Background

Patent ductus arteriosus (PDA) is a frequent cardiovascular problem in preterm infants.

Objectives

The goal of this study was to evaluate the management and outcomes of hemodynamically significant PDA (HS-PDA) in a level 3 Neonatal Intensive Care Unit (NICU) and to identify possible risk factors and associated morbidities.

Methods

A retrospective study including all newborns (NB) < 30 weeks of gestation admitted with PDA and a comparative study between HS and non-HS PDA was conducted. Data were collected from clinical records between January 2010 and December 2018.

Results

A total of 143 NB was found, 103 HS-PDA and 40 non-HS-PDA.

In 6.8% HS-PDA was managed exclusively with fluid restriction while 93,2% needed medical or surgical (n=9) treatment.

HS-PDA was more frequent in extreme preterm infants (p=0.03) and in NB needing endotracheal intubation in resuscitation at birth (p<0.001).

Respiratory distress syndrome (p=0.006), surfactant administration (p<0.001) and mechanical ventilation > 7 days (p<0.001) were higher in the HS-PDA group

Anemia with transfusion criteria (p=0,014), intra-periventricular hemorrhage (p=0.019) and acute renal injury (p=0.003) were more common in the HS-PDA group.

Hospitalization for >100 days (p=0,039) and mortality (p=0.019) were higher in HS-PDA group.

At the six-month follow up, 2 HS-PDA were referred for surgical ligation.

Conclusion

Immaturity per se, as expected, was associated with HS-PDA with a higher incidence in extreme preterm infants.

In this study, most of the cases were managed with medical treatment.

HS-PDA was associated with worse clinical outcomes leading to higher mortality rates in preterm infants.

Background

Patent ductus arteriosus (PDA) is a common finding in newborns (NB), especially in extreme preterm infants. There are few publications about the impact and approach of this condition in infants > 28 weeks of gestation.

Objectives

Verify the management and impact of PDA in preterm infants > 30 weeks of gestation and term neonates.

Methods

A retrospective study including all NB ≥ 30 weeks of gestation admitted to a level 3 Neonatal Intensive Care Unit with PDA was conducted. Data were collected from clinical records between January 2010 and December 2018. NB with congenital cardiopathy were excluded.

Results

The final sample of 105 NB was divided in two groups:

30 to 33 weeks + 6/7 days (n=64): In 48.4% of the cases echocardiography was performed due to a heart murmur. A hemodynamically significant PDA (HS-PDA) was found in 22 cases and 13 were treated with ibuprofen. At the time of hospital discharge 32 maintained a restrictive PDA compared with only 2 cases at the 6-month follow-up review.

Late preterm and term NB (n=41): Echocardiography was performed mainly due to a heart murmur (41.5%), prenatal suspicion of cardiac anomalies (14.6%) or clinical deterioration (12.2%). HS-PDA was found in 7 cases, one treated with ibuprofen. At the 6-month follow-up review 2 patients maintained a restrictive PDA while 2 needed surgical ligation.

Conclusion

In moderate and late preterm and in term infants HS-PDA mainly presents with a heart murmur. This condition is usually managed with fluid restriction leading to a good clinical outcome.

Background

Pulmonary interstitial emphysema (PIE) results from overdistention and rupture of the alveoli. PIE is a complication usually associated, although not exclusively, with mechanical ventilation in preterm newborns. Unilateral emphysema causes mediastinal shift and compression of the contralateral lung, which leads to higher ventilatory pressures, overdistension and a worsening cycle of events.

Objectives

The goal of this paper was to present a sucessful aproach of PIE by selective ventilation

Methods

The authors present a case report of a female preterm born at 28 weeks of gestation from caesarian delivery due to maternal pre-eclampsia.

Results

Female preterm with a birthweight of 875 grams (appropriate for gestational age). Due to respiratory distress syndrome nasal-biphasic positive airway pressure was initiated and two doses of surfactant were administered. On day two, she developed a left-sided hypertensive pneumothorax, which led to intubation and drainage with a chest tube. In the following days there was respiratory deterioration, with hyperinflation of the left lung and the need for multiple chest tubes.

On day 20 the chest x-ray showed severe PIE and compression of the right lung, confirmed by CT scan (image 1 and 2). Selective right bronchial intubation and right lung ventilation was decided with clinical improvement. Endotracheal tube was withdrawn to mid-tracheal position on day 34. She was successfully extubated on day 36, remaining clinically stable.

Conclusion

Selective intubation and ventilation of the contralateral lung has been described as a treatment option for unilateral pulmonary emphysema as it enables the affected lung to recover leading to lower risk for baro and volutrauma.

