RESUMO
The purpose of the study is to test whether NT-proBNP serves as a screening tool for low-risk patent ductus arteriosus and safely avoids routine early echocardiography. This is a prospective observational study in preterm infants ≤32 weeks of gestational age. Infants with ≥5100 pg/ml (positive screening) at 48-72 hours of life received comprehensive echocardiography and were treated according to shunt severity. Infants with NT-proBNP below 5100 pg/ml (negative screening) were managed expectantly. The main outcome was need for ductus treatment within the first 7 days of life. One hundred twenty-five infants were included; 82 had a negative NT-proBNP screening and 43 had a positive NT-proBNP screening. No infant (0%) with a negative screening was treated for ductus while 26 (60.4%) with a positive screening were treated (p < 0.001). NT-proBNP avoided a 65.6% of routine echocardiograms. NT-proBNP had an excellent performance to predict PDA treatment (AUC = 0.967).Conclusion: NT-proBNP at 48-72 hours of life has an excellent performance to detect low risk and avoids unnecessary echocardiograms. This may contribute to optimize PDA management in terms of resource utilization.
Assuntos
Permeabilidade do Canal Arterial , Recém-Nascido Prematuro , Lactente , Recém-Nascido , Humanos , Seguimentos , Biomarcadores , Peptídeo Natriurético Encefálico , Permeabilidade do Canal Arterial/diagnóstico por imagemRESUMO
INTRODUCTION: Central venous catheter (CVC) insertion in neonates and small infants is a challenging and high risk procedure. Ultrasound (US) guided cannulation increases the success rate and reduces procedural-related complications. The internal jugular vein is the most frequent site for US-guided CVC insertion. However this approach is technically demanding in neonates and small infants. US-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a new approach that may be advantageous in case of difficult central venous catheterization. We present our preliminary experience with this technique in a case series of neonates and small infants. METHODS: Case series of neonates and small infants weighing less than 5kg, in whom US-guided supraclavicular cannulation of the BCV was attempted. A longitudinal "in plane" supraclavicular approach to the BCV was performed using a 12Hz linear or a 8Hz microconvex transducer. All cannulations were performed by the same operator, a pediatrician with previous experience in US-guided central venous catheterization. RESULTS: The study included 6 patients with a median (range) weight of 2.1 (0.94-4.1) kg and age of 1.9 (0.6-4) months. Two cases required 2 punctures, while cannulation was achieved at the first attempt in the remaining 4 cases. There were no procedural or catheter-related complications. CVCs were withdrawn after 9 (6-15) days. CONCLUSIONS: The US-guided supraclavicular approach to the BCV is a feasible and safe alternative in neonates and very small infants. More studies are needed to define the role of this new venous access before its routine application in daily practice.