EARLY DUCTAL SHUNTING AND INTRAVENTRICULAR HEMORRHAGE IN VENTILATED PRETERM INFANTS

Aim-To establish if there is an association between early cardiovascul ar adaptation and intraventricular haemorrhage (IVH). Methods-One hund red and seventeen ventilated preterm infants (mean gestational age 27 weeks, mean birthweight 993 g) were studied echocardiographically with in the first 36 hours. Measurements included right (RVO) and left vent ricular outputs (LVO), ductus arteriosus (PDA) and atrial shunt diamet er using colour Doppler and pulsed Doppler direction and velocity of b oth shunts. Clinical variables collected over the first 24 hours inclu ded use of antenatal steroids, respiratory severity, and mean blood pr essure. Cerebral ultrasound scans were reported by a radiologist blind ed to clinical and echocardiographic data. Results-Antenatal steroids (two doses) had been given to 73% of the 86 infants with no IVH compar ed with 48% of the 21 infants with grades 1 and 2 IVH, and just 10% of 10 babies with grades 3 and 4 (P<0.05). Both groups with IVH had sign ificantly larger FDA diameters than the group with no IVH. Infants wit h grades 3 and 4 IVH had significantly lower RVO than the other infant s. These differences were more pronounced when only infants with defin ite late IVH were analysed. Logistic regression analysis showed lack o f antenatal steroids and larger PDA diameters were significantly assoc iated with any grade of IVH and lack of antenatal steroids; lower RVO was significantly associated with grades 3 and 4 IVH. Conclusions-Larg er early PDA shunts, lower RVO, and lack of antenatal steroids were si gnificantly associated with IVH.