Abstract
Introduction. Patent arterial duct is a frequent complication of the neonatal period of extremely low birth body weight infants (ELBW).
Low probability of spontaneous closure of the duct in this category of newborns, as well as the established connection between patent
arterial duct and incidence, has a sufficient basis for the early closure of hemodynamically relevant patent arterial duct (HRPAD).
Currently the preference is given to the medicated closure of the duct with non-steroidal anti-inflammatory drugs (NSAIDs), as a less
traumatic procedure with minimal side effects. However, 40-year-old experience in the application of NSAIDs to close the duct
showed the selective effect of this drug. Identification of factors, influencing the result of a medicated duct closure, will increase the
effectiveness of the chosen therapy and contribute to the individualization of the approach to the management of a newborn with
HRPAD.
Purpose. To establish hemodynamic predictors of the efficacy of a medicated arterial duct closure in newborns with extremely low
body weight to determine the management.
Material and methods. The study includes 41 newborns with a functioning arterial duct, established on the basis of echocardiographic
and Dopplerographic study. According to the protocol, all the infants received the therapy with the ibuprofen drug. In 33 children
the arterial duct was closed (group 1) and in 8 children (group 2) due to the inefficiency of the therapy, surgical correction of
this condition was undergone. To establish the factors that determined the treatment effectiveness in children of group 1, a comparative
analysis of anamnestic, clinical, instrumental and laboratory parameters in newborns of the studied groups was provided.
Results. Using mathematical analysis the connection of high values of the maximum speed of blood flow in the arterial duct and diastolic
blood pressure was related as well as low values of the ratio left atrium to aortic root with successful medicated closure of the
arterial duct in newborns with ELBW.
Conclusions. The major hemodynamic predictors of the efficacy of the medicated closure of HRPAD in neonates with gestational age
less than 28 weeks were identified for the first time in this study : the maximum speed of the blood flow through the arterial duct, the
ratio of the left atrium to aortic root and the value of diastolic pressure. Using mathematical analysis, a pathophysiological connection
of a maximum speed of the blood flow in the arterial duct with the pressure in the pulmonary artery was revealed. Developed on
the basis of the values of hemodynamic parameters of the nomogram will allow a doctor – functionalist, a neonatologist and an intensive
care specialist with the probability of 50, 75 and 90% to evaluate objectively the chance of success of medicated closure of
HRPAD in newborns with ELBW.
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