title: A right-to-left or bidirectional ductal shunt in preterm neonates: grave implication?
abstract: We delineate the natural history of a right-to-left or bidirectional (RL/BD) patent ductus arteriosus (PDA) in preterm infants and compare outcomes of an RL/BD and a left-to-right (LR) ductal shunt. We performed a retrospective chart review of preterm infants (< 32 weeks), who, between 2 and 30 days of age, had an RL/BD PDA > 1.5 mm (study group; N = 74) or an LR PDA (N = 87) on echocardiogram (ECHO). In the study group, 27% of infants who were of significantly lower gestational age and birth weight had a "prolonged" RL/BD PDA on two or more ECHOs. Infants with RL/BD PDA required significantly greater surfactant (98.6% versus 94.2%) and less PDA therapy (27% versus 92%) and had higher mortality (48.6% versus 21.8%) compared with those with LR PDA. On regression analysis, lower gestation (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.15 to 1.83) and RL/BD PDA (OR 4.74; 95% CI: 2.18 to 10.3) were significantly associated with mortality. The independent association between an RL/BD PDA shunt and mortality warrants further investigation. Insights into the etiology of pulmonary hypertension may optimize outcomes in this population.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan 48201, USA. rbapat@dmc.org
authors.forename: Roopali
authors.initials: R
authors.lastname: Bapat
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
mesh_terms: D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000150:complications*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010547:Persistent Fetal Circulation Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D047928:Premature Birth / Q000503:physiopathology; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D002316:Cardiotonic Agents; D011663:Pulmonary Surfactants; D004280:Dobutamine; D004298:Dopamine