N Evans1, M Kluckow, A Currie. 1. Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia. nevans@med.usyd.edu.au
Abstract
AIMS: To examine the hypothesis that right to left shunting occurs mainly in the lungs rather than through the fetal channels in neonates. METHODS: Thirty two term babies requiring over 70% oxygen had daily colour Doppler echocardiograms until recovery. Measurements included left ventricular fractional shortening, right and left ventricular outputs, colour and pulsed Doppler ductal and atrial shunting and systolic pulmonary artery pressure (SPAP) derived from ductal shunt or tricuspid incompetence velocities. RESULTS: The babies were retrospectively classified into a respiratory group (n = 19) and a persistent pulmonary hypertension (PPHN) group (n = 13) on the basis of clinical history and radiology. At the initial echocardiogram, just 50% of babies had suprasystemic SPAP. Despite better oxygenation, more of the PPHN group had suprasystemic PAP (85% vs 26%). A correlation between SPAP and Oxygen index (OI) was present only in the respiratory group (r = 0.7). Low ventricular outputs (< 150 ml/kg/min) were common in both groups (53% and 79%). The respiratory group had more closed ducts (47% vs 0%) and those ducts which were patient were more constricted (1.75 mm vs 2.6 mm). Pure right to left ductal shunts were seen in just 15% and pure right to left atrial shunts in just 6% of all babies. The serial echocardiograms showed that SPAP fell and ducts closed well before oxygenation improved. Ventricular outputs increased with age in both groups. CONCLUSIONS: Apart from early on in the sickest babies with a primarily respiratory diagnosis and the babies with primary PPHN, most right to left shunting occurred at an intrapulmonary level.
AIMS: To examine the hypothesis that right to left shunting occurs mainly in the lungs rather than through the fetal channels in neonates. METHODS: Thirty two term babies requiring over 70% oxygen had daily colour Doppler echocardiograms until recovery. Measurements included left ventricular fractional shortening, right and left ventricular outputs, colour and pulsed Doppler ductal and atrial shunting and systolic pulmonary artery pressure (SPAP) derived from ductal shunt or tricuspid incompetence velocities. RESULTS: The babies were retrospectively classified into a respiratory group (n = 19) and a persistent pulmonary hypertension (PPHN) group (n = 13) on the basis of clinical history and radiology. At the initial echocardiogram, just 50% of babies had suprasystemic SPAP. Despite better oxygenation, more of the PPHN group had suprasystemic PAP (85% vs 26%). A correlation between SPAP and Oxygen index (OI) was present only in the respiratory group (r = 0.7). Low ventricular outputs (< 150 ml/kg/min) were common in both groups (53% and 79%). The respiratory group had more closed ducts (47% vs 0%) and those ducts which were patient were more constricted (1.75 mm vs 2.6 mm). Pure right to left ductal shunts were seen in just 15% and pure right to left atrial shunts in just 6% of all babies. The serial echocardiograms showed that SPAP fell and ducts closed well before oxygenation improved. Ventricular outputs increased with age in both groups. CONCLUSIONS: Apart from early on in the sickest babies with a primarily respiratory diagnosis and the babies with primary PPHN, most right to left shunting occurred at an intrapulmonary level.
Authors: Chloë Joynt; David L Bigam; Gregory Charrois; Laurence D Jewell; Gregory Korbutt; Po-Yin Cheung Journal: Intensive Care Med Date: 2010-03-11 Impact factor: 17.440
Authors: Chloë Joynt; David L Bigam; Gregory Charrois; Laurence D Jewell; Gregory Korbutt; Po-Yin Cheung Journal: Intensive Care Med Date: 2008-03-21 Impact factor: 17.440
Authors: Afif El-Khuffash; Patrick J McNamara; Colm Breatnach; Neidin Bussmann; Aisling Smith; Oliver Feeney; Elizabeth Tully; Joanna Griffin; Willem P de Boode; Brian Cleary; Orla Franklin; Eugene Dempsey Journal: Matern Health Neonatol Perinatol Date: 2018-12-03