PATENT FORAMEN OVALE WITH LEFT-TO-RIGHT SHUNT IN BRONCHOPULMONARY DYSPLASIA - COINCIDENTAL OR ASSOCIATED COMPLICATION

Despite the use of exogenous surfactants, the incidence of bronchopulm onary dysplasia (BPD) has not decreased as much as expected. Of 208 ne wborns involved in trials with Exosurf at our center, 51 had BPD. Amon g these newborns, 8 were found retrospectively to have secondary worse ning of respiratory distress syndrome after initial improvement with s urfactant treatment. Oxygen requirements decreased from 89 +/- 15% to 58 +/- 16% (mean +/- SD), respectively, before and 48 h after surfacta nt, and then reached a plateau of 34 +/- 10% before dramatic deteriora tion at 22 +/- 9 days of life. The patients had signs of cardiac failu re and increased oxygen requirements of up to 76 +/- 19% within 6 h. A patent foramen ovale (PFO) was demonstrated at echocardiography with a left to right shunt at Doppler. No other cause of worsening was foun d. Five infants had significant improvement when treated with digoxin and furosemide. This retrospective study raises questions about the re lationship between PFO and BPD that should be explored in a prospectiv e study.