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“Shunt index” can be used to predict clinically significant patent ductus arteriosus in premature neonates in early post-natal life

Published online by Cambridge University Press:  02 July 2013

Ece Yapakçı ,
Ayşe Ecevit ,
Birgin Törer ,
Deniz Anuk Ince ,
Mahmut Gökdemir ,
Hande Gülcan  and
Aylin Tarcan
Ece Yapakçı
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
Ayşe Ecevit
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
Birgin Törer
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
Deniz Anuk Ince*
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
Mahmut Gökdemir
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Baskent University, Ankara, Turkey
Hande Gülcan
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
Aylin Tarcan
Affiliation:
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
*
Correspondence to: D. A. Ince, Baskent University Faculty of Medicine, Cocuk Saglıgı ve Hastalıkları Poliklinigi, Fevzi Çakmak mah. 6. cadde 72/1 Giris kat 06490, Bahcelievler, Cankaya, Ankara, Turkey. Tel: +90 532 7156178; Fax: +90 312 215 75 97; E-mail: [email protected]
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Abstract

Background: This study aimed to examine the differences between arterial and inferior caval vein oxygen saturation, fractional oxygen extraction, and the shunt index, which were calculated in the diagnosis of patent ductus arteriosus. Methods: Twenty-seven preterm infants were included in this study and were divided into two groups according to patent ductus arteriosus. Among them, 11 (41%) infants had haemodynamically significant patent ductus arteriosus and 16 (59%) did not have significant patent ductus arteriosus. Synchronous arterial and venous blood gases were measured during the first post-natal hours after the insertion of umbilical catheters. The differences between arterial and inferior caval vein oxygen saturation, inferior body fractional oxygen extraction, and the shunt index were calculated. Echocardiography was performed before the 72nd hour of life in a selected group of patients who had haemodynamically significant patent ductus arteriosus. Ibuprofen treatment was administered to patients with patent ductus arteriosus. Echocardiography was performed on the 72nd hour of life in preterm infants without any clinical suspicion of patent ductus arteriosus. Results: The early measured differences between arterial and inferior caval vein oxygen saturation and inferior body fractional oxygen extraction were found to be lower and the shunt index was found to be higher in the haemodynamically significant patent ductus arteriosus group than in the group without haemodynamically significant patent ductus arteriosus. Conclusion: We found that the shunt index, calculated in the first hours of life as ≥63%, predicted haemodynamically significant patent ductus arteriosus with a sensitivity of 78% and specificity of 82% in preterm newborns.

Keywords

Prematurityinferior caval vein oxygen saturationmixed venous oxygen saturationpatent ductus arteriosusfractional oxygen extractionshunt index
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 4 , August 2014 , pp. 605 - 609
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Plotz, FB, van Lingen, RA, Bos, AP. Venous oxygen measurements in the inferior vena cava in neonates with respiratory failure. Crit Care 1998; 2: 57–60.Google Scholar
2. Whyte, RK. Mixed venous oxygen saturation in the newborn. Can we and should we measure it? Scand J Clin Lab Invest Suppl 1990; 203: 203–211.CrossRefGoogle Scholar
3. Hart, J, Vemgal, P, Cocks-Drew, S, Harrison, C, Andersen, C. The relation between inferior vena cava oxygen saturation, superior vena cava flow, fractional oxygen extraction and haemoglobin affinity in sick newborns: a pilot study. Acta Paediatr 2006; 95: 50–55.Google Scholar
4. O'Connor, TA, Hall, RT. Mixed venous oxygenation in critically ill neonates. Crit Care Med 1994; 22: 343–346.Google Scholar
5. Dudell, G, Cornish, JD, Bartlett, RH. What constitutes adequate oxygenation? Pediatrics 1990; 85: 39–41.Google Scholar
6. van der Hoeven, MA, Maertzdorf, WJ, Blanco, CE. Feasibility and accuracy of fiberobtic catheter for measurement of venous oxygen saturation in newborn infants. Acta Paediatr 1995; 84: 122–127.Google Scholar
7. Hirschl, RB, Palmer, P, Heiss, KF, Hultquist, K, Fazzalari, F, Bartlett, RH. Evaluation of the right atrial venous oxygen saturation as a physiologic monitor in a neonatal model. J Pediatr Surg 1993; 28: 901–905.Google Scholar
8. van der Hoeven, MA, Maertzdorf, WJ, Blanco, CE. Mixed venous oxygen saturation and biochemical parameters of hypoxia during progressive hypoxemia in 10- to 14-day-old piglets. Pediatr Res 1997; 42: 878–884.Google Scholar
9. van der Hoeven, MA, Maertzdorf, WJ, Blanco, CE. Relationship between mixed venous oxygen saturation and markers of tissue oxygenation in progressive hypoxic hypoxia and in isovolemic anemic hypoxia in 8- to 12-day-old piglets. Crit Care Med 1999; 27: 1885–1892.Google Scholar
10. van der Hoeven, MA, Maertzdorf, WJ, Blanco, CE. Continuous central venous oxygen saturation (ScvO2) measurement using a fibre optic catheter in newborn infants. Arch Dis Child Fetal Neonatal Ed 1996; 74: 177–181.CrossRefGoogle ScholarPubMed
11. MacDonald, MG, Chou, MM. Preventing complications from lines and tubes. Semin Perinatol 1986; 10: 224–233.Google ScholarPubMed
12. Martin, J, Shekerdemian, LS. The monitoring of venous saturations of oxygen in children with congenitally malformed hearts. Cardiol Young 2009; 19: 34–39.CrossRefGoogle ScholarPubMed
13. Goodrich, C. Continuous central venous oximetry monitoring. Crit Care Nurs Clin North Am 2006; 18: 203–209.CrossRefGoogle ScholarPubMed
14. Liakopoulos, OJ, Ho, JK, Yezbick, A, et al. An experimental and clinical evaluation of a novel central venous catheter with integrated oximetry for pediatric patients undergoing cardiac surgery. Anesth Analg 2007; 105: 1598–1604.Google Scholar
15. Kissoon, N, Spenceley, N, Krahn, G, Milner, R. Continuous central venous oxygen saturation monitoring under varying physiological conditions in an animal model. Anaesth Intensive Care 2010; 38: 883–889.Google Scholar
16. Wardle, SP, Yoxall, CW, Weindling, AM. Peripheral oxygenation in hypotensive preterm babies. Pediatr Res 1999; 45: 343–349.CrossRefGoogle ScholarPubMed
17. Evans, N, Malcolm, G, Osborn, D, Kluckow, M. Diagnosis of patent ductus arteriosus in preterm infants. NeoRev 2004; 5: 86–97.Google Scholar
18. Skinner, J. Diagnosis of patent ductus arteriosus. Semin Neonatol 2001; 6: 49–61.CrossRefGoogle ScholarPubMed
19. Schulze, A, Whyte, RK, Clifton Way, R, Sinclair, JC. Effect of the arterial oxygenation level on cardiac output, oxygen extraction and oxygen consumption in low birth weight infants receiving mechanical ventilation. J Pediatr 1995; 126: 777–784.CrossRefGoogle ScholarPubMed