Abstract
Sudden, unexplained circulatory collapse occurring after successful initial resuscitation of the extremely immature newborn has been attributed to massive intracranial hemorrhage. Our failure to find pathologic confirmation in three such infants led to a prospective attempt to define alternative mechanisms. Ten consecutive infants between 24 and 26 weeks gestation were resuscitated, placed on ventilators and followed serially with aortograms and differential blood gases and blood pressures.
Four could not be resuscitated. After initial stabilization of the six remaining infants, leg pressures were higher than arm pressures and aortograms revealed no left to right shunt. Coincidental with rising PaO2 and radiographic evidence of improved lung aeration, leg blood pressures fell to levels equal to or lower than arm pressures in 5/6 infants. Aortograms revealed massive left to right shunts with minimal distal aortic flow. Only 1/5 had a murmur. Intractable aciemia and cardiovascular collapse occurred within 1 to 6 hours of the fall in leg pressures. 4/5 Infants died. Only two had significant intracranial hemorrhage. Sudden massive ductal shunting in the immature newborn can cause precipitous circulatory collapse in the absence of intracranial hemorrhage. The ability of the extremely immature newborn to survive in the extrauterine environment may depend on early closure of this low resistance shunt.
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Delemos, R., Stanley, M., Null, D. et al. PRECIPITOUS CIRCULATORY COLLAPSE IN THE IMMATURE NEWBORN FROM SHUNTING ACROSS THE DUCTUS ARTERIOSUS. Pediatr Res 11, 388 (1977). https://doi.org/10.1203/00006450-197704000-00112
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DOI: https://doi.org/10.1203/00006450-197704000-00112