Systemic to pulmonary collaterals in very low birth weight infants: color Doppler detection of systemic to pulmonary connections during neonatal and early infancy period

Objective. Angiographic visualization of systemic to pulmonary collaterals (SPC) has been documented in premature infants needing prolonged ventilator y support. Noninvasive identification of such communications in premature i nfants was reported recently. The purpose of this study was to describe: 1) incidence, 2) clinical findings and implications, and 3) short-term follow -up of SPC diagnosed by echocardiography in very low birth weight (VLBW) in fants admitted to the neonatal intensive care unit. Methods. From December 1, 1994 to August 31, 1996, 196 infants with birth w eight <1500 g were admitted to the neonatal intensive care unit; 133 of the m received serial echocardiographic evaluations at 1 to 2 days, at 2 weeks, and at 1, 2, and 3 months of life. Follow-up echocardiograms were schedule d at 6 months and 1 year of age for patients with SPC persisting at 3 month s of age. Results. 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 arc h or the proximal descending aorta. Ten patients (11%) were treated for con gestive heart failure. The symptoms improved and anticongestive therapy was discontinued in 9. One patient with persistent congestive heart failure un derwent therapeutic cardiac catheterization and 1 prominent SPC was emboliz ed. Conclusions. The incidence of SPC in VLBW infants is much higher than previ ously reported. We postulate that SPC are bronchopulmonary communications t hat enlarge and/or proliferate in response to a given stimulus. These commu nications are associated with increased time on positive pressure ventilati on and length of stay in the hospital. SPC may lead to pulmonary edema and should be searched for in VLBW infants with a more complicated course. Echocardiographic examination with color Doppler performed in premature inf ants to evaluate left to right shunts should include careful search for sys temic to pulmonary collaterals.