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Kuo CM, Su PC, Yang ST, Chung HW, Chen HL. Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:610. [PMID: 38790605 PMCID: PMC11119670 DOI: 10.3390/children11050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Ductus arteriosus closure may be delayed in preterm infants, and prostaglandin, a vasodilator, can affect ductal patency. Furosemide can increase renal prostaglandin synthesis, so its net effect on patent ductus arteriosus (PDA) is uncertain. Our goal is to explore the relationship between furosemide and spontaneous ductal closure in very-low-birth-weight preterm infants. Our treatment for PDA involves fluid restriction initially and furosemide administration for hemodynamically significant PDA until closure is confirmed by the echocardiogram. We enrolled 105 infants from 1 January 2019 to 30 June 2022 and evaluated the impact of furosemide on ductal closure, including exposure duration and cumulative dose. There is no correlation between furosemide exposure and spontaneous ductal closure (p = 0.384). Furosemide exposure does not delay the postmenstrual age at which spontaneous ductal closure occurs (p = 0.558). The time for spontaneous ductal closure is positively associated with furosemide prescription days (coefficient value = 0.547, p = 0.026) and negatively with gestational age (coefficient value = -0.384, p = 0.062). The prescription of furosemide does not impact the probability or time duration of ductus arteriosus spontaneous closure. The cumulative dose of furosemide has minimal impact on ductal closure. The correlation between furosemide exposure duration and ductal patency duration is likely due to our treatment protocol, with gestational age being a significant factor.
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Affiliation(s)
- Chi-Mei Kuo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Pin-Chun Su
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Shu-Ting Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
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Savio F, Sirico D, Mazzon G, Bonadies L, Guiducci S, Nardo D, Salvadori S, Avesani M, Castaldi B, Baraldi E, Di Salvo G. Cardiac Mechanics Evaluation in Preschool-Aged Children with Preterm Birth History: A Speckle Tracking and 4D Echocardiography Study. J Clin Med 2024; 13:2762. [PMID: 38792304 PMCID: PMC11122247 DOI: 10.3390/jcm13102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The premature-born adult population is set to grow significantly, and prematurity has emerged as an important cardiovascular risk factor. We aimed to comprehensively assess cardiac mechanics and function in a cohort of ex-preterm preschoolers. Methods: Ex-preterm children (<30 weeks of gestation), aged 2 to 5 years, underwent transthoracic 2D, speckle-tracking, and 4D echocardiography. The findings were compared with 19 full-term children. Results: Our cohort of 38 children with prematurity history showed a normal morpho-functional echocardiographic assessment. However, compared to controls, the indexed 3D end-diastolic volumes of ventricular chambers were reduced (left ventricle 58.7 ± 11.2 vs. 67.2 ± 8.5 mL/m2; right ventricle 50.3 ± 10.4 vs. 57.7 ± 11 mL/m2; p = 0.02). Left ventricle global and longitudinal systolic function were worse in terms of fraction shortening (32.9% ± 6.8 vs. 36.5% ± 5.4; p = 0.05), ejection fraction (59.2% ± 4.3 vs. 62.3% ± 3.7; p = 0.003), and global longitudinal strain (-23.6% ± 2.4 vs. -25.5% ± 1.7; p = 0.003). Finally, we found a reduced left atrial strain (47.4% ± 9.7 vs. 54.9% ± 6.8; p = 0.004). Conclusions: Preschool-aged ex-preterm children exhibited smaller ventricles and subclinical impairment of left ventricle systolic and diastolic function compared to term children. Long-term follow-up is warranted to track the evolution of these findings.
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Affiliation(s)
- Federica Savio
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Giada Mazzon
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Silvia Guiducci
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Daniel Nardo
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Sabrina Salvadori
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Martina Avesani
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
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吴 梓, 张 漪, 周 茜, 刘 沁, 程 实, 夏 世. [Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:343-349. [PMID: 38660897 PMCID: PMC11057302 DOI: 10.7499/j.issn.1008-8830.2310145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). METHODS A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis. RESULTS The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05). CONCLUSIONS A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.
