Patent ductus arteriosus – not only apaediatric issue

The ductus arteriosus is a vascular structure of the foetal circulation that connects the great arteries and determines the blood flow from the pulmonary trunk to the aorta bypassing the pulmonary circulation. After birth, it comes to the functional and structural closure of the ductus arteriosus and the foetal circulation changes into circulation of adult type. Sometimes, however, physiological degradation of the duct after the first few weeks of life does not happen – this situation is called patent ductus arteriosus and accounts for approximately 10% of congenital heart defects. Patent ductus arteriosus may be asymptomatic or manifest itself with disturbances, mainly associated with the respiratory and circulatory systems, as well as disorders of other organs. A common clinical symptom is a characteristic continuous murmur, called machine-like murmur. The occurrence and severity of symptoms depend primarily on the size of the shunt through the duct and also on the age of the patient. The major complications of patent ductus arteriosus are bacterial endocarditis and pulmonary vascular disease. Treatment is based on the definitive closure of the ductus. During the first few weeks after birth, pharmacological closure with cyclooxygenase inhibitors (indomethacin, ibuprofen) is possible. Patent ductus arteriosus can also be managed with the use of non-invasive techniques (catheter procedures) or surgical treatment (a less invasive video-assisted thoracoscopy is also possible). The situation is different when there are complex anatomical heart defects in which the postnatally patent ductus arteriosus plays a different, beneficial role – these are so-called ductus-dependent defects. The management of such patients consists in maintaining the patency of the ductus arteriosus, because it determines the normal blood flow. There are also rare cases of premature (prenatal) closure of the ductus arteriosus, which may lead to the failure of foetal circulation

Case reportCongenitally corrected transposition of the great arteries with coexisting stenosis of pulmonary trunk valve and ventricular septum defect in a 55-year-old woman – a case report

Congenitally corrected transposition of the great arteries (CCTGA) is a rare cardiac malformation. This anomaly is characterised by atrioventricular as well as ventriculoarterial discordance. Isolated CCTGA may cause no symptoms until adult life. Most CCTGA cases with concomitant cardiac abnormalities are symptomatic and are therefore usually diagnosed in childhood. In the majority of patients, congestive heart failure secondary to right ventricular dysfunction occurring by the fifth or sixth decade enables diagnosis. We present an oligosymptomatic 55-year-old woman with corrected transposition of the great arteries and coexisting stenosis of pulmonary trunk valve and ventricular septum defect

Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis

Background: Necrotizing enterocolitis (NEC) is one of the most serious disorders of gastrointestinal tract during neonatal period. Early diagnosis and adequate treatment are essential in the presence of clinical suspicion of NEC. Plain abdominal radiography is currently the modality of choice for initial evaluation of gastrointestinal tract in neonates. However, when the diagnosis is uncertain, abdominal ultrasound with bowel assessment might be an important complementary examination. The aim of the study was to evaluate usefulness of ultrasound in the diagnosis of NEC and its value for implementation of proper treatment. Material and Methods: The data of nine neonates diagnosed with NEC, hospitalized at the Provincial Hospital No. 2 in Rzeszow in the period from September 2009 to April 2013 was retrospectively analyzed. Apart from abdominal radiography, abdominal ultrasound with bowel assessment was performed in all nine cases. Imaging findings, epidemiological data, coexisting risk factors and disease course were assessed. Results: Most children in the group were preterm neonates. Findings in plain abdominal radiography were normal or nonspecific. A wider spectrum of findings was demonstrated in all ultrasound examinations and intestinal pneumatosis, a pathognomonic sign for NEC, was more frequently noted than in plain abdominal x-ray. Most children were treated by surgical intervention with resection of necrotic bowel loops and in more than half of the cases location of changes identified during surgery was concordant with ultrasonographic findings. Conclusions: Abdominal ultrasound examination might be helpful in the diagnosis of NEC, especially when plain abdominal radiography findings do not correlate with clinical symptoms. However, abdominal radiography is still considered the modality of choice. The range of morphological changes detectable on ultrasound examination is much wider than in plain abdominal radiography. Ultrasound examination allows for more accurate assessment of changes within intestines and adjacent tissues, which aids clinicians in making more accurate therapeutic decisions and implementing proper treatment

Wczesne przesiewowe wykrywanie krytycznych wad wrodzonych serca u bezobjawowych noworodków w województwie mazowieckim: doświadczenia Programu Pulsoksymetrii w ramach POLKARD 2006–2008

