Razi Journal of Medical Sciences

fa تعیین حساسیت و ویژگی معیارهای بالینی در پایش نیاز به درمان دارویی مجرای باز شریانی در نوزادان نارس به روش مقطعی - توصیفی Factors Predicting Quality of Life of Surgical Technologists in Operating Room نوزادان Neonatology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: مجرای باز شریانی (PDA) از جمله اختلالات مادرزادی در نوزادان نارس می‌باشد که شدیدا در ارتباط با افزایش مرگ ومیر در آنها محسوب می‌شود. تشخیص PDA و انواع آن به عنوان یکی از مهم‌ترین اختلالات نوزادان نارس از اهمیت زیادی برخوردار می‌باشد، امروزه تشخیص PDA توسط اکوکاردیوگرافی صورت می پذیرد، اما در این مقاله تلاش شده است تا با تعریف یک امتیاز (score) بر اساس 5 معیار بالینی وتعیین حساسیت و ویژگی آن در مقایسه با اکوکاردیوگرافی بتوان PDA  را تشخیص داد. روش کار: در این تحقیق که به صورت مقطعی - توصیفی انجام شد تعداد 124 نوزاد نارس به صورت تصادفی مورد مطالعه قرار گرفتند. بر اساس اکوکاردیوگرافی انجام شده بر روی این نوزادان وجود PDA و نوع آن توسط کاردیولوژیست اطفال مشخص شده است. بطور همزمان 5 معیار بالینی شامل تعداد ضربان قلب، نبض محیطی، نبض پره کوردیال، سوفل قلبی و cardiothoracic ratio در این 124 نوزاد نارس نیز اندازه گیری شده و بر اساس این معیارها امتیاز (score) محاسبه شد. نتایج حاصل از این تحقیق توسط نرم افزار SPSS مورد آنالیز قرارگرفت نهایتا براساس تحلیل‌های آماری و منحنی ROC، رابطه بین امتیاز محاسبه شده بر اساس معیارهای بالینی با PDA  اثبات شد. یافته‌ها: بر اساس تحلیل منحنی ROC در نقطه (امتیاز) 3، مقدار حساسیت برابر 65% و مقدار ویژگی 95% می‌باشد و در نقطه (امتیاز) 2 مقدار حساسیت برابر 90% و مقدار ویژگی برابر 87% می‌باشد. با توجه به منحنی ROC از 5 معیار بالینی برای تشخیص hemodynamically significant PDA، ترتیب اثرگذاری این 5 معیار به ترتیب ،cardiothoracic ratio، نبض پره کوردیال، سوفل قلبی، ضربان قلب و نبض محیطی می‌باشند.  نتیجه‌گیری: بر این اساس می‌توان گفت با استفاده از اندازه گیری معیارهای بالینی و محاسبه امتیاز، می‌توان PDA را تشخیص داد.  </div> <div style="text-align: justify;">Background & Aims: Patent ductus arteriosus (PDA) is one of the congenital disorders in premature neonates, which is strongly associated with increased mortality in them. Currently, echocardiography is the method of choice for detecting PDA, and due to the high cost of this method and its lack of easy access, finding a suitable and low-cost alternative method, including the use of clinical parameters to quickly detect PDA in premature neonates and determine the cases in need Treatment is very important. Therefore, in this study, we decided to investigate the sensitivity and specificity of clinical criteria in the diagnosis of PDA in comparison with the echocardiography method. Preterm neonates refer to neonates who are born before 37 weeks from the first day of the last menstrual period (1) due to developmental delay and also weakness in the immune system, these neonates are about 40 times more than neonates with normal weight at risk of mortality (2). The ductus arteriosus is a vein that connects the pulmonary artery to the aorta. This duct is the fetal vascular connection between the pulmonary artery and the aorta artery, which diverts blood from the pulmonary bed to the systemic circulation during the fetal period (3). In the uterus, blood is shunted from the lungs due to the high pressure in the lungs. Therefore, the blood leaves the right ventricle, enters the ductus arteriosus, and from there enters the aorta (4). The ductus arteriosus contracts after birth and usually closes within 72 hours after birth. If this active contraction does not occur after birth, the ductus arteriosus will remain open. Usually, within 10 to 15 hours after birth, this contraction causes the functional closure of the ductus arteriosus, which starts from the side of the pulmonary artery and finally progresses to the end of the aorta (5). Therefore, keeping this duct open causes the oxygen-rich blood in the aorta to mix with the deoxygenated blood flowing in the pulmonary artery. Therefore, a lot of blood is transferred to the lungs, which increases the pressure on the heart, increases the blood pressure in the pulmonary veins, and also impairs the ventilation of the lungs (6). A large blood shunt from the ductus arteriosus increases pulmonary blood flow and also decreases systemic blood flow (7). Neonates with reduced systemic blood circulation are exposed to dangerous complications such as increased systolic and diastolic pressure, increased oxygen demand, pulmonary edema, tachycardia, active pericardium, heart failure, intracerebral hemorrhage, pulmonary hemorrhage, and necrotizing enterocolitis (8). Methods: This cross-sectional study was conducted on preterm neonates with PDA and preterm neonates without PDA who were admitted to the NICU department of Akbarabadi Hospital in Tehran during 2017 and 2018. In this study, 124 preterm neonates with a gestational age of 25 to 37 weeks were included in the study. Preterm neonates with convulsions, life-threatening infections, clinical or radiographic evidence of necrotizing enterocolitis, evidence of hemorrhage, congenital neurological disorders, metabolic and genetic syndromes, pulmonary hypoplasia syndrome, congenital heart anomalies, and other fatal abnormalities. , were excluded from the