Doppler assessment of pulmonary artery pressure in neonates at risk of chronic lung disease
a Department of Neonatology,
Tokyo Metropolitan Tsukiji Maternity Hospital,
Tokyo, Japan, b Department of Paediatrics, Faculty of
Medicine University of Tokyo
Correspondence to: Dr Bai-Horng Su, Division of Neonatology, Department of Paediatrics, China Medical College Hospital, 75 Yuh Der Road, Taichung, Taiwan.
Accepted 4 February 1997
AIM
To evaluate the pulmonary artery pressure
(PAP) change in very low birthweight (VLBW) infants at risk of chronic
lung disease (CLD).
METHODSThe time to peak velocity:right
ventricular ejection time (TPV:RVET) ratio calculated from the
pulmonary artery Doppler waveform, which is inversely related to PAP,
was used. The TPV:RVET ratio was corrected for different heart rate
(TPV:RVET(c)). Seventy three VLBW infants studied on days 1, 2, 3, 7, 14, 21 and 28 were enrolled for the analysis.
RESULTSTwenty two infants developed CLD with a
characteristic chest radiograph at day 28. Fifty one did not, of whom
17 were oxygen dependent on account of apnoea rather than respiratory
disease, and 34 were non-oxygen dependent. The TPV:RVET(c) ratio rose
progressively in all three groups over the first three days of life,
suggesting a fall in PAP. In the oxygen and non-oxygen dependent
groups, the mean (SD) ratio rose to 0.53 (0.09) and 0.57 (0.09),
respectively, on day 7, then remained relatively constant thereafter.
The CLD group rose more slowly after day 3 and had a significantly
lower mean ratio from day 7 onwards compared with the other two groups (day 7: P<0.001, days 14-28: P<0.0001), and fell significantly from
0.47 (0.11) on day 7 to 0.41 (0.07) on day 28 (P=0.01), suggesting a
progressive rise in PAP. The mean (SD) ratios at day 28 of all infants
were: CLD group 0.41 (0.07); oxygen dependent group 0.66 (0.15); and
the non-oxygen group 0.67 (0.11). The CLD group had a significantly
lower ratio than the oxygen dependent group and the non-oxygen group
(P<0.0001). Using the TPV:RVET(c) ratio of <0.46, infants at risk of
developing CLD could be predicted on day 7 (predictive value 82.8%,
sensitivity 54.5%, specificity 94.1%).
CONCLUSIONThe non-invasive assessment of PAP
using the TPV:RVET(c) ratio may be useful in the longitudinal
monitoring of PAP change in VLBW infants, and for prediction of chronic
lung disease.
© 1997 by Archives of Disease in Childhood
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