Abstract 1724

Angiographic visualization of systemic to pulmonary collaterals (SPC) has been documented in premature infants needing prolonged ventilatory support. Recently, we reported non-invasive identification of such communications in premature infants. From December 1, 1994 to August 31, 1996, 196 infants of birth weight <1500 gm were admitted to the neonatal intensive care unit; 133 of them received serial echocardiographic evaluations at 1 to 2 days, 2 weeks, and at 1, 2 and 3 months of life. Follow-up was scheduled at 6 months and 1 year of age for patients with SPC persisting at 3 months of age. SPC were demonstrated in 88 patients (66%) at 1 to 90 days of life (mean 28 days). In most cases the SPC originated at the distal aortic or the proximal descending aorta. There was no difference in gestational age, sex or birth weight between the patients with SPC and those without evidence of SPC. The incidence of respiratory distress syndrome requiring surfactant therapy (61% vs. 38%) and patent ductus arteriosus requiring therapy (48% vs. 20%) were significantly higher in infants with SPC (p value 0.009 and 0.001 respectively). The need for post-natal steroids for lung disease was higher in the patients with SPC (56% vs. 40%, p=0.038). Ten patients (11%) were treated for congestive heart failure. The symptoms improved and anticongestive therapy was discontinued in 9. One patient with persistent congestive heart failure underwent therapeutic cardiac catheterization and a large SPC was embolized.

CONCLUSIONS: The incidence of SPC in premature infants is much higher than previously reported. We postulate that they are bronchopulmonary communications that enlarge and/or proliferate with the changes associated with premature birth adaptation. These communications may contribute to pulmonary edema and increase the time on positive pressure ventilation and length of stay in the hospital. Echocardiographic examination with color Doppler performed in premature infants to evaluate left to right shunts should include careful search for systemic to pulmonary collaterals.