study. Also, a checklist was provided in which case and demographic information related to preterm neonates was recorded. Parameters such as birth age, height and weight, gender, duration of hospitalization in NICU, duration of mechanical ventilation, history of any underlying or congenital disease (such as heart and lung disease, sepsis, other infectious diseases, diseases respiratory, history of cardiac arrest, etc.), neurological diseases, type of birth (NVD or cesarean section), gestational age, mothers' age were also recorded. After initial examinations and selection of patients based on inclusion and exclusion criteria, various clinical parameters in newborns including heart rate, peripheral pulse status, precordial pulse status, heart murmur status, cardiothoracic ratio, first minute Apgar score and Fifth, the deterioration of the respiratory condition was investigated in terms of physical and clinical examinations. A heart rate less than 160 was given a score of zero, a heart rate between 160 and 180 was given a score of 1, and a heart rate greater than 180 was given a score of 2. Cardiothoracic ratio less than 0.6, 0.6 to 0.65 and more than 0.65 were determined with zero, 1 and 2 scores, respectively. The status without murmur, systolic murmur and diastolic murmur were defined with 0, 1 and 2 scores, respectively. Normal peripheral pulse score zero, brachial banding score 1, brachial and dorsalis pedis banding score 2, precordial pulse not visible and not palpable with score 0, palpable precordial pulse with score 1 and visible precordial pulse with score 2.  The scores of each of the clinical criteria were added together and a score equal to or greater than 3 was considered to be associated with the incidence of hemodynamically significant PDA. Then echocardiography was performed in the examined neonates by an experienced pediatric cardiologist. The results of this research were analyzed by SPSS software. In this study, p value equal to or less than 0.05 was considered statistically significant. To determine the sensitivity and specificity of clinical factors in determining PDA requiring treatment, the ROC diagram and the area under the ROC curve were used. The results related to the sensitivity and specificity of each of the physical and clinical examinations as a factor in the diagnosis of active PDA in need of treatment were compared with echocardiography results. Results: Based on statistical analysis and ROC curve performed in this study, the relationship between scores calculated based on Clinical criteria were demonstrated with PDA. Based on this, it can be said that by measuring clinical criteria and calculating the score can be detected PDA.  Also based on the ROC curve analysis at point (score) 3, the sensitivity value is 65% and the specificity value is 95%, and at point (score) 2 the sensitivity value is 90% and the specificity value is 87%. Conclusion: AUC = 0.94 for the diagnosis of hs-PDA indicates the fact that the definition of the score parameter based on the clinical criteria presented in this research can help in the diagnosis of PDA without echo. Only the difference between the pre-ductal and post-ductal oxygen saturation and the intensity of the dorsalis pedis pulse should be taken into account. Also, since the level of sensitivity is higher in the score of two, and this means that the false negative cases are less in the score of two, therefore, the score of two can be a more appropriate score for detecting cases that need treatment. According to the ROC curve of 5 clinical criteria for the diagnosis of hemodynamically PDA, the order of effectiveness of these 5 criteria are CTR, precordial pulse, heart murmur, heart rate and peripheral pulse respectively.  </div> مجرای باز شریانی, نوزادان نارس, اکوکاردیوگرافی, معیارهای بالینی Patent ductus arteriosus, Premature infants,Echocardiography, Clinical criteria 63 73 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7189-1&slc_lang=fa&sid=1 Ali Mazori علی معذوری 3900319475328460076146 3900319475328460076146 No Assistant Professor, Neonatal Specialist, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. استادیار، فوق تخصص نوزادان، دانشکده پزشکی دانشگاه علوم پزشکی ایران، تهران، ایران Mohammad Radgodarzi محمد راد گودرزی 3900319475328460076147 3900319475328460076147 No Assistant Professor, Pediatric Cardiology Specialist, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran استادیار، فوق تخصص قلب اطفال، دانشکده علوم پزشکی دانشگاه علوم پزشکی ایران، تهران، ایران Mahboubeh Kamali محبوبه کمالی 3900319475328460076148 3900319475328460076148 No Student of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشجوی تخصص کودکان، دانشکده پزشکی دانشگاه علوم پزشکی ایران، تهران، ایران Pegah Taherifar پگاه طاهری فر 3900319475328460076149 3900319475328460076149 No Anesthesiologist, Ilam University of Medical Sciences, Ilam, Iran متخصص بیهوشی، دانشگاه علوم پزشکی ایلام، ایلام، ایران Ehsan Jahani احسان جهانی e.jahani@umz.ac.ir 3900319475328460076145 3900319475328460076145 Yes Associate Professor, Technical and Engineering Faculty, University of Mazandaran, Babolsar, Iran دانشیار، دانشکده فنی و مهندسی، دانشگاه مازندران، بابلسر، ایران