Background

Patent ductus arteriosus (PDA) is a frequent cardiovascular problem in preterm infants.

Objectives

The goal of this study was to evaluate the management and outcomes of hemodynamically significant PDA (HS-PDA) in a level 3 Neonatal Intensive Care Unit (NICU) and to identify possible risk factors and associated morbidities.

Methods

A retrospective study including all newborns (NB) < 30 weeks of gestation admitted with PDA and a comparative study between HS and non-HS PDA was conducted. Data were collected from clinical records between January 2010 and December 2018.

Results

A total of 143 NB was found, 103 HS-PDA and 40 non-HS-PDA.

In 6.8% HS-PDA was managed exclusively with fluid restriction while 93,2% needed medical or surgical (n=9) treatment.

HS-PDA was more frequent in extreme preterm infants (p=0.03) and in NB needing endotracheal intubation in resuscitation at birth (p<0.001).

Respiratory distress syndrome (p=0.006), surfactant administration (p<0.001) and mechanical ventilation > 7 days (p<0.001) were higher in the HS-PDA group

Anemia with transfusion criteria (p=0,014), intra-periventricular hemorrhage (p=0.019) and acute renal injury (p=0.003) were more common in the HS-PDA group.

Hospitalization for >100 days (p=0,039) and mortality (p=0.019) were higher in HS-PDA group.

At the six-month follow up, 2 HS-PDA were referred for surgical ligation.

Conclusion

Immaturity per se, as expected, was associated with HS-PDA with a higher incidence in extreme preterm infants.

In this study, most of the cases were managed with medical treatment.

HS-PDA was associated with worse clinical outcomes leading to higher mortality rates in preterm infants.

Background

Patent ductus arteriosus (PDA) is a common finding in newborns (NB), especially in extreme preterm infants. There are few publications about the impact and approach of this condition in infants > 28 weeks of gestation.

Objectives

Verify the management and impact of PDA in preterm infants > 30 weeks of gestation and term neonates.

Methods

A retrospective study including all NB ≥ 30 weeks of gestation admitted to a level 3 Neonatal Intensive Care Unit with PDA was conducted. Data were collected from clinical records between January 2010 and December 2018. NB with congenital cardiopathy were excluded.

Results

The final sample of 105 NB was divided in two groups:

30 to 33 weeks + 6/7 days (n=64): In 48.4% of the cases echocardiography was performed due to a heart murmur. A hemodynamically significant PDA (HS-PDA) was found in 22 cases and 13 were treated with ibuprofen. At the time of hospital discharge 32 maintained a restrictive PDA compared with only 2 cases at the 6-month follow-up review.

Late preterm and term NB (n=41): Echocardiography was performed mainly due to a heart murmur (41.5%), prenatal suspicion of cardiac anomalies (14.6%) or clinical deterioration (12.2%). HS-PDA was found in 7 cases, one treated with ibuprofen. At the 6-month follow-up review 2 patients maintained a restrictive PDA while 2 needed surgical ligation.

Conclusion

In moderate and late preterm and in term infants HS-PDA mainly presents with a heart murmur. This condition is usually managed with fluid restriction leading to a good clinical outcome.

Background

Pulmonary interstitial emphysema (PIE) results from overdistention and rupture of the alveoli. PIE is a complication usually associated, although not exclusively, with mechanical ventilation in preterm newborns. Unilateral emphysema causes mediastinal shift and compression of the contralateral lung, which leads to higher ventilatory pressures, overdistension and a worsening cycle of events.

Objectives

The goal of this paper was to present a sucessful aproach of PIE by selective ventilation

Methods

The authors present a case report of a female preterm born at 28 weeks of gestation from caesarian delivery due to maternal pre-eclampsia.

Results

Female preterm with a birthweight of 875 grams (appropriate for gestational age). Due to respiratory distress syndrome nasal-biphasic positive airway pressure was initiated and two doses of surfactant were administered. On day two, she developed a left-sided hypertensive pneumothorax, which led to intubation and drainage with a chest tube. In the following days there was respiratory deterioration, with hyperinflation of the left lung and the need for multiple chest tubes.

On day 20 the chest x-ray showed severe PIE and compression of the right lung, confirmed by CT scan (image 1 and 2). Selective right bronchial intubation and right lung ventilation was decided with clinical improvement. Endotracheal tube was withdrawn to mid-tracheal position on day 34. She was successfully extubated on day 36, remaining clinically stable.

Conclusion

Selective intubation and ventilation of the contralateral lung has been described as a treatment option for unilateral pulmonary emphysema as it enables the affected lung to recover leading to lower risk for baro and volutrauma.