مقایسه علائم بالینی با یافته‌های اکوکاردیوگرافی برای تشخیص مجرای شریانی باز در نوزادان نارس

   Background & Aims: Patent ductus arteriosus (PDA) is common in premature neonates and can cause adverse complications such as intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia in neonates. The purpose of this study was to evaluate the validity of clinical criteria in diagnosing of PDA in premature neonate. Methods |& Materials: This study was conducted on 61 premature neonates born between 24 to 34 weeks of gestation and with birth weight from 500 to 2100 grams including clinical signs such as tachycardia, heart murmur, hyperdynamic chest, presence of dorsalis pedis pulse, hypotension and worsening of respiratory status at 48-72 hours after birth. Echocardiographic evaluations were done by a pediatric cardiologist blinded to clinical findings. Neonates with sepsis, IVH, congenital anomalies, congenital heart diseases and NEC were excluded from the study. Results: From all 61 premature neonates who entered this study 14 neonates had hemodynamically significant PDA with left to right shunt ( PDA+). In five neonates PDA was small and in 42 neonates ductus arteriosus was not patent (collectively PDA-). From clinical criteria who evaluated, heart murmur, heart rate, presence of dorsalis pedis pulse, systolic and diastolic blood pressures between two groups had not differences in statistical analysis. But the number of neonates who had hyperdynamic precordium and worsening of respiratory status in 48-72 h of life was more in PDA+ group. And this difference in statistical analysis was meaningful. (P = 0.01) Conclusions: Clinical signs are not reliable and sufficient for early diagnosing of PDA in premature neonates routine echocardiography must be done for this purpose. From clinical signs hyperdynamic precordium and worsening respiratory status at 48-72 h of life have high sensitivity. in addition, in conjunction with echocardiography are helpful for early diagnosing of PDA in premature neonates.    SOURCE: URMIA MED J 2014: 25(4): 274 ISSN: 1027-3727