Assessing Patent Ductus Arteriosus (PDA) Significance on Cardiac Output by Whole-Body Bio-impedance
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ORIGINAL ARTICLE
Assessing Patent Ductus Arteriosus (PDA) Significance on Cardiac Output by Whole‑Body Bio‑impedance Ruth Rafaeli Rabin2 · Ilya Rosin1 · Avraham Matitiau2 · Yael Simpson1 · Orna Flidel‑Rimon1 Received: 22 March 2020 / Accepted: 22 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We evaluated the effectiveness of a whole-body bioimpedance device (NICaS®, NI Medical, Petach Tikva, Israel) to predict the presence of a hemodynamically significant patent ductus arteriosus (PDA) in premature infants. A total of 36 infants less than 35 week’s gestation age and birth weights of less than 1750 g were included in the study. Using the NICaS® device, we obtained whole-body bioimpedance measurements of stroke volume index (SI), cardiac output index (CI) and total peripheral resistance index. A total of 61 measurements were taken together with echocardiograph imaging. The study population was divided into three groups according to the echocardiograph results: group 1—small PDA, group 2—moderate PDA, and group 3—large PDA. Both SI and CI significantly increased from a median value of 22.6 ml/m2 and 3.4 l/min/m2 to 23.8 and 3.7, to 39.8 and 5.4 between groups 1, 2 and 3 respectively. The difference was statistically significant between groups 1 and 3 (P = 0.005 for SI and P = 0.002 for CI) and between groups 2 and 3 (P = 0.037 for SI and P = 0.05 for CI). We found statistically significant differences in SI and CI between infants with large PDAs and infants with no or small and medium PDAs. We suggest that these differences can be used in real time, in addition to echocardiography, in assessing the presence of significant PDAs. Keywords Patent ductus arteriosus · Preterm infant · Whole-body bioimpedance · Stroke volume index (SI) · Cardiac output index (CI) · Total peripheral resistance index (TPRI)
Introduction Patent ductus arteriosus (PDA) is a prevalent condition affecting premature infants. The prevalence of PDAs is inversely related to gestational age. Approximately 75–80% of premature infants born less than 28 weeks gestation age will have a PDA [1–3]. PDAs increase the risk of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), pulmonary hemorrhage and necrotizing enterocolitis (NEC) [2, 4, 5]. Most PDAs close by themselves but at a slower rate than in term infants. By the age of 6 months, 90–100% of the PDAs will spontaneously close [1–3, 6]. Current management options for PDAs include conservative and interventional approaches. The conservative * Orna Flidel‑Rimon [email protected] 1
Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel
Unit of Pediatric Cardiology, Hebrew University, Jerusalem, Israel
2
approach includes fluid restriction, diuretics, increasing systemic cardiac output and so forth. The interventional approach includes pharmacological and surgical treatments [1, 2, 5–7]. Historically, the pharmacological treatment was comprised of indomethacin treatment, but today, most centers use ibuprofen, p
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