血N端脑钠肽前体在早产儿症状性动脉导管未闭诊治中的应用价值

目的探讨血浆N端脑钠肽前体(NT-pro BNP)在早产儿症状性动脉导管未闭(s PDA)诊治中的临床应用价值。方法选取2013年10月—2014年9月入住新生儿重症监护病房、胎龄28~32周、出生体质量??1 500 g的早产儿107例,分别于生后第4、7天检测NT-pro BNP,采血后30 min内行超声心动图检查。根据生后第4天超声心动图检查结果分PDA组(39例)与对照组(68例);PDA组根据有无超声血流动力学显著改变及临床表现分为症状性PDA(s PDA组,20例)和无症状性PDA(as PDA组,19例);s PDA组再根据是否服用布洛芬分为治疗组(13例)与非治疗组(7例)。结果生后第4天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组,as PDA组高于对照组,差异均有统计学意义(P??0.05);生后第7天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组和对照组,差异有统计学意义(P??0.05),as PDA组与对照组的差异则无统计学意义(P??0.05)。治疗组生后第7天血浆NT-pro BNP水平较第4天显著下降,差异有统计学意义(P??0.05);非治疗组生后第7天与第4天血浆NT-pro BNP水平的差异无统计学意义(P??0.05)。PDA患儿生后第4天血浆NT-pro BNP水平与动脉导管(DA)直径、左心房/主动脉根部内径比值(LA/AO)及DA直径与左肺动脉内径比值(TDD/LPA)呈正相关(r=0.498~0.670,P均??0.05)。生后第4天血浆NT-pro BNP水平预测s PDA的ROC曲线下面积(AUC)为0.969(95%CI:0.938~1.000),NT-pro BNP水平在13 964 pg/m L时,诊断s PDA的灵敏度为95%,特异度为95.4%。结论 s PDA早产儿血浆NT-pro BNP水平明显增高,治疗后下降。第4天血浆NT-pro BNP是预测s PDA的敏感指标,动态监测血浆NT-pro BNP水平变化对指导早产儿PDA治疗策略的选择有重要临床价值。     

早产儿动脉导管未闭的临床研究

目的　观察早产儿动脉导管未闭 (PDA)发生率、影响因素及血流动力学的变化 ,提供监测及干预治疗的建议。方法　 86例胎龄 2 8～ 3 6周、无呼吸机治疗 (未用或已停用 )的早产儿 ,出生 2～ 5d行首次超声心动图检查。对诊断为PDA的早产儿动态超声心动图监测。结果　生后 3～ 4d超声心动图诊断PDA 2 2例 ,胎龄 (3 3 .1± 2 .0 )周。生后 8.5d 2 0例复查 ,16例动脉导管自行关闭 ;4例PDA早产儿经治疗 ,动脉导管关闭 2例 (1例吲哚美辛 ;1例动脉导管再开放 )。最终遗留PDA 3例。单因素及多因素Logistic回归分析发现 ,出生体质量越低 ,PDA发生机率越高 (χ2 =2 .890 7　P =0 .0 891) ;生后窒息及严重疾病增加PDA发生的危险性 (χ2 =4.3 72 9　P =0 .0 3 65 ;χ2 =11.65 90　P =0 .0 0 0 6)。PDA存在使早产儿左心房 /主动脉根内径比值增高 (1.0 8± 0 .18vs 1.0 0± 0 .0 7　P =0 .0 48) ,心功能良好。结论　平均胎龄 3 3周、平均日龄 3d、一般状况较好的早产儿超声心动图诊断PDA机率 2 5 .6% ,85 %早产儿PDA可自行关闭。低出生体质量、出生窒息、严重疾病及症状性PDA发生或持续均是高危因素。     

