Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestation
R Arlettaza, N Archerb, A R Wilkinsonb
a Neonatal Unit,
University Hospital, Zürich, Switzerland, b Neonatal Unit, Department of Paediatrics,
University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
Correspondence to: Professor Wilkinson andrew.wilkinson{at}paediatrics.ox.ac.uk
Accepted 16 July 2001
AIMS
To define how
often transient pulmonary branch stenosis (PBS) develops after closure
of a patent ductus arteriosus (PDA) in babies born at less than 32 weeks gestation; to describe the natural history of PBS and the
relation between PBS and a cardiac murmur.
METHODSFifty three
preterm infants born at a gestational age less than 32 weeks and who
had PDA diagnosed on echocardiography were recruited. An echocardiogram
was performed on alternate days until the ductus arteriosus closed. If
PBS was diagnosed, the baby was followed up until PBS resolved.
RESULTSIn 59%, PBS
developed in one or both branches after closure of the PDA. In 21%,
both pulmonary branches were affected. In 79%, the left pulmonary
artery alone was involved but the right side was never affected alone.
PBS had resolved in 74% by the time the infants reached 40 weeks, in
95% at a corrected age of 6 weeks, and in 100% at a corrected age of
3 months. There is a better correlation between a cardiac murmur and
PBS than between a murmur and PDA.
CONCLUSIONSPBS in
preterm infants is usually not present at birth but develops after
closure of a PDA. PBS resolves by a corrected age of 3 months. The
presence of a murmur after closure of a PDA is usually related to PBS
and not to reopening of the ductus arteriosus.
Keywords: pulmonary branch stenosis; patent ductus arteriosus; cardiac murmur; preterm infants
© 2001 by Archives of Disease in Childhood
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