Prognostic value of color Doppler echocardiographic findings in premature newborns with patent ductus arteriosus.

This study intended to evaluate the relationship between the prognosis for premature newborns (PM) with patient ductus arteriosus (PDA) and their Doppler echocardiographic findings. From January 1989 to December 1995, of 369 premature newborns in their first postnatal week, 196 underwent ductal evaluations echocardiographically: 47 of these 196 cases were found to have PDA. Each echocardiogram had complete data for cardiac output, ejection fraction, the left atrial-to-the-aortic ratio (LA/AO), the systolic time interval of the right ventricle (RVSTI), the transvalvular pressure gradient from tricuspid regurgitation (TGTR) and ductal Doppler color flow maps. These 47 premature newborns with PDA were grouped into (A) "asymptomatic" patients whose ductus closed spontaneously within a one-year follow-up (15 subjects), (B) "symptomatic" patients whose ductus were closed by pharmacological or surgical managements (20 subjects), and (C) "complicated" patients whose ductus caused mortality of the host (12 subjects). The remaining 149 premature newborns with a closed ductus (CD) served as controls. The RVSTI in these 47 premature newborns with PDA was found to be significantly higher than those of 149 CD (0.26 +/- 0.12 vs. 0.18 +/- 0.06, p < 0.005), and denoting that PM-PDA had a higher mean pulmonary arterial pressure. The TGTR of these 47 premature newborns with PDA was also higher than these of the 149 CD controls (30.50 +/- 11.85 mmHg vs. 20.54 +/- 6.88 mmHg, p < 0.005), denoting that PM-PDA had a higher pulmonary arterial systolic pressures. Gestational age of group C neonates was younger than group A (29.46 +/- 3.41 weeks vs. 32.80 +/- 2.78 weeks, P < 0.01). The birth weight of Group C neonates was lower than that of Group A (1366.17 +/- 684.28 gm vs. 2061.67 +/- 751.77 gm. p < 0.01), therefore, extreme prematurity and small-for-gestational-age could have increased the mortality of PM-PDA. Doppler color flow maps of group C showed a wider ductal patency, less ductal waist-narrowing, more vehement red-color forward flow and less midstream mosaicism. It was concluded that patient with extreme prematurity, with very-low-birth-weight or wider patent ductus, higher pulmonary hypertension, less midstream mosaicism, or less ductal waist-narrowing would have a poorer prognosis.

Exogenous surfactant therapy for neonatal respiratory distress syndrome: a two-year clinical experience.

The purpose of this study were to gain local experience, to find out the efficacy and side effects of surfactant and to find out whether surfactant therapy will lower the mortality and morbidity of premature infants. From Nov. 1992 to Dec. 1994, there were 25 premature infants in his neonatal intensive care unit (NICU) enrolled in this study. Another 25 premature infants with study group matched gestational age, weight, and Apgar score, who had been previously treated at this NICU from 1990 to 1992 served as control group. Modified bovine surfactant (Survanta, Abbot), 100 mg/Kg of surfactant phospholipid in 4 ml solution was administered intratracheally in four divided doses. The premature infants in the study group had prompt and sustained improvement in oxygenation. The improvement in FiO2 and arterial-to-alveolar oxygen tension ratio (a/APO2) were significantly different from the control infants from 12 hours post-treatment till the subsequent 48 hours after treatment. There was no difference in mortality rate between the two groups. There was no side effect noted from surfactant therapy. It was therefore concluded that modified bovine surfactant therapy is safe and effective for neonates with respiratory distress syndrome. A larger study is required to find out whether it lowers the mortality and morbidity in premature infants in Taiwan.

The association of periventricular echodensity with cerebral palsy in preterm infants.

The purpose of this study was to investigate the risk factors of development of cerebral palsy (CP) in preterm infants who had periventricular echogenic abnormalities with or without cyst formation. During a period of 66 months, 332 newborns of 34 weeks gestation or less born at our hospital received serial brain ultrasound scans. Sixty-six of the 332 infants, 36 males and 30 females, were detected increased periventricular echodensity (PVE) during admission period. Subsequently, serial brain ultrasound scans were done for the 66 preterm infants at our follow-up clinic. Their neurodevelopment outcomes were then followed up for 10-48 months. The degree of periventricular echodensity (PVE) was graded as mild; or moderate to severe, according to the extent of the echodensity. Periventricular echodensity with cyst formation was classified by the size of the cyst at its widest diameter as either large (3 mm or multiple) or small (< 3 mm) in the parasagittal image. Eighteen of 66 (27.3%) infants developed cerebral palsy (CP). Infants with PVE with large cystic formation were at significantly higher risk for development of cerebral palsy (P < 0.005). Nine of 16 (56.3%) patients in the CP group had a longer duration of PVE than the non-CP group (8 of 46 patients: 17.4%) (p < 0.005). It is concluded that large cystic periventricular echodensity and long duration of PVE are associated with later development of cerebral palsy.