口服消炎痛和布洛芬治疗早产儿动脉导管未闭的比较

目的：静脉注射消炎痛是早产儿动脉导管未闭的常规治疗方法,但治疗过程中常出现一些副作用,如少尿、消化道出血、脑血流灌注减少。近年来,静脉注射布洛芬已用于治疗早产儿动脉导管未闭。布洛芬治疗不会减少脑血流灌注,也不会影响胃肠道和肾脏的血流动力学。伊朗目前尚无消炎痛和布洛芬的静脉制剂供应。该研究旨在比较这两种药的口服制剂治疗早产儿动脉导管未闭的疗效和安全性。方法：36例胎龄小于34周经超声心动图确诊患有动脉导管未闭的早产儿被随机分为两组,每组18人。一组给予消炎痛口服,每次0.2 mg/kg,24 h给药 1 次,共3次。另一组给予布洛芬口服,共 3 次,间隔时间为24 h,首剂为 10 mg/kg,随后两次各 5 mg/kg。用药后观察导管闭合率、副作用、并发症及临床过程。结果：用药后布洛芬组18例患儿动脉导管都闭合（100％）,而消炎痛组18例中有15例患儿动脉导管闭合（83.3%）（P＞0.05）。两组疗效差异统计学无显著性意义。治疗前后两组的血清尿素氮和肌酐含量差异也无显著性意义。消炎痛组发生了3例（16.6%）坏死性小肠结肠炎,布洛芬组则无,差异有显著性意义 (P＜0.05)。治疗1个月后两组成活率均为 94%（17／18）。消炎痛组1例死于坏死性小肠结肠炎,布洛芬组1例死于败血症。结论：口服布洛芬治疗早产儿动脉导管未闭和口服消炎痛治疗一样有效,而且坏死性小肠结肠炎的发生率较口服消炎痛治疗低。［中国当代儿科杂志,2007,9（5）：399-403］     

心血管系统疾病

8720330 消炎痛治疗早产儿动脉导管未闭1例/李必华∥医师进修杂志。—1986,(8)。—37 新生1天男婴,出生12小时后出现呼吸急促,口周青紫,对症治疗后好转。7天后出现呼吸急促,左锁骨下可闻及Ⅱ～Ⅲ级收缩期杂音,心间搏动强,超声心动图显示左房内径/     

早产儿症状性动脉导管未闭的消炎痛治疗

常规的消炎痛三剂疗法治疗早产儿症状性动脉导管未闭(sPDA)合并呼吸道疾病时,复发率很高,约3O%病例再发生在到右的分流。作者在3次连续性对照研究中发现,消炎痛给药后10小时引起导管收缩的血清浓度约1.0μg/ml。延长消炎痛治疗使浓度维持在0.5μg/ml,对抑制两种血管扩张性前列腺素PGI_2及PGE_2是有效的。病人及方法前瞻性研究1982～1985年西德一组32名早产儿sPDA,出生体重650～2900克,胎龄25～34周。试用消炎痛分为负荷期、维持期及清除期。治疗开始剂量为0.2mg/kg,肌注,每次间隔12小时,继续用2次,试图在此负荷期的第3次投药后     

低体重早产儿动脉导管未闭的早期手术干预

目的探讨低体重早产儿动脉导管未闭(PDA)的早期手术干预方法及疗效。方法2012年1月至2015年12月本院收治33例低体重早产儿PDA,均在NICU协助下进行手术治疗。根据治疗方案分为药物治疗失败后采用Prolene缝线结扎未闭动脉导管组(G1组)和直接采用Prolene缝线结扎未闭动脉导管组(G2组)两组,比较两组病史、临床资料、病死率及主要并发症情况。结果两组病史因素及临床资料比较,差异无统计学意义(P0.05)。G2组无一例死亡,G1组病死率为13.3%,差异有统计学意义(χ~2=6.28,P0.05),G2组并发症的发生率为11.1%,G1组并发症的发生率为33.3%,差异有统计学意义(χ~2=11.92,P0.05)。结论早期在NICU与外科协作下选用Prolene缝线结扎未闭动脉导管是PDA安全有效的治疗方式。     

