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Dynamic Changes of Pulmonary Arterial Pressure and Ductus Arteriosus in Human Newborns From Birth to 72 Hours of Age

View Article: PubMed Central - PubMed

ABSTRACT

Normal pulmonary artery pressure and pulmonary hypertension assessment of newborns is rarely reported. The aim of the study is to explore dynamic changes of pulmonary arterial pressure and ductus arteriosus in human newborns from birth to 72 h of age with echocardiography.

A total of 76 cases of normal newborns were prospectively detected by echocardiography after birth of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h, respectively. Ductus arteriosus diameter, blood shunt direction, blood flow velocity, and pressure gradient were recorded. The brachial artery blood pressure were measured to estimate the pulmonary artery systolic pressure (PASP) and pulmonary artery diastolic pressure (PADP) using patent ductus arteriosus pressure gradient method. The mean pulmonary artery pressure (PAMP) were calculated by equation of PAMP = PADP + 1/3(PASP-PADP).

(1) There were 76 cases of normal newborns. Among them, 29 cases (38%) ductus arteriosus closed within 24 h, 59 cases (78%) closed within 48 h, 72 cases (95%) closed within 72 h, and 4 cases (5%) ductus arteriosus not closed within 72 h. (2) The ductus arteriosus diameter of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h after birth was 4.60 ± 0.59 mm, 3.37 ± 0.59 mm, 2.47 ± 0.49 mm, 1.89 ± 0.41 mm, 1.61 ± 0.35 mm, and 1.20 ± 0.24 mm, respectively. Compared all of the ductus arteriosus diameter of the above time periods, there were statistically differences with P < 0.05, respectively. (3) The mean PASP in 2 h, 6 h, 12 h, 24 h, 48 h, 72 h after birth were 76.58 ± 7.28 mm Hg, 65.53 ± 9.25mm Hg, 52.51 ± 9.07 mm Hg, 43.83 ± 7.90 mm Hg, 38.07 ± 8.26 mm Hg, and 36 ± 6.48 mm Hg, respectively. The PADP of the above time period were 37.88 ± 5.56 mm Hg, 29.93 ± 7.91 mm Hg, 23.43 ± 7.37 mm Hg, 19.70 ± 8.51 mm Hg, 13.85 ± 5.58 mm Hg, 13.25 ± 6.18 mm Hg, respectively. The PAMP of the above time period were 63.41 ± 7.03 mm Hg, 51.78 ± 9.82 mm Hg, 40.94 ± 9.32 mm Hg, 34.39 ± 9.89 mm Hg, 26.23 ± 7.49 mm Hg, 25.25 ± 8.29 mm Hg, respectively. There were statistically differences with P < 0.05 between each time periods of PASP, PADP, and PAMP. (4) The upper 95% limit reference range of PASP of normal newborns of 72 h after birth were 39.97 mm Hg.

(1) Normal newborns ductus arteriosus diameter gradually decreased after birth, and 95% of them spontaneous closed within 24 to 72 h. (2) Normal newborns pulmonary artery pressure showed a gradually decline after birth, the upper 95% limit reference range for PASP measured in normal newborns <72 h of age was 39.97 mm Hg. Therefore, the diagnostic criteria of newborns pulmonary hypertension may be >40.00 mm Hg according to our limited study.

No MeSH data available.


The line graph between day-age and PASP, PADP, PAMP indicated that with the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually. PASP = pulmonary artery systolic pressure, PADP = pulmonary artery diastolic pressure, PAMP = mean pulmonary artery pressure.
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Figure 3: The line graph between day-age and PASP, PADP, PAMP indicated that with the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually. PASP = pulmonary artery systolic pressure, PADP = pulmonary artery diastolic pressure, PAMP = mean pulmonary artery pressure.

Mentions: We also recorded the ductus arteriosus flow spectrum. All of the 76 cases of normal newborns had a bidirectional shunt 2 h after birth, 42 cases had a bidirectional shunt and 34 cases had a unidirectional left to right shunt 6 h after birth, 9 cases had a bidirectional shunt and 67 cases had a unidirectional left to right shunt 12 h after birth, all the newborn infants had a bidirectional shunt 24 h after birth. Only 5 cases had a very small or transient shunt (Table 3). Pulmonary arterial pressure was obtained based on the Doppler spectrum. Compared the PASP, PADP, PAMP before and after the above each time period, there were statistically differences with all P < 0.05. With the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually (Figure 3). And 95% confidence interval upper limit of newborn infants PASP within each time period was calculated as follows: within 2 h ≤79.66 mm Hg, within 6 h≤74.23 mm Hg, within 12 h≤67.17 mm Hg, within 24 h≤57.13 mm Hg, within 48 h≤47.27 mm Hg, within 72 h≤39.97 mm Hg, respectively.


