Publication: Relación entre el índice de perfusión y la presencia de ductus arterioso persistente en el prematuro
Authors
Gil Sarrión, Elena
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Escuelas::Escuela Internacional de Doctorado
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Bosch Giménez, Vicente María ; Canals Candela, Francisco José
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
INTRODUCCIÓN: El ductus arterioso es una estructura fetal cuya persistencia en recién nacidos se asocia con un aumento de la morbimortalidad causado fundamentalmente por un hiperaflujo pulmonar y una hipoperfusión sistémica, especialmente en <28 semanas de gestación o peso <1000g. El diagnóstico se realiza mediante ecocardiografía, sin embargo, no siempre está disponible. La hipótesis de nuestro estudio fue que la presencia de ductus arterioso persistente con repercusión hemodinámica altera la perfusión de los tejidos periféricos de la circulación postductal, observándose un cambio en el índice de perfusión. El objetivo de nuestro estudio consiste en comprobar la relación entre parámetros de la monitorización habitual como el índice de perfusión y los DAPHS (Ductus Arterioso Persistente Hemodinámicamente Significativo).
MATERIAL Y MÉTODOS: Estudio observacional, analítico y prospectivo en neonatos menores de 34 semanas de gestación nacidos en el Hospital General de Elche realizado durante 26 meses. Se excluyeron los pacientes que presentaron una cardiopatía mayor, malformación congénita, depresión perinatal severa o hipertensión pulmonar persistente, así como, la imposibilidad para la realización de ecocardiografía o la revocación de consentimiento informado. Tras la exploración física, se realizan las mediciones del IP (Índice de Perfusión) preductales y postductales pudiendo obtener el ∆IP (diferencia del índice de perfusión preductal y el postductal) junto a la ecocardiografía el 1er, 3er día y 2º semana de vida.
RESULTADOS: Se estudiaron 96 neonatos: 24 presentaban DAPHS frente a 72 sin DAPHS. Encontramos diferencias de ∆IP en DAPHS (Mediana:0,54 p25: 0,13 y p75: 0,97) frente a no DAPHS (Mediana: 0,18 p25: 0,06 y p75: 0,47) estadísticamente significativas (p=,013). El punto de corte de ∆IP con mayor concordancia en pacientes con DAPHS fue de 0,28 en el tercer día de vida (Kappa 0.25). Este punto de corte presentó una sensibilidad del 71%, una especificidad del 63% y un valor predictivo negativo del 86%, siendo el valor predictivo positivo menor. El índice de perfusión menor se obtuvo el primer día de vida. Se obtuvieron valores de referencia de índices de perfusión en una población española en menores de 34 semanas. Objetivamos diferencias significativas en varios parámetros ecocardiográficos en pacientes con DAPHS en el tercer día de vida, resaltando el patrón pulsátil del ductus (p <,001) y el flujo en aorta descendente (p <,001).
CONCLUSIONES: Nuestro estudio establece una relación estadísticamente significativa entre el ∆IP y el DAPHS. Se plantean valores de referencia del índice de perfusión en una población española.
INTRODUCTION: The ductus arteriosus is a fetal structure whose persistence in newborns is associated with increased morbidity and mortality, primarily due to pulmonary overcirculation and systemic hypoperfusion, especially in infants born at <28 weeks of gestation or with a birth weight <1000g. Diagnosis is made by echocardiography; however, this tool is not always available. Our study hypothesized that the presence of a hemodynamically significant patent ductus arteriosus (hsPDA) alters perfusion in peripheral tissues of the postductal circulation, which could be observed as a change in the perfusion index. The aim of our study was to assess the relationship between routinely monitored parameters, such as the perfusion index, and the presence of hsPDA. MATERIALS AND METHODS: This was an observational, analytical, and prospective study conducted on neonates born at less than 34 weeks of gestation at the General Hospital of Elche over a 26-month period. Patients with major congenital heart disease, congenital malformations, severe perinatal depression, or persistent pulmonary hypertension were excluded, as well as those for whom echocardiography could not be performed or informed consent was withdrawn. Following physical examination, preductal and postductal perfusion index (PI) measurements were taken to calculate ∆PI (the difference between preductal and postductal perfusion index), along with echocardiography on the 1st, 3rd day, and during the 2nd week of life. RESULTS: A total of 96 neonates were studied: 24 with hsPDA and 72 without. Statistically significant differences were found in ∆PI in the hsPDA group (Median: 0.54, p25: 0.13, p75: 0.97) compared to the non-hsPDA group (Median: 0.18, p25: 0.06, p75: 0.47) (p = 0.013). The ∆PI cutoff point with the highest concordance in hsPDA patients was 0.28 on the third day of life (Kappa = 0.25). This cutoff point showed a sensitivity of 71%, a specificity of 63%, and a negative predictive value of 86%, with a lower positive predictive value. The lowest perfusion index was recorded on the first day of life. Reference values for perfusion indices were established for a Spanish population of infants under 34 weeks. Significant differences were observed in several echocardiographic parameters in patients with hsPDA on the third day of life, particularly in ductal pulsatile pattern (p < 0.001) and descending aortic flow (p < 0.001). CONCLUSIONS: Our study establishes a statistically significant relationship between ∆PI and hsPDA. Reference values for the perfusion index are proposed for a Spanish population.
INTRODUCTION: The ductus arteriosus is a fetal structure whose persistence in newborns is associated with increased morbidity and mortality, primarily due to pulmonary overcirculation and systemic hypoperfusion, especially in infants born at <28 weeks of gestation or with a birth weight <1000g. Diagnosis is made by echocardiography; however, this tool is not always available. Our study hypothesized that the presence of a hemodynamically significant patent ductus arteriosus (hsPDA) alters perfusion in peripheral tissues of the postductal circulation, which could be observed as a change in the perfusion index. The aim of our study was to assess the relationship between routinely monitored parameters, such as the perfusion index, and the presence of hsPDA. MATERIALS AND METHODS: This was an observational, analytical, and prospective study conducted on neonates born at less than 34 weeks of gestation at the General Hospital of Elche over a 26-month period. Patients with major congenital heart disease, congenital malformations, severe perinatal depression, or persistent pulmonary hypertension were excluded, as well as those for whom echocardiography could not be performed or informed consent was withdrawn. Following physical examination, preductal and postductal perfusion index (PI) measurements were taken to calculate ∆PI (the difference between preductal and postductal perfusion index), along with echocardiography on the 1st, 3rd day, and during the 2nd week of life. RESULTS: A total of 96 neonates were studied: 24 with hsPDA and 72 without. Statistically significant differences were found in ∆PI in the hsPDA group (Median: 0.54, p25: 0.13, p75: 0.97) compared to the non-hsPDA group (Median: 0.18, p25: 0.06, p75: 0.47) (p = 0.013). The ∆PI cutoff point with the highest concordance in hsPDA patients was 0.28 on the third day of life (Kappa = 0.25). This cutoff point showed a sensitivity of 71%, a specificity of 63%, and a negative predictive value of 86%, with a lower positive predictive value. The lowest perfusion index was recorded on the first day of life. Reference values for perfusion indices were established for a Spanish population of infants under 34 weeks. Significant differences were observed in several echocardiographic parameters in patients with hsPDA on the third day of life, particularly in ductal pulsatile pattern (p < 0.001) and descending aortic flow (p < 0.001). CONCLUSIONS: Our study establishes a statistically significant relationship between ∆PI and hsPDA. Reference values for the perfusion index are proposed for a Spanish population.
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