الفهرس 
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Abstract
ABSTRACT
Background: The ability to determine a patient’s hemodynamics status is critical in intensive care medicine. Echocardiography (Echo) is the most common noninvasive method to assess CO in infants, but it is technically demanding and operator dependent, and can only be obtained intermittently. Electrical cardiometry (EC) provides noninvasive and continuous CO measurements in clinical practice. It is an impedance-based device that provides real-time cardiovascular assessment in an absolute number. The pulsatile change of impedance in relation to the cardiac cycle is used in the calculation of hemodynamic measures.
Objective: To determine hemodynamic parameters in the first 48 hours using continuous non-invasive vital and structural measurements to predict which infants would develop clinical and echocardiographic criteria for PDA treatment in our NICU.
Patients and Methods: This prospective cohort study included 75 preterm infants had G.A ranging from 28 – 36 wks (mean G.A: 33.65 ± 2.06 W) recruited from neonatal intensive care units of Ain Shams University, Children’s Hospital. Their mean of birth weight 2.01 ± 0.61 kg(range 0.75 – 3.5), median of APGAR at one minute 7 (6 – 7) and at 5 minutes 9 (9 – 9). All recruited cases divided into2 groups: 1st group: 42 preterm with hemodynamically stable PDA. 2nd group: 33 preterm with hemodynamically unsatable PDA. Both two groups were subjected to full maternal history taking, general examination, anthropometric measurements, Clinical data (HR, BL.P, UOP and peripheral saturation), echo parameters, ICON parameters, radiological and laboratory data were used to assess the hemodynamic status of PDA.
Results: By using transthoracic Echo, the accuracy of EC in term and even preterm neonates has been described. It has been studied in different clinical scenarios including surgical ligation for patent ductus arteriosus (PDA), hemodynamic transition after birth, caffeine administration, and umbilical cord milking in preterm infants. CO measurement by EC is dependent on aortic flow to calculate CO, any circulatory channel between thoracic great vessels that influences the aortic flow may subsequently affect EC measurement. For preterm infants, the presence of a PDA is a valid concern because shunting of blood between the aorta and pulmonary artery may disrupt EC measurement. Clinicians may question the accuracy of EC in determining CO in preterm infants with hemodynamically significant PDA (hsPDA). Arterial hypotension due to a PDA may be a reasonable marker to determine whether there was hsPDA or not.
Conclusion: The definition of an hsPDA continues to evolve. The hemodynamic significance of a PDA should be interpreted by considering the gestational and chronological age, and by assessing the vulnerability of organs at risk for overflow (the lungs), or hypoperfusion (eg, the brain, intestines, and kidneys). Assessment of multiple echo‐ cardiographic indices with organ blood flow Doppler is helpful in evaluating the hemodynamic significance of a PDA. Further work is needed to reach a consensus of how to define and manage an hsPD. EC has the advantage of being non-invasive, operator-independent. arterial hypotension due to a PDA may be a reasonable marker to determine whether there was hsPDA or not. Future studies are needed with hour specific blood pressure targets for early PDA treatment.