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Post a Comment Prediction of persistence of hemodynamically significant open arterial duct in profoundlypreterm infants
- Authors: Klimachev A.M.1, Nikolaeva T.N.2, Klimacheva O.V.2
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Affiliations:
- Regional Children's Clinical Hospital
- Yaroslavl State Medical University
- Issue: Vol 38, No 1 (2021)
- Pages: 108-114
- Section: Methods of diagnosis and technologies
- URL: https://journals.rcsi.science/PMJ/article/view/65199
- DOI: https://doi.org/10.17816/pmj381108-114
- ID: 65199
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Abstract
Objective. To develop a method for predicting the persistence of hemodynamically significant ductus arteriosus in profoundly premature newborns based on the evaluation of clinical data and the results of additional studies.
Material and methods. Sixty-nine profoundly preterm newborns were examined including 37 with very low and 32 with extremely low body weight. Clinical and anamnestic data, the results of laboratory radiographic and instrumental examinations were evaluated. The state of the arterial duct, as well as the parameters of central and intracardiac hemodynamics were determined by echocardiography. The criteria for hemodynamically significant open arterial duct (OAD) were the following: duct size greater than 1.5 mm, left-right blood bypass, the presence of retrograde blood flow in the aorta greater than 50 % of the antegrade value. There were 2 groups: comparison (n = 41) – children with hemodynamically insignificant ductus arteriosus, main (n = 28) – children with hemodynamically significant ductus arteriosus after 72 hours of postnatal life.
Results. After 72 hours of the postnatal life, a hemodynamically significant ductus arteriosus is detected in 40.6 % of profoundly premature newborns. The factors of a long-term persistence of ductus arteriosus are as follows: birth at term of gestation less than 27 weeks with a low Apgar score within the first minute of life (≤ 4 points), a patient has a sharp weakening or absence of reflexes of the newborn, severe muscular hypotonia, signs of peripheral circulation, moist fine wheezing and crepitation in the lungs, strengthening of their images on the radiograph due to the interstitial and vascular components, dilation of the left and right ventricles and the left atrium. The method for predicting the dynamics of the open ductus arteriosus in profoundly premature newborns has been developed.
Conclusion. The use of the developed prognostic table makes it possible to identify with an accuracy of 85.7 % profoundly premature newborns with a high risk of persistence of a hemodynamically significant ductus arteriosus after 72 hours of postnatal life.
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##article.viewOnOriginalSite##About the authors
A. M. Klimachev
Regional Children's Clinical Hospital
Email: tnn40@mail.ru
Candidate of Medical Sciences, physician, Unit of Functional Diagnostics
Russian Federation, YaroslavlT. N. Nikolaeva
Yaroslavl State Medical University
Author for correspondence.
Email: tnn40@mail.ru
MD, PhD, Professor, Department of Pediatrics № 1
Russian Federation, YaroslavlO. V. Klimacheva
Yaroslavl State Medical University
Email: tnn40@mail.ru
Candidate of Medical Sciences, Associate Professor, Department of Therapy of Pediatric Faculty
Russian Federation, YaroslavlReferences
- Karpova A.L., Bokerija E.L., Nikolaeva T.N., Spivak E.M., Karpov N.Ju., Mostovoj A.V., Marasina A.V. Screening of blood oxygen saturation as a method for detecting congenital heart defects in newborns: modern approaches, problems, opinions. Detskie bolezni serdca i sosudov 2015; 4: 29–37 (in Russian).
- Karpova A.L., Bokerija E.L., Nikolaeva T.N., Spivak E.M., Mostovoj A.V., Marasina A.V. Scoring technologies for detecting congenital heart defects in newborns. Neonatologija: novosti, mnenija, obuchenie 2016; 2 (12): 40–49 (in Russian).
- Karpova A.L., Spivak E.M., Pyhanceva A.N., Bokerija E.L., Karpov N.Ju., Kondakova N.N., Tret'jakova L.N. Pulse oximetry as a method of early neonatal screening for critical heart defects in children. Neonatologija: novosti, mnenija, obuchenie 2015; 4 (10): 68–72 (in Russian).
- Bokerija E.L. Perinatal cardiology: present and future. Part I: Congenital heart defects. Rossijskij vestnik perinatologii i pediatrii 2019; 3 (64): 5–10 (in Russian).
- Fisjuk Ju.A., Harlamova N.V., Chasha T.V., Gorozhanina T.Z., Budalova A.V. Clinical risk factors for the development of a functioning hemodynamically significant ductus arteriosus in premature newborns. Vestnik Ivanovskoj medicinskoj akademii 2020; 1(25): 20–24 (in Russian).
- Spivak E.M., Nikolaeva T.N., Klimachev A.M. Features of clinical manifestations of the open ductus arteriosus in profoundly premature newborns. Rossijskij vestnik perinatologii i pediatrii 2016; 1 (61): 51–55 (in Russian).
- Klimacheva O.V., Klimachev A.M., Spivak E.M. Method for postnatal prediction of the persistence of a hemodynamically significant open ductus arteriosus in premature infants. Patent na izobretenie RU 2556793 C1 2015 (in Russian).
- Klimachev A.M., Spivak E.M., Bo-gacheva A.N., Klimacheva O.V., Galaganova N.N. Clinical features of various variants of the open ductus arteriosus in profoundly premature newborns. Rossijskij vestnik perinatologii i pediatrii 2016; 3 (61): 150 (in Russian).
- Spivak E.M., Karpova A.L., Klimachev A.M., Kondakova N.N. Clinical and hemodynamic characteristics of the open ductus arteriosus in profoundly premature newborns. Voprosy prakticheskoj pediatrii 2013; 6 (8): 16–19 (in Russian).
- Klimachev A.M., Spivak E.M. Clinical features of profoundly premature newborns with various variants of the open ductus arteriosus. Smolenskij medicinskij al'manah 2020; 2: 85–88 (in Russian).
- Spivak E.M., Klimachev A.M., Majden I.V. Central hemodynamics in open ductus arteriosus in premature infants. Jaroslavskij pedagogicheskij vestnik 2013; 1 (3): 127–130 (in Russian).
- Klimacheva O.V., Klimachev A.M., Spivak E.M. Method for postnatal prediction of the persistence of a hemodynamically significant open ductus arteriosus in premature infants. Patent na izobretenie RU 2556793 C1 2015 (in Russian).