近红外光谱技术对有血流动力学意义的动脉导管未闭早产儿肠道组织氧饱和度监测价值的前瞻性研究

目的 使用近红外光谱技术研究有血流动力学意义的动脉导管未闭（hemodynamically significant patent ductus arteriosus,hsPDA）早产儿肠道组织氧饱和度（regional oxygen saturation,rSO₂）的变化及规律,初步探索hsPDA早产儿肠道组织血氧水平变化的临床意义。 方法 前瞻性选取2017年10月至2020年10月深圳市龙岗中心医院新生儿科收治的胎龄<32周和/或出生体重<1 500 g的动脉导管未闭（patent ductus arteriosus,PDA）早产儿。按照hsPDA的诊断标准分为hsPDA组和无血流动力学意义的动脉导管未闭（non-hemodynamically significant patent ductus arteriosus,nhsPDA）组,将hsPDA组早产儿根据口服布洛芬后动脉导管关闭情况分为hsPDA关闭亚组和hsPDA未闭亚组。分别在诊断PDA时及治疗后测定血流动力学指标,持续监测患儿肠道组织rSO₂水平,分析其变化规律。 结果 共有241例PDA早产儿纳入研究,其中hsPDA组55例（22.8%）,nhsPDA组186例（77.2%）;hsPDA关闭亚组36例（65%）,hsPDA未闭亚组19例（35%）。hsPDA组左心房内径/主动脉根部内径值大于nhsPDA组,左室射血分数和短轴缩短率均低于nhsPDA组（P<0.05）。hsPDA组患儿肠道组织rSO₂在诊断后6 h内各时间点（1、2、4、6 h）均低于nhsPDA组（P<0.05）;hsPDA组早产儿肠道组织rSO₂随时间呈下降趋势（P<0.05）,至6 h时达最低值（0.448±0.014）。hsPDA关闭亚组左心房内径/主动脉根部内径值低于hsPDA未闭亚组,左室射血分数和短轴缩短率高于hsPDA未闭亚组（P<0.05）。hsPDA关闭亚组患儿肠道组织rSO₂在治疗后48~96 h内各时间点（48、72、96 h）均高于hsPDA未闭亚组（P<0.05）;hsPDA关闭亚组早产儿肠道组织rSO₂从治疗24 h后随时间呈上升趋势（P<0.05）,至96 h达最高值（0.578±0.031）。 结论 hsPDA对早产儿肠道组织氧合有影响,可通过近红外光谱技术持续监测hsPDA早产儿肠道组织rSO₂变化趋势指导临床管理。     

第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的疗效分析

目的初步分析第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的疗效,为更加系统地治疗小儿先天性心脏病提供理论依据。方法选取四川省医学科学院四川省人民医院儿科2016年11月至2017年11月收治且符合纳入标准的46例先天性心脏病患儿作为研究对象,采用随机分组的方法将患儿分成第一代Cera动脉导管未闭封堵器(ADOⅠ)组和第二代Cera动脉导管未闭封堵器(ADOⅡ)组,所有患儿选用Cera动脉导管未闭封堵器(均符合治疗准则及患儿的解剖特点),每组各23例;并比较围术期两组患儿的气管导管拔除时间、ICU滞留时间,超声心动图监测结果以及出院时、出院后1个月和出院后3个月的红细胞、红细胞压积、血红蛋白指标计数等指标。结果 ADOⅡ组患儿气管导管拔除时间、ICU滞留时间显著低于ADOⅠ组(P 0. 05)。两组患儿治疗前后超声心动图监测结果显示,ADOⅡ组出院后1个月和出院后3个月射血分数、左室短轴缩短百分率、每搏输出量均显著高于ADOⅠ组(P 0. 05),而舒张末期左心房内径显著低于ADOⅠ组(P 0. 05)。两组患儿出院时、出院后1个月和出院后3个月比较,红细胞、红细胞压积、血红蛋白指标计数的差异均有统计学意义(P 0. 05)。从治疗结局来看,ADOⅠ组有效率为82. 61%、ADOⅡ组有效率为95. 65%,差异有统计学意义(P 0. 05)。结论第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的整体疗效更佳,值得临床推广。     

心血管系统疾病

8861590 二维和M型超声心动图在2岁以内婴幼儿动脉导管未闭手术前诊断中的应用/范崇济…∥天津医药。—1988,16(6).—331～333 天津儿童医院内科2年中共收治2岁以下动脉导管未闭(PDA)患儿43例,1岁以内22例,最小28天。均由M型及二维超声心动图诊断,并经手术证实。仅6例为排除可能合并室间隔缺损或肺动脉高压,做了心导管检查。利用二     

布洛芬治疗极低出生体质量儿动脉导管未闭效果的相关因素北大核心CSCD

目的探讨布洛芬治疗早产儿动脉导管未闭（PDA）的相关影响因素。方法对2013年1月至2015年12月在河南省人民医院新生儿科住院且出生体质量〈1 500 g的1 236例早产儿进行分析。于出生7 d行床边超声心动图检查,对发生PDA的早产儿排除口服布洛芬的禁忌证者入组。实际进入调查376例。予口服/鼻饲布洛芬治疗后72 h再次床边超声心动图检查了解PDA的关闭率,分析引起布洛芬治疗PDA失败的高危因素。结果单因素分析显示,小胎龄、低出生体质量、宫内窘迫、出生窒息病史、呼吸窘迫综合征、感染、呼吸支持、导管直径、导管两端压差、导管水平峰值流速等是引起PDA药物治疗失败的高危因素（均P〈0.05）;Logistic回归分析显示,呼吸窘迫综合征、感染、呼吸支持、导管直径、导管两端压差、导管水平峰值流速等是PDA发生的独立高危因素,胎龄和出生体质量为保护性因素。结论关注引起早产儿PDA药物治疗失败的高危因素,早期防治PDA可提高早产儿的存活率和生存质量。     

