Blood flow assessed by color Doppler imaging in retinopathy of prematurity.

OBJECTIVE: To quantify central retinal arterial and venous blood flow using ultrasound color Doppler imaging. STUDY DESIGN: In this prospective observational study, eyes of eight preterm infants with retinopathy of prematurity stage 2 and of eight preterm infants without retinopathy (gestational age <30 weeks, birth weight <1500 g) were evaluated by color Doppler imaging. RESULT: Ocular blood flow velocities measured at 28±1 days of life did not differ significantly in the eyes of preterm infants who subsequently did and did not develop retinopathy. Development of retinopathy was associated with highly significant (P<0.0001 each) increases in central retinal vein maximum velocities (from 1.99±0.36 to 3.72±0.61 cm s(-1)), central retinal artery systolic flow velocities (from 6.44±1.52 to 9.87±1.99 cm s(-1)) and flow velocity integrals (from 1.27±0.30 to 2.17±0.50 cm) at 64±13 days of life. In infants without retinopathy, no significant changes were observed except for an increase in central retinal vein maximum velocities (from 1.96±0.22 to 2.62±0.44 cm s(-1), P=0.003). CONCLUSION: Retinopathy of prematurity appears to be accompanied by increased retinal blood flow.

Urinary NT-proBNP and ductal closure in preterm infants.

OBJECTIVE: To explore the association of urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and closure of patent ductus arteriosus (PDA) in preterm infants. STUDY DESIGN: Blinded prospective study involving 136 preterm infants (median (interquartile range) gestational age 28 (26 to 30) weeks; birth weight 1030 (780 to 1270) g). NT-proBNP was determined in urine collected on day of life (DOL) 2, 7, 14 and 28. RESULT: Urinary NT-proBNP/creatinine ratios declined continuously between DOL 2 (74 (17 to 248) µg g(-1)) and DOL 28 (4 (2 to 12) µg g(-1)) and were significantly elevated in ventilated infants on DOL 2, 7 and 14, and in ventilated infants with a hemodynamically significant PDA on DOL 2. Furthermore, urinary NT-proBNP/creatinine ratios on day 14 were higher in 14 ventilated infants who did not respond to pharmacological treatment and subsequently required surgical PDA closure (247 (214 to 547) µg g(-1)) than in ventilated infants (n=7) with successful pharmacological PDA closure (55 (21 to 114) µg g(-1); P<0.05). A cutoff >210 µg g(-1) on day 14 had a sensitivity of 75% and specificity of 100% for predicting non-responsiveness to pharmacological treatment. CONCLUSION: Measurement of urinary NT-proBNP is a new and simple non-invasive test for preterm infants, which may be helpful in guiding PDA treatment decisions.

Neurodevelopmental outcome after COX inhibitor treatment for patent ductus arteriosus.

AIM: To compare neurodevelopmental results in very low birth weight (VLBW) infants two years after successful or failed cyclooxygenase inhibitor treatment with either indomethacin or ibuprofen for a haemodynamically significant patent ductus arteriosus (hsPDA). METHODS: We retrospectively evaluated closure rates and outcome parameters of VLBW infants with hsPDA 89 of whom were treated with indomethacin and 93 with ibuprofen. RESULTS: Indomethacin and ibuprofen therapy groups did not differ in their baseline clinical profile (median gestational age 26.0 and 26.2wksd) in early (median CRIB 6 and 5, respiratory distress >2 degrees in 36 and 34 infants) and late morbidities (intraventricular hemorrhage >2 degrees in 9 and 10 infants, bronchopulmonary dysplasia in 31 and 27 infants, 80 and 85 survivors), PDA closure rates (63 and 58%) or neurodevelopmental outcome. The therapy failure group (54 infants) was characterized by lower median gestational age (25.0wksd) and higher mortality (17%). No differences were found in the neurodevelopmental outcome of the surviving infants with ligation as compared to the survivors with successful pharmacological closure of the PDA at 24months corrected age. CONCLUSION: Use of either ibuprofen or indomethacin for closure of a hsPDA did not influence two year neurodevelopmental outcomes in VLBW infants.

Bilateral agenesis of the superior vena cava associated with congenital hydrothorax.

Agenesis of the superior vena cava is a rare anomaly that is generally asymptomatic in the neonate. We report a male neonate with bilateral (total) agenesis of the superior vena cava with obstructed thoracic duct and subsequent congenital hydrothorax, anomalies that were detected by prenatal ultrasound at 25 weeks' gestation. The cardiac anomaly was confirmed by postnatal magnetic resonance angiography. The chylothorax disappeared with conservative therapy.