Prostacyclin concentrations and transitional circulation in preterm infants requiring mechanical ventilation
a University of Sydney and Department of Neonatal
Medicine, Royal North Shore Hospital, Pacific
Highway, St Leonards, NSW 2065 Australia, b Department of Renal Medicine, c Royal Prince Alfred Hospital and University of
Sydney
Correspondence to: Dr Martin Kluckow. Email: mkluckow{at}med.usyd.edu.au
Accepted 11 July 1998
AIM
To describe the association between early
postnatal prostacyclin concentrations in preterm infants;
echocardiographic measurements of ductal diameter and ventricular
output and clinical outcomes of intraventricular haemorrhage (IVH) and
patent ductus arteriosus (PDA).
METHODSForty nine preterm infants born
before 30 weeks of gestational age (median birthweight 980 g, median
gestational age 27 weeks) underwent echocardiographic studies at 5, 12, 24 and 48 hours of postnatal age. Measurements included ventricular
outputs and the ductal shunt diameter as a measure of the shunt
size. Simultaneous measurements of blood pressures, mean airway
pressure and inspired fraction of oxygen (FIO2) were
recorded. A blood sample for the prostacyclin metabolite
6-ketoprostaglandin F1-alpha (6KPGF1
) was taken at the 5 and 24 hour echocardiogram.
ResultsThe mean 6KPGF1 concentrations were
higher than adult concentrations at 5 (515 pg/ml) and 24 (255 pg/ml)
hours. There was no association with gestational age. Raised
6KPGF1 concentrations were related to increased need for
mechanical ventilation and severity of respiratory disease. At 5 hours,
increased 6KPGF1 concentrations were associated with
larger PDA and at 24 hours with larger PDA and higher left ventricular
output. Infants with higher 6KPGF1 concentrations were
more likely to develop clinically significant PDA. There was no
association between early measurements of 6KPGF1 and IVH.
CONCLUSIONSEarly postnatal prostacyclin
concentrations are markedly raised in preterm infants, particularly in
those with more severe lung disease. Raised 6KPGF1
concentrations were associated with an increased ductal diameter and
subsequent PDA, but not IVH.
© 1999 by Archives of Disease in Childhood
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