The relationship between the continuous opening of arterial catheters and platelet parameters in preterm infants北大核心CSCD

Objective To analyze the correlation between the continuous opening of patent ductus arteriosus (PDA) in preterm infants and platelet parameters in the first 24 hours of life. Methods The preterm infants (gestational age <34 weeks) admitted to Neonatal Intensive Care Unit(NICU)of the Affiliated Xuzhou Hospital of Southeast University from November 2012 to July 2018 were enrolled. The following data were collected retrospectively: the platelet parameters in the first 24 hours of life, clinical factors possibly related to continuous opening of PDA, and echocardiography examination fin-dings on the 4 -7 day after birth. According to the diagnostic criteria of PDA, all preterm infants were divided into symptomatic PDA (sPDA) group, non - sPDA (nsPDA) group, and non - PDA (nPDA) group. SPSS 20.0 software was used for data analysis. Data were analyzed by Chi -square test,LSD or Tambane's T2 of One - Way analysis of variance, and binary Logistic regression analysis of the receiver operating characteristic (ROC) curve. Results Totally 760 preterm infants were chosen, and among them there were 67 cases (8. 8%) in sPDA group, 106 cases (14. 0%) in nsPDA group,and 587 cases (77. 2%) in nPDA group. There were significant differences in the terms of gestation age,birth weight,platelet counts (PLT),and plateletcrit (PCT) in the first 24 hours of life among 3 groups (all P < 0. 05). The smaller gestation age, the lower birth weight, the lower PLT and PCT in the first 24 hours of life,and the higher incidence of PDA in preterm infants. There were no significant differences in the platelet distribution width,mean platelet volume,and platelet large cell ratio in the first 24 hours of life among 3 groups (all P >0. 05). The low lower birth weight and PCT in the first 24 hours of life were independent risk factors for the occurrence of sPDA in preterm infants (P =0. 013,0. 000). The risk of occurrence of sPDA in preterm infants will be increased by 3.279 -fold (95% CI;2. 369 -4.479) if PCT in the first 24 hours of life is decreased by 0. 10%. The area under the ROC curves of PCT and PLT in the first 24 hours of life for prediction of sPDA in preterm infants was 0. 757 (95%C/:0.712 -0.814) and 0.718 (95%C/:0.671 -0.768),respectively. The best cutoff values of PCT and PLT were 0. 178% (sensitivity was 75. 7%, specificity was 71. 9%) and 207. 5 x 10 /L (sensitivity was 71. 4% specificity was 63. 2%). Conclusions The continuous opening of PDA in preterm infants may have correlation with the platelet. The low PCT, rather than PLT, in the first 24 hours of life was an independent risk factor and has medium predictive value for the occurrence of sPDA in preterm infants on the 4 - 7 day after birth. © 2019 Authors. All rights reserved.     

Aortic flow velocity curves in the diagnosis and the followup of symptomatic patent ductus arteriosus in preterm infants during therapeutic interventions

In preterm infants, persistent ductus arteriosus (PDA) fails to close soon after birth and becomes symptomatic (sPDA) in about 40% of the infants, causing cardio-respiratory deterioration by a left-to-right shunt across the PDA. Aortic run-off of blood, predominantly occurring during ventricular diastole, causes an abnormal diastolic retrograde aortic blood flow. This aortic reverse flow can be assessed semi-quantitatively in a noninvasive way, using continuous-wave Doppler-ultrasonography. An increased ratio (R/F ratio) of the abnormal retrograde aortic blood flow (R) related to the normal forward flow (F) in the aorta indicates presence of sPDA in preterm infants. The R/F ratio was assessed in 30 premature infants, including 13 cases without sPDA, and 17 infants with sPDA--in 12 of them before and after surgical ligation of PDA, in five concomitantly to pharmacological closure of PDA by the application of indomethacin. The R/F ratio was low in all infants without sPDA and in infants following surgical ligation of PDA. On the other hand, a high R/F ratio was found in all patients with sPDA before specific treatment. During indomethacin-induced closure of PDA the R/F ratio decreased continuously, whereas it remained high in infants with sPDA not responding to indomethacin treatment.     

Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants

BACKGROUND: The usefulness of diastolic pulmonary flow velocity determined by echocardiography in the assessment of symptomatic patent ductus arteriosus (sPDA) in preterm infants has not been confirmed. METHODS: Echocardiography was performed daily in infants ranging from 23 to 31 gestational weeks of age, and diastolic flow velocity of the left pulmonary artery (DFLPA) was measured. The DFLPA data before indomethacin administration for sPDA were compared with data obtained after indomethacin administration. The normal range of DFLPA was also determined from serial measurements performed in infants who did not develop sPDA during the first 7 days of life. Then, this range was compared with data from infants who did develop sPDA during this time. RESULTS: In infants who underwent indomethacin treatment, DFLPA increased with the development of sPDA and decreased when the symptoms of sPDA disappeared. On the basis of results from serial DFLPA measurement, the sensitivity and specificity of DFLPA for assessing sPDA was found to be 0.82 and 0.83, respectively. CONCLUSIONS: Measurement of DFLPA by echocardiography is a useful method for assessing sPDA in preterm infants.     

生后早期床旁心脏超声预测极低出生体重儿动脉导管持续开放的研究(英文翻译)

目的 探讨出生早期床旁心脏超声预测极低出生体重儿（very low birth weight infant,VLBWI）动脉导管持续开放的价值。 方法 回顾性选取2020年3月至2021年6月收治的51例VLBWI为研究对象,入院时日龄≤3 d并且住院时间≥14 d。根据出生14 d及28 d动脉导管未闭（patent ductus arteriosus,PDA）直径大小分为3组：大PDA组（PDA直径≥2 mm）、小PDA组（PDA直径<2 mm）和PDA关闭组（PDA直径=0 mm）,比较3组间生后72 h的心脏超声参数。采用受试者工作特征（receiver operating characteristic,ROC）曲线评估生后72 h心脏超声参数预测生后14 d和28 d动脉导管持续开放（PDA直径≥2 mm）的价值。 结果 生后14 d时,大PDA组有17例,小PDA组11例,PDA关闭组23例;生后28 d时,大PDA组有14例,小PDA组9例,PDA关闭组26例。3组患儿间胎龄、出生体重、肺泡表面活性物质应用及低血压发生率的比较差异有统计学意义（P<0.05）。生后72 h的PDA直径、左肺动脉舒张末期流速、左心室输出量、左心室输出量/上腔静脉血流与生后14 d及28 d时动脉导管持续开放有关（P<0.05）;左心房/主动脉根部直径与生后28 d时动脉导管持续开放有关（P<0.05）。ROC曲线结果显示,生后72 h PDA直径预测生后14 d及28 d动脉导管持续开放的曲线下面积最大,分别为0.841和0.927;其次是左肺动脉舒张末期流速,其曲线下面积分别为0.793和0.833。 结论 生后72 h的床旁心脏超声指标,尤其是PDA直径及左肺动脉舒张末期流速,可预测VLBWI生后14 d和28 d动脉导管持续开放,为后续PDA早期目标性治疗策略的实施提供依据。     

Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestation

AIMS: To define how often transient pulmonary branch stenosis (PBS) develops after closure of a patent ductus arteriosus (PDA) in babies born at less than 32 weeks gestation; to describe the natural history of PBS and the relation between PBS and a cardiac murmur. METHODS: Fifty three preterm infants born at a gestational age less than 32 weeks and who had PDA diagnosed on echocardiography were recruited. An echocardiogram was performed on alternate days until the ductus arteriosus closed. If PBS was diagnosed, the baby was followed up until PBS resolved. RESULTS: In 59%, PBS developed in one or both branches after closure of the PDA. In 21%, both pulmonary branches were affected. In 79%, the left pulmonary artery alone was involved but the right side was never affected alone. PBS had resolved in 74% by the time the infants reached 40 weeks, in 95% at a corrected age of 6 weeks, and in 100% at a corrected age of 3 months. There is a better correlation between a cardiac murmur and PBS than between a murmur and PDA. CONCLUSIONS: PBS in preterm infants is usually not present at birth but develops after closure of a PDA. PBS resolves by a corrected age of 3 months. The presence of a murmur after closure of a PDA is usually related to PBS and not to reopening of the ductus arteriosus.     

