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Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants
1Department of Neonatal Medicine, King George V Hospital, Part of Royal Prince Alfred Hospital, NSW, Australia.
Insights
Early cardiovascular changes, including larger patent ductus arteriosus (PDA) shunts and lower right ventricular output (RVO), are linked to intraventricular hemorrhage (IVH) in preterm infants. Lack of antenatal steroids also increases IVH risk.
Area of Science:
- Neonatal physiology
- Pediatric cardiology
- Perinatal medicine
Background:
- Intraventricular hemorrhage (IVH) is a significant complication in preterm infants.
- Early cardiovascular adaptation plays a crucial role in neonatal outcomes.
- Understanding risk factors for IVH is essential for timely intervention.
Purpose of the Study:
- To investigate the association between early cardiovascular parameters and the incidence of IVH in preterm neonates.
- To identify specific echocardiographic findings predictive of IVH.
- To evaluate the role of antenatal steroid administration in relation to IVH risk.
Main Methods:
- Echocardiographic assessment of 117 ventilated preterm infants within 36 hours of birth.
- Measurements included right ventricular output (RVO), left ventricular output (LVO), and patent ductus arteriosus (PDA) shunt characteristics.
- Clinical data on antenatal steroid use, respiratory severity, and blood pressure were collected; cerebral ultrasounds were reviewed by a blinded radiologist.
Main Results:
- Infants with IVH had significantly larger PDA diameters compared to those without IVH.
- Lower RVO was observed in infants with higher grades of IVH (grades 3 and 4).
- Lack of antenatal steroid administration was significantly associated with increased IVH risk.
Conclusions:
- Larger early PDA shunts are associated with a higher risk of IVH.
- Diminished RVO is linked to severe IVH.
- Antenatal steroid use may offer protective effects against IVH in preterm infants.
Aim:
To establish if there is an association between early cardiovascular adaptation and intraventricular haemorrhage (IVH).
Methods:
One hundred and seventeen ventilated preterm infants (mean gestational age 27 weeks, mean birthweight 993 g) were studied echocardiographically within the first 36 hours. Measurements included right (RVO) and left ventricular outputs (LVO), ductus arteriosus (PDA) and atrial shunt diameter using colour Doppler and pulsed Doppler direction and velocity of both shunts. Clinical variables collected over the first 24 hours included use of antenatal steroids, respiratory severity, and mean blood pressure. Cerebral ultrasound scans were reported by a radiologist blinded to clinical and echocardiographic data.
Results:
Antenatal steroids (two doses) had been given to 73% of the 86 infants with no IVH compared with 48% of the 21 infants with grades 1 and 2 IVH, and just 10% of 10 babies with grades 3 and 4 (P < 0.05). Both groups with IVH had significantly larger PDA diameters than the group with no IVH. Infants with grades 3 and 4 IVH had significantly lower RVO than the other infants. These differences were more pronounced when only infants with definite late IVH were analysed. Logistic regression analysis showed lack of antenatal steroids and larger PDA diameters were significantly associated with any grade of IVH and lack of antenatal steroids; lower RVO was significantly associated with grades 3 and 4 IVH.
Conclusions:
Larger early PDA shunts, lower RVO, and lack of antenatal steroids were significantly associated with IVH.