Abstract
To observe the timing and sequence of appearance of presenting signs of symptomatic PDA, we continuously and systematically monitored, (1) the onset of diuresis (through intake and output calculation), (2) changes in FiO2, (3) x-ray evidence of increased pulmonary flow, (4) pulse pressure (determined through UA or radial line), (5) pulse pressure/systolic pressure ratio (PP/SBP), (6) daily LA/AO ratio and (7) the first appearance of PDA murmur in 7 VLBW (<1500 gm) infants from birth until most PDA symptoms fully developed. The chain of events began with the onset of diuresis on an average of the 4th day (range 2-8 day) with an abrupt increase in mean urine output of 450% (range 231-775%) compared to the previous day. The FiO2 requirement invariably dropped below 30% one day after the onset of diuresis (i.e. av. 5th day). 12 to 24 hrs later (6th day) the evidence of increased pulmonary flow presented itself on x-rays, this was the time when PP began to widen. By the 7th day of life PP reached 20 mmHg or above and PP/SP ratio exceeded 48% (range 43-55%). Clinical evidence of bounding pulses was obvious at this time. By the 8th day (range 6-llth day) LA/AO ratio had reached >1.2 and on an average of the 9th day (range 7-10th day) the typical PDA murmur finally appeared. Although the timing of appearance may differ in each case, the sequence of events remained the same. Understanding the order of these events helps manage PDA better.
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Tien, H., Wei, T., Sun, S. et al. 146 SEQUENCE AND TIMING OF EVENTS ASSOCIATED WITH SYMP TOMATIC PATIENT DUCTUS ARTERIOSUS (PDA) IN VLBW INFANTS. Pediatr Res 19, 135 (1985). https://doi.org/10.1203/00006450-198504000-00176
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DOI: https://doi.org/10.1203/00006450-198504000-00176