Cerebral and Abdominal Arterial Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

Using Doppler echocardiography we evaluated the effect of ductal shunt flow on the cerebral and abdominal arterial blood flow in 25 preterm infants. Eligible for inclusion in this study were healthy preterm newborn infants. They were divided into two groups based on their gestational age: group A, 33-36 weeks (15 infants) and group B, 28–32 weeks (10 infants). Two-dimensional Doppler echocardiograms were obtained in each infant during the first 8 hours of life and repeated every 6–12 hours until no ductal shunt flow could be detected. Flow in the ductus arteriosus, the basilar artery and the coeliac artery were examined. Closure of the ductus arteriosus occurred significantly later(p< 0.05) in group B than in group A. Pulsatility indices of flow in the basilar and coeliac arteries were high when the ductus was patent, decreasing to a fixed level with closure. This study suggests that a shunt of the patent ductus arteriosus (PDA) adversely influences the cerebral and abdominal blood flow in preterm infants.     

Recovery of prostaglandin production associated with reopening of the ductus arteriosus after indomethacin treatment in preterm infants with respiratory distress syndrome

Increased PGE production has been demonstrated in 9 of 17 preterm infants with patent ductus arteriosus (PDA) associated with respiratory distress syndrome (RDS). Inhibition of PGE production in eight preterm infants with PDA and RDS was associated with marked improvement in the respiratory and circulatory function of all of them. However, in six of them this effect was only transient. In the posttreatment period of five and a half days reopening of the ductus arteriosus was frequently associated with increased PGE production and a drop of indomethacin serum levels. Three of these six infants were transferred for surgical ligation whereas the other three were successfully treated with a second course of indomethacin. However, the margin between closure of the ductus arteriosus and the deterioration of kidney function in preterm infants treated with a presently recommended indomethacin dosage was narrow. In conclusion, until an acceptable therapeutic serum level of indomethacin for ductal closure in preterm infants has been established and the duration of effective prostaglandin synthesis inhibition is known, it is too early for a general recommendation of a dosage regime of indomethacin for the pharmacological closure of PDA in infants with RDS.     

Introduction of plasma indomethacin level monitoring and evaluation of an effective threshold level in very low birth weight infants with symptomatic patent ductus arteriosus

First results are described of individually tailored indomethacin dose rates employing on-line drug level monitoring for pharmacologically induced ductal constriction in very low birth weight infants with symptomatic patent ductus arteriosus (sPDA). In addition prolonged indomethacin therapy was introduced. From our data it appears that the effective threshold indomethacin level for the induction of ductus constriction has to be about 1000 ng/ml 10 h postdosing, while ductus closure can be maintained with a dose rate that exceeds a plasma level of 500 ng/ml for at least 1 week. These maintenance levels were also effective in completely suppressing the urinary metabolite excretion rates of PGI₂ and PGE₂, which are potential mediators of ductal relaxation. On-line indomethacin level monitoring appears to be practically essential for prolonged indomethacin therapy to overcome the marked variation of indomethacin disposition in preterm infants with sPDA.Abbreviations sPDA symptomatic patent ductus arteriosus - PDA-MUR patent ductus arteriosus murmur - PGE-M 7-hydroxy-5,11-diketotetranorprostane-1,16-dioic acid - IMV intermittent mandatory ventilation - R/F retrograde and forward flow ratio - HPLC high pressure liquid chromatography - GC-MS gas chromatography-mass spectrometry Dedicated to Prof. Dr. H. Bickel on the occasion of his 65th birthday     

Serial N-terminal pro-brain natriuretic peptide measurement as a predictor of significant patent ductus arteriosus in preterm infants beyond the first week of life

The aim of the study was to assess the role of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration as a predictor of patent ductus arteriosus (PDA) in very low birth weight infants beyond the first week of life. This was a prospective observational study; newborns with a birth weight?Echocardiography and NT-proBNP levels were repeated at weekly intervals. The primary outcome was correlation between PDA and NT-proBNP level and between measurements of PDA significance and NT-proBNP. Sixty-nine neonates were enrolled following parental consent. The mean birth weight was 1119?±?257 g and mean gestational age was 28.6?±?2.6 weeks. Median NT-proBNP level on day seven was 11469 ng/l in infants with a PDA vs. 898 ng/l in infants without a PDA (p?Conclusion: NT-proBNP concentration is significantly increased in infants with a PDA and correlates well with PDA diameter in the first three weeks of life.