Background: Early diagnosis of critical congenital heart defects (CCHD) may be missed both during prenatal echocardiography and the short stay in the neonatal nursery, leading to circulatory collapse or death of the newborn before readmission to hospital. Aim: To assess the usefulness of pulse oximetry as a screening test in early diagnosis of CCHD in newborns. Methods: A prospective screening pulse oximetry test was conducted in 51 neonatal units in the Mazovia province of Poland as part of the POLKARD 2006&#8211;2008 programme between 16 January, 2007 and 31 January, 2008. Newborns with no circulatory symptoms or coexisting diseases, and no prenatal diagnosis, were enrolled. The test was performed between the 2nd and 24th hours of life in stable newborns. A double arterial oxygen saturation (SpO2) reading < 95% on a lower extremity led to cardiovascular evaluation and echocardiography. Results: From a population of 52,993 newborns (14.2% of births in Poland), a group of 51,698 asymptomatic infants was isolated. CCHD was diagnosed solely by pulse oximetry in 15 newborns, which constituted 18.3% of all CCHD; 14 (0.026%) false positives were obtained and there were four false negative results. The sensitivity of the test was 78.9% and specificity 99.9%. The positive predictive value was 51.7% and negative 99.9%. Conclusions: Pulse oximetry fulfilling the screening test criteria, performed on a large population of newborns in Poland, proved useful in supporting prenatal diagnostics and postnatal physical examination in the early detection of initially asymptomatic CCHD. Good sensitivity and specificity results of the pulse oximetry test have allowed it to be recommended for use in neonatal units nationwide.Wstęp: Brak wczesnego rozpoznania krytycznej wady wrodzonej serca zarówno w diagnostyce prenatalnej, jak i w czasie krótkiego pobytu na oddziale noworodkowym może prowadzić do zapaści krążeniowej lub zgonu noworodka przed ponownym przyjęciem do szpitala. Cel: Celem pracy była ocena przydatności i wiarygodności testu pulsoksymetrycznego we wczesnym wykrywaniu krytycznych wad wrodzonych serca u noworodków. Metody: W 51 oddziałach noworodkowych województwa mazowieckiego w ramach programu POLKARD 2006&#8211;2008 w okresie 15.01.2007&#8211;31.01.2008 przeprowadzono prospektywne przesiewowe badanie pulsoksymetryczne. Wyodrębniono grupę noworodków bez objawów krążeniowych, wad towarzyszących, bez diagnostyki prenatalnej. Pomiar wykonywano w > 2&#8211;24 godz. życia u noworodka w stanie stabilnym. Dwukrotna wartość saturacji < 95% na stopie powodowała przeprowadzenie diagnostyki kardiologicznej. Wyniki: Z populacji 52 993 noworodków (14,2% urodzeń w Polsce) wyodrębniono grupę 51 698 bez objawów, wśród których wyłącznie za pomocą pulsoksymetrii rozpoznano krytyczne wady wrodzone serca u 15 noworodków, co stanowiło 18,3% wszystkich tych wad. Uzyskano 14 (0,026%) wyników fałszywie dodatnich. U 4 noworodków nie rozpoznano wady serca w okresie przed wystąpieniem objawów. Czułość badania wynosiła 78,9%, swoistość 99,9%, wartość predykcyjna wyniku dodatniego 51,7%, a ujemnego 99,9%. Wnioski: Przeprowadzony w dużej populacji noworodków w Polsce test pulsoksymetryczny spełniający kryteria testu przesiewowego okazał się przydatny jako wspomagający diagnostykę prenatalną i badanie lekarskie moduł diagnostyczny we wczesnym wykrywaniu początkowo bezobjawowych krytycznych wad wrodzonych serca w populacji polskich noworodków. Uzyskane dobre wyniki czułości i swoistości badania pulsoksymetrycznego pozwoliły na rekomendowanie go do zastosowania na oddziałach noworodkowych w całym kraju

Protocol for a multicenter, double-blind, randomized, placebo-controlled phase III trial of the inhaled Β2-adrenergic receptor agonist salbutamol for transient tachypnea of the newborn (the REFSAL trial)

BACKGROUND: Transient tachypnea of the newborn (TTN), which results from inadequate absorption of fetal lung fluid, is the most common cause of neonatal respiratory distress. Stimulation of β-adrenergic receptors enhances alveolar fluid absorption. Therefore, the β2-adrenergic receptor agonist salbutamol has been proposed as a treatment for TTN. This study aims to evaluate the efficacy and safety of salbutamol as supportive pharmacotherapy together with non-invasive nasal continuous positive airway pressure (NIV/nCPAP) for the prevention of persistent pulmonary hypertension of the newborn (PPHN) in infants with TTN. METHODS AND ANALYSIS: This multicenter, double-blind, phase III trial will include infants with a gestational age between 32 and 42 weeks who are affected by respiratory disorders and treated in eight neonatal intensive care units in Poland. A total of 608 infants within 24 h after birth will be enrolled and randomly assigned (1:1) to receive nebulized salbutamol with NIV or placebo (nebulized 0.9% NaCl) with NIV. The primary outcome is the percentage of infants with TTN who develop PPHN. The secondary outcomes are the severity of respiratory distress (assessed with the modified TTN Silverman score), frequency of need for intubation, duration of NIV and hospitalization, acid–base balance (blood pH, partial pressure of O(2) and CO(2), and base excess), and blood serum ionogram for Na(+), K(+), and Ca(2+). DISCUSSION: The Respiratory Failure with Salbutamol (REFSAL) study will be the first clinical trial to evaluate the efficacy and safety of salbutamol in the prevention of persistent pulmonary hypertension in newborns with tachypnea, and will improve short term outcomes. If successful, the study will demonstrate the feasibility of early intervention with NIV/nCPAP together with nebulized salbutamol in the management of TTN. ETHICS AND DISSEMINATION: The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Warsaw, Poland on November 16, 2020 (decision number KB/190/2020). All procedures will follow the principles of the Declaration of Helsinki. The results of the study will be submitted for knowledge translation in peer-reviewed journals and presented at national and international pediatric society conferences. CLINICAL TRIAL REGISTRATION: It is registered at ClinicalTrials.gov NCT05527704, EudraCT 2020-003913-36; Protocol version 5.0 from 04/01/2022