Dynamic Changes of Pulmonary Arterial Pressure and Ductus Arteriosus in Human Newborns From Birth to 72 Hours of Age
The line graph between day-age and PASP, PADP, PAMP indicated that with the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually. PASP = pulmonary artery systolic pressure, PADP = pulmonary artery diastolic pressure, PAMP = mean pulmonary artery pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998292&req=5

Figure 3: The line graph between day-age and PASP, PADP, PAMP indicated that with the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually. PASP = pulmonary artery systolic pressure, PADP = pulmonary artery diastolic pressure, PAMP = mean pulmonary artery pressure.
Mentions: We also recorded the ductus arteriosus flow spectrum. All of the 76 cases of normal newborns had a bidirectional shunt 2 h after birth, 42 cases had a bidirectional shunt and 34 cases had a unidirectional left to right shunt 6 h after birth, 9 cases had a bidirectional shunt and 67 cases had a unidirectional left to right shunt 12 h after birth, all the newborn infants had a bidirectional shunt 24 h after birth. Only 5 cases had a very small or transient shunt (Table 3). Pulmonary arterial pressure was obtained based on the Doppler spectrum. Compared the PASP, PADP, PAMP before and after the above each time period, there were statistically differences with all P < 0.05. With the increasing of neonatal day-age, PASP, PADP, PAMP decreased gradually (Figure 3). And 95% confidence interval upper limit of newborn infants PASP within each time period was calculated as follows: within 2 h ≤79.66 mm Hg, within 6 h≤74.23 mm Hg, within 12 h≤67.17 mm Hg, within 24 h≤57.13 mm Hg, within 48 h≤47.27 mm Hg, within 72 h≤39.97 mm Hg, respectively.

View Article: PubMed Central - PubMed

ABSTRACT

Normal pulmonary artery pressure and pulmonary hypertension assessment of newborns is rarely reported. The aim of the study is to explore dynamic changes of pulmonary arterial pressure and ductus arteriosus in human newborns from birth to 72&#8202;h of age with echocardiography.

A total of 76 cases of normal newborns were prospectively detected by echocardiography after birth of 2&#8202;h, 6&#8202;h, 12&#8202;h, 24&#8202;h, 48&#8202;h, and 72&#8202;h, respectively. Ductus arteriosus diameter, blood shunt direction, blood flow velocity, and pressure gradient were recorded. The brachial artery blood pressure were measured to estimate the pulmonary artery systolic pressure (PASP) and pulmonary artery diastolic pressure (PADP) using patent ductus arteriosus pressure gradient method. The mean pulmonary artery pressure (PAMP) were calculated by equation of PAMP&#8202;=&#8202;PADP&#8202;+&#8202;1/3(PASP-PADP).

(1) There were 76 cases of normal newborns. Among them, 29 cases (38%) ductus arteriosus closed within 24&#8202;h, 59 cases (78%) closed within 48&#8202;h, 72 cases (95%) closed within 72&#8202;h, and 4 cases (5%) ductus arteriosus not closed within 72&#8202;h. (2) The ductus arteriosus diameter of 2&#8202;h, 6&#8202;h, 12&#8202;h, 24&#8202;h, 48&#8202;h, and 72&#8202;h after birth was 4.60&#8202;&plusmn;&#8202;0.59&#8202;mm, 3.37&#8202;&plusmn;&#8202;0.59&#8202;mm, 2.47&#8202;&plusmn;&#8202;0.49&#8202;mm, 1.89&#8202;&plusmn;&#8202;0.41&#8202;mm, 1.61&#8202;&plusmn;&#8202;0.35&#8202;mm, and 1.20&#8202;&plusmn;&#8202;0.24&#8202;mm, respectively. Compared all of the ductus arteriosus diameter of the above time periods, there were statistically differences with P&#8202;&lt;&#8202;0.05, respectively. (3) The mean PASP in 2&#8202;h, 6&#8202;h, 12&#8202;h, 24&#8202;h, 48&#8202;h, 72&#8202;h after birth were 76.58&#8202;&plusmn;&#8202;7.28 mm Hg, 65.53&#8202;&plusmn;&#8202;9.25mm Hg, 52.51&#8202;&plusmn;&#8202;9.07 mm Hg, 43.83&#8202;&plusmn;&#8202;7.90 mm Hg, 38.07&#8202;&plusmn;&#8202;8.26 mm Hg, and 36&#8202;&plusmn;&#8202;6.48 mm Hg, respectively. The PADP of the above time period were 37.88&#8202;&plusmn;&#8202;5.56 mm Hg, 29.93&#8202;&plusmn;&#8202;7.91 mm Hg, 23.43&#8202;&plusmn;&#8202;7.37 mm Hg, 19.70&#8202;&plusmn;&#8202;8.51 mm Hg, 13.85&#8202;&plusmn;&#8202;5.58 mm Hg, 13.25&#8202;&plusmn;&#8202;6.18 mm Hg, respectively. The PAMP of the above time period were 63.41&#8202;&plusmn;&#8202;7.03 mm Hg, 51.78&#8202;&plusmn;&#8202;9.82 mm Hg, 40.94&#8202;&plusmn;&#8202;9.32 mm Hg, 34.39&#8202;&plusmn;&#8202;9.89 mm Hg, 26.23&#8202;&plusmn;&#8202;7.49 mm Hg, 25.25&#8202;&plusmn;&#8202;8.29 mm Hg, respectively. There were statistically differences with P&#8202;&lt;&#8202;0.05 between each time periods of PASP, PADP, and PAMP. (4) The upper 95% limit reference range of PASP of normal newborns of 72&#8202;h after birth were 39.97 mm Hg.

(1) Normal newborns ductus arteriosus diameter gradually decreased after birth, and 95% of them spontaneous closed within 24 to 72&#8202;h. (2) Normal newborns pulmonary artery pressure showed a gradually decline after birth, the upper 95% limit reference range for PASP measured in normal newborns &lt;72&#8202;h of age was 39.97 mm Hg. Therefore, the diagnostic criteria of newborns pulmonary hypertension may be &gt;40.00 mm Hg according to our limited study.

No MeSH data available.