Should Echocardiographic Evaluation Be Performed Routinely in the First 72 Hours in Extremely Low Birth Weight Babies?

Abstract

OBJECTIVE: Hemodynamically significant patent ductus arteriosus is resulting in severe mortality and morbidity in infants with extremely low birth weight. In our study, we aimed to evaluate the necessity of performing routine echocardiography in the first 72 hours in extremely low birth weight infants. STUDY DESIGN: This study was planned retrospectively. Between June 2016 and December 2018, 36 patients diagnosed with hemodynamically significant patent ductus arteriosus who were hospitalized in the neonatal intensive care unit, with ≤28 gestational weeks or ≤1000g were included in this study. These babies were routinely performed echocardiography for patent ductus arteriosus between 24-72 hours, although they were asymptomatic in the period from June 2016 to December 2017 (n=23). Between January 2018 and December 2018, patients without patent ductus arteriosus symptoms were expected to complete 72 hours for routine patent ductus arteriosus screening (n=13). The patients were divided into 2 groups as the early echocardiography group (n=23) and the late echocardiography group (n=13). In the presence of at least one of the clinical signs of systemic hypo perfusion and/or pulmonary hyper perfusion, symptomatic patent ductus arteriosus was accepted and closure treatment was applied with ibuprofen (n=23) or paracetamol (n=5). While the two groups were compared in terms of demographic features, echocardiography findings, and the state of taking closure therapy, patients receiving closure therapy were compared in terms of mortality and premature morbidity. RESULTS: The mean birth weight of 36 patients was 855±241 g, and the mean gestational age was 26.4±2.1 gestational weeks. It was observed that the two groups were similar in terms of demographic characteristics. Although the findings of echocardiography and treatment rates were similar between the two groups, it was observed that the echocardiography group had earlier closure treatment (p=0.03). In patients receiving closure treatment, performing early (n=17) and late (n=11) echocardiography showed no statistical difference in the long-term results. CONCLUSION: Performing early echocardiography without symptoms in infants with extremely low birth weight may provoke the clinician to give patent ductus arteriosus closure treatment earlier. In infants with extremely low birth weight, unnecessary closure treatment can be prevented by closely monitoring the symptoms of patent ductus arteriosus and performing echocardiography when necessary.