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Affiliation(s)
| | | | | | - 沁 刘
- 华中科技大学同济医学院附属湖北妇幼保健院超声科,湖北武汉430070
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Jung JK, Kim EY, Heo JS, Park KH, Choi BM. Analysis of perinatal risk factors for massive pulmonary hemorrhage in very low birth weight infant: A nationwide large cohort database. Early Hum Dev 2024; 191:105977. [PMID: 38460343 DOI: 10.1016/j.earlhumdev.2024.105977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To determine perinatal risk factors for Massive pulmonary hemorrhage (MPH) and MPH-caused mortality to guide clinicians in implementing preventive measures at the beginning of life for improving the survival of very low birth weight infant (VLBWIs). STUDY DESIGN A total of 13,826 VLBWIs born between 2013 and 2020 in the Korean Neonatal Network database were included. RESULTS MPH occurred in 870 (6.3 %) VLBWIs. Among infants with MPH, 162 (18.6 %) VLBWIs died due to MPH. In the multivariate logistic regression analysis, independent risk factors for MPH were identified as small for gestational age, multiple gestation, high CRIB-II score, use of surfactant, and symptomatic patent ductus arteriosus (sPDA) in VLBIWs. Independent risk factors for MPH-caused mortality were identified as multiple gestation in VLBWIs. Receiving a complete course of antenatal corticosteroids (ACS) was found to be a significant independent protective factor for MPH-caused mortality in VLBWIs. CONCLUSION Proactive managements for reducing unnecessary use of pulmonary surfactant and for decreasing the risk of sPDA at the beginning of life could be recommended as preventive strategies to reduce the risk of MPH in extremely preterm infants. ACS therapy is highly recommended for women with a high likelihood of giving birth preterm to reduce the risk of mortality caused by MPH.
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Affiliation(s)
- Jong Ki Jung
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Yeob Kim
- Medical Science Research Center, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hee Park
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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Liguori MB, Ali SKM, Bussman N, Colaizy T, Hundscheid T, Phad N, Clyman R, de Boode WP, de Waal K, El-Khuffash A, Gupta S, Laughon M. Patent Ductus Arteriosus in Premature Infants: Clinical Trials and Equipoise. J Pediatr 2023; 261:113532. [PMID: 37269903 DOI: 10.1016/j.jpeds.2023.113532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Macrina B Liguori
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Sanoj K M Ali
- Division of Neonatology, Sidra Medicine, Ar-Rayyan, Doha, Qatar
| | - Neidín Bussman
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Tarah Colaizy
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Tim Hundscheid
- Division of Neonatology, Department of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Ronald Clyman
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA
| | - Willem-Pieter de Boode
- Division of Neonatology, Department of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Samir Gupta
- Division of Neonatology, Sidra Medicine, Ar-Rayyan, Doha, Qatar; Department of Neonatology, Durham University, Durham, United Kingdom
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Gezmu AM, Tefera E, Mochankana K, Imran F, Joel D, Pelaelo I, Nakstad B. Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana. Front Pediatr 2023; 11:1171223. [PMID: 37388284 PMCID: PMC10306393 DOI: 10.3389/fped.2023.1171223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. Methods and materials A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. Result There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. Conclusion This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.
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Affiliation(s)
| | - Endale Tefera
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Kagiso Mochankana
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Fizzah Imran
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Irene Pelaelo
- Department of Paediatrics, Princess Marina Hospital Botswana MOH, Gaborone, Botswana
| | - Britt Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatric and Adolescent Medicine, Inst Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Wei YJ, Ju YT, Hsieh ML, Kan CD, Lin YC, Wang JN. Surgical ligation, not transcatheter closure, associated with a higher severity of bronchopulmonary dysplasia in extremely preterm infant intervened for patent ductus arteriosus. Pediatr Pulmonol 2023; 58:1221-1228. [PMID: 36696083 DOI: 10.1002/ppul.26325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Patent ductus arteriosus (PDA) is a common complication among premature infants, which may be responsible for prematurity-related complications such as bronchopulmonary dysplasia (BPD). It is unclear whether different interventional methods contribute to the severity of BPD, given the original National Institute of Child Health and Human Development (NICHD) 2001 definition. To date, surgical ligation and the transcatheter approach have been equally successful in premature infants with hemodynamically significant PDA after medical treatment failure. Immediate improvement in the respiratory condition has been reported after transcatheter closure. However, the short-term pulmonary outcome has not been clarified yet. METHODS This retrospective study investigated infants born with a body weight <1000 g and who underwent either surgical ligation or transcatheter closure of PDA in a single tertiary institution. The infants were divided into groups according to the type of procedure (surgical ligation or transcatheter occlusion). The primary outcome was the severity of BPD at discharge or at a postmenstrual age of 36 weeks. The outcome was analyzed with logistic regression. RESULTS Forty-four patients met the inclusion criteria, of whom 14 underwent transcatheter occlusion and 30 underwent surgical ligation. The overall birth body weights and gestational age ranges were not different. The univariate model revealed an association between the procedure type and BPD severity. After adjusting for confounders, the multivariate model confirmed associations between BPD severity and procedure type and severe respiratory distress syndrome requiring surfactant. CONCLUSION Compared with the transcatheter approach, surgery for PDA in extremely preterm infants is associated with severe BPD at discharge. Further large-scale studies are needed to determine the exact mechanism.
