there were 130 with idiopathic respiratory distress syndrome, 73 of whom received ventilation for their disease. The ductus arteriosus was considered patent by clinical criteria in 41 of these babies, all but 1 of whom had a murmur. Of the remaining 32 infants there were 2 babies only who died and both were found to have a patent ductus arteriosus which had not been detected clinically. Another baby died whilst being ventilated for idiopathic respiratory distress syndrome and although autopsy information is not available it seems likely that factors other than a patent ductus arteriosus caused death. The mean age of murmur detection in those ventilated infants considered to have a patent ductus arteriosus was 6 days (range 2-19). Infants without a murmur or other features of a ductus arteriosus did not require to be ventilated beyond day 7 with the exception of the 2 fatalities already mentioned. Thus, relying on clinical criteria and particularly on the presence of a murmur, if sought often, rarely results in missing or seriously delaying the diagnosis of patent ductus arteriosus in babies with severe idiopathic respiratory distress syndrome.