Construction of Ductal Diameter Centiles in the First 24 h of Life and Their Relation to Cerebral Blood Flow in Neonates Weighing Less Than 1250 g in the First 24 h of Life.

AIMS AND OBJECTIVES: To evaluate the ductal diameter centiles in the first 24 h of life and their relation to cerebral blood flow in neonates weighing <1250 g in the first 24 h of life. METHOD AND MATERIAL: This prospective observational cohort study enrolled 44 infants with birth weight <1250 g. Two-dimensional echocardiography and color Doppler were performed within the first 12 h of life and were repeated again in the next 12 h of life to assess the ductal size and middle cerebral artery (MCA) flows [peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI)]. RESULTS: The mean patent ductus arteriosus (PDA) size (mm) within 0-6 h was 1.88 ± 1.12, within 7-12 h was 2.02 ± 0.973, within 13-18 h was 1.47 ± 1.00 and within 19-24 h was 1.42 ± 0.705. There was a significant increase in the PSV and MV of the MCA in infants with open PDA compared with those with closed PDA (p < 0.05) when measured between 13 and 24 h of life. There was no correlation between the PDA size and simultaneous PSV, EDV, MV and PI of MCA within 12 h of life. The PDA size within 13-24 h showed correlation with only the PSV of the MCA (p = 0.05) and not with the EDV, MV and PI. There was no significant difference in the PSV, EDV, MV and PI among the infants depending on the size of the PDA. CONCLUSION: There is a progressive decrease in the PDA size in the first 24 h of life. The PSV and MV of the MCA are increased in infants with closed PDA, but among those with open PDA, size does not relate to MCA flows in the first 24 h of life.

Initiating nasal continuous positive airway pressure in preterm neonates at 5 cm as against 7 cm did not decrease the need for mechanical ventilation.

AIM: The optimum starting nasal continuous positive airway pressure (nCPAP) for infants on bubble nCPAP is unknown. We compared whether an initial bubble nCPAP of 7 cm rather than 5 cm of water prevented the need for mechanical ventilation among preterm neonates with respiratory distress. METHODS: Preterm neonates born at 27-34 weeks with the onset of respiratory distress within 24 hours of birth were randomised to receive high or standard nCPAP at either 7 cm or 5 cm of water, respectively. The primary outcome was the need for mechanical ventilation in the first week of life. RESULTS: The baseline characteristics were comparable between the two groups. The proportion of infants who required mechanical ventilation during the first week of life was similar between the two groups (standard 29/133, 21.8% versus high 30/138, 21.7%), with a relative risk of 0.99 and range of 0.56-1.77. The secondary outcomes were similar between the two groups, including mortality before discharge, pulmonary air leaks, need of surfactant therapy, bronchopulmonary dysplasia and duration of nCPAP. CONCLUSION: Initiating nCPAP at a higher pressure of 7 cm in preterm neonates with respiratory distress, rather than the standard 5 cm, did not decrease the need for mechanical ventilation during the first week of life.