Early Role of the Atrial Level Communication in Premature Infants with Patent Ductus Arteriosus

Abstract Background High-volume systemic-to-pulmonary ductus arteriosus shunts in premature infants are associated with adverse neonatal outcomes. The role of an atrial communication (AC) in modulating effects of a presumed hemodynamically significant patent ductus arteriosus (hsPDA) is poorly studied. The objective of this study was to characterize the relationship between early AC and echocardiography indices of PDA shunt volume and clinical neonatal outcomes. Methods We performed a retrospective review of preterm infants (born 1 mm) then compared echocardiography measures of PDA shunt volume. We also compared clinical outcomes, including chronic lung disease (CLD) and intraventricular hemorrhage (IVH) between all 4 groups. Results A total of 199 preterm infants (mean birthweight and gestational age of 928 ± 632 grams and 26.6 ± 1.5 weeks, respectively) were identified; 159 infants had PDA ≥1.5 mm, of whom 52 had AC ≤1 mm and 107 had AC >1 mm. The remaining 40 infants had PDA 1 mm. Infants with PDA ≥1.5 mm and AC >1 mm had higher pulmonary vein D wave velocity (p 1 mm had higher risk of composite outcome of CLD or death prior to hospital discharge (p Conclusion Echocardiography evidence of AC >1 mm in patients with a PDA ≥1.5 mm, during the first postnatal week, may be a marker of a more pathologic hsPDA in premature infants. Future investigations should evaluate if early identification and treatment of patients with both high-volume PDA and larger atrial level communications may help mitigate adverse outcomes, such as CLD or death, in this high-risk patient population.