State of Renal Blood Flow in Premature Children with Hemodynamically Significant Patent Ductus Arteriosus
Abstract: Introduction: Hemodynamically significant patent ductus arteriosus (HSPDA) lowers the renal circulation because of the "ductal stealing phenomenon," which can change the renal blood flow.
The aim: To study the state of blood flow in the main renal artery and interlobar renal artery in premature infants with HSPDA.
Materials and methods: 74 preterm newborns (gestational age 29-36 weeks) were divided into three groups: І - 40 children with HSPDA, ІІ - 17 children with patent ductus arteriosus (PDA) without hemodynamic disorders, ІІІ - 17 children with closed ductus arteriosus. Color ultrasound Doppler scan of the vascular bed of the kidneys was performed using a microconvex sensor with a frequency of 5-8 MHz ("TOSHIBA" Nemso XG model SSA-580A (Japan) from the main renal artery to the interlobar renal arteries of the right kidney. The following parameters of renal blood flow were studied: peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI).
Results: Peak systolic velocity (PSV) in the main renal artery and interlobar renal arteries did not differ significantly between groups. On the first, third, and tenth days of life, there was a significant decrease in the EDV of blood flow and increased RI in the main renal artery. The EDV of blood flow and RI in the interlobar renal artery on the first day of life did not differ depending on PDA's presence and its hemodynamic significance. On the third and tenth days of life and in the interlobar renal artery, a significant decrease in EDV of blood flow and increased RI were noted. These renal blood flow characteristics were closely related to the size of the PDA on the first day of life.
Conclusion: A feature of renal hemodynamics in HSPDA in premature infants is a decrease in the EDV of blood flow in the main renal artery and interlobar renal artery, as well as an increase in the RI of these vessels, directly correlating with the size of the PDA in the first day of life. During the first ten days of life, dynamic control revealed a slowed process of restoration of renal blood flow in babies with HSPDA, despite the PDA's closure.
2. Rios DR, Bhattacharya S, Levy PT, McNamara PJ. Circulatory Insufficiency and Hypotension Related to the Ductus Arteriosus in Neonates. Front Pediatr. 2018;6:62. doi:10.3389/fped.2018.00062.
3. Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol. 2012;36(2):123-9. doi:10.1053/j.semperi.2011.09.022.
4. El Hajjar M, Vaksmann G, Rakza T, Kongolo G, Storme L. Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed. 2005 Sep;90(5):F419-22. doi: 10.1136/adc.2003.027698.
5. Slaughter JL, Cua CL, Notestine JL, et al. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation. BMC Pediatr. 2019 Sep 13;19(1):333. doi: 10.1186/s12887-019-1708-z. .
6. Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate. 2006;89(4):330-5. doi: 10.1159/000092870.
7. Giliberti P, De Leonibus C, Giordano L, Giliberti P. The physiopathology of the patent ductus arteriosus. J Matern Fetal Neonatal Med. 2009;22 Suppl 3:6-9. doi: 10.1080/14767050903198215.
8. Hsu KH, Nguyen J, Dekom S, Ramanathan R, Noori S. Effects of Patent Ductus Arteriosus on Organ Blood Flow in Infants Born Very Preterm: A Prospective Study with Serial Echocardiography. J Pediatr. 2020 Jan;216:95-100.e2. doi: 10.1016/j.jpeds.2019.08.057.
9. Sehgal A, Coombs P, Tan K, McNamara PJ. Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus. J Perinatol. 2011 Mar;31(3):150-6. doi: 10.1038/jp.2010.83.
10. Wong SN, Lo RN, Hui PW. Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic patent ductus arteriosus. J Ultrasound Med. 1990 Mar;9(3):125-30. doi: 10.7863/jum.19184.108.40.206.
11. Bömelburg T, Jorch G. Abnormal blood flow patterns in renal arteries of small preterm infants with patent ductus arteriosus detected by Doppler ultrasonography. Eur J Pediatr. 1989 Jun;148(7):660-4. doi: 10.1007/BF00441528.
12. Obolonskyi A, Snisar V, Surkov D, et al. Management of patent ductus arteriosus in premature infants. Medicni perspektivi. 2019;24(2):33-40. doi.org/10.26641/2307-0404.2019.2.170125A.
13. Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants? Congenit Heart Dis. 2019 Jan;14(1):21-6. doi: 10.1111/chd.12727.
14. Olkhova EB. Sonographycs options violations of renal hemodynamics in newborns. Radiology practice. 2012;2:53-67. [In Russian]. https://intelmed.ru/files/science_item.
15. Trihan JE, Perez-Martin A, Guillaumat J, Lanéelle D. Normative and pathological values of hemodynamic and Doppler ultrasound arterial findings in children. Vasa. 2020 Jun;49(4):264-74. doi: 10.1024/0301-1526/a000860.
16. Clyman RI, Mauray F, Heymann MA, Roman C. Cardiovascular effects of patent ductus arteriosus in preterm lambs with respiratory distress. J Pediatr. 1987 Oct;111(4):579-87. doi: 10.1016/s0022-3476(87)80126-9.
17. Tumayeva TS, Gerasimenko AV, Naumenko EI, Ryazina IY. Renal hemodynamics in early adaptation period in children born by cesarean section. Pediatria. 2016;95(1):35-40. [In Russian]. https://pediatriajournal.ru/files/upload/mags/350/2016_1_4518.pdf.
18. Vokueva TI. Ultrasound diagnostics of central hemodynamic and organ blood flow disorders in premature infants with a functioning ductus arteriosus: abstract of Dissertation PhD. Moskow. 2008:21. [In Russian]. https://www.dissercat.com/content/ultrazvukovaya-diagnostika-narushenii-tsentralnoi-gemodinamiki-i-organnogo-krovotoka-u-nedon/read.
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