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Affiliation(s)
- Yu-Jen Wei
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Tzu Ju
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Min-Ling Hsieh
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chung-Dann Kan
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Jasani B, Weisz DE, Reese J, Jain A. Combination pharmacotherapy for patent ductus arteriosus: Rationale and evidence. Semin Perinatol 2023; 47:151720. [PMID: 36914507 DOI: 10.1016/j.semperi.2023.151720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and low efficacy in extremely low gestational age neonates (ELGANs) have highlighted a need for alternative options. Combination therapy with acetaminophen and ibuprofen is a novel strategy for PDA treatment in ELGANs, as it may facilitate higher ductal closure rates via additive action on two separate pathways inhibiting prostaglandin production. Initial small observational studies and pilot randomized clinical trials indicate potentially higher efficacy of the combination regime to induce ductal closure in comparison to treatment with ibuprofen alone. In this review, we examine the potential clinical impact of treatment failure in ELGANs with significant PDA, highlight the biological rationale in support of studying combination therapy, and review the randomized and non-randomized studies to date. With the rising number of ELGANs receiving neonatal intensive care, who are vulnerable to PDA-related morbidities, there is an urgent need for adequately powered clinical trials to systematically investigate the efficacy and safety of combination therapy for PDA treatment.
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Affiliation(s)
- Bonny Jasani
- Division of Neonatology, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Dany E Weisz
- Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jeff Reese
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.
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The Association of Patent Ductus Arteriosus with Inflammation: A Narrative Review of the Role of Inflammatory Biomarkers and Treatment Strategy in Premature Infants. Int J Mol Sci 2022; 23:ijms232213877. [PMID: 36430355 PMCID: PMC9699120 DOI: 10.3390/ijms232213877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process.
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Pulmonary hemorrhage in extremely low birth weight infants: Significance of the size of left to right shunting through a valve incompetent patent foramen ovale. J Perinatol 2022; 42:1233-1237. [PMID: 35851183 DOI: 10.1038/s41372-022-01464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pulmonary hemorrhage is a rare but severe complication of extremely low birth weight (ELBW) infants. The association of hemodynamically significant patent ductus arteriosus (hsPDA) and the diameter of the foramen ovale (FO) with pulmonary hemorrhage has not been reported. STUDY DESIGN Case control study of ELBW infants with and without pulmonary hemorrhage. Each ELBW infant with an echocardiogram within 48 h of pulmonary hemorrhage was analyzed. RESULT 16 infants with pulmonary hemorrhage were matched with 32 controls by birth weight and gestational age. Echocardiogram showed hsPDA in all infants and those with pulmonary hemorrhage had significantly smaller patent FO [PFO] (1 vs 2.4 mm, p < 0.01) (OR 0.007; 95% CI 0.00007, 0.67 p = 0.03). Incidence of pulmonary hemorrhage was 8.9%. CONCLUSION ELBW infants with hsPDA who experienced pulmonary hemorrhage had a significantly restricted or closed FO. Evaluation of FO should be considered with serial echocardiograms when evaluating for hsPDA.
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Ficial B, Bonafiglia E, Gangemi A, Clemente M, Cappelleri A, Corsini I, Biban P. Impact of Aortic Diameter Measurements at Three Anatomical Landmarks on Left Ventricular Output Calculation in Neonates. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1187-1194. [PMID: 34423855 DOI: 10.1002/jum.15808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonates, when left ventricular outflow tract diameter (LVOTD) was measured at the hinges of the aortic valve (AV), at the aortic sinus (AS), and at the sinotubular junction (STJ). METHODS This was an observational study. In the first cohort of very preterm neonates, we assessed intraobserver and interobserver repeatability of LVOTD measured at the AV, AS, and STJ and of the corresponding LVO. In the second cohort of older neonates, we compared paired LVO measurements by echo and magnetic resonance imaging (MRI). RESULTS In the first cohort of 48 neonates, mean (standard deviation) weight and age at scan were 1046 (302) g and 28.1 (2.7) weeks. Interobserver bias (95% limits of agreement [LOA]) for LVOTD at the AV, AS, and STJ was 0 (-0.3 to 0.3) mm, 0 (-0.7 to 0.7) mm, and 0 (-0.8 to 0.7) mm, respectively. Interobserver bias (95% LOA) for the corresponding LVO was -1.3 (-31 to 33) ml/kg/min, -0.5 (-88 to 87) ml/kg/min, and -7.2 (-83 to 69) ml/kg/min, respectively. In the second cohort of 10 neonates, median (range) weight and age at scan were 1942 (970-3640) g and 37.2 (31.7-39.8) weeks. LVO measured at the AV showed stronger agreement with MRI: bias (LOA) -10.6 (-74 to 52) ml/kg/min, compared to LVO measured at AS and STJ: 194 (-0.5 to 388) ml/kg/min and 43 (-72 to 159) ml/kg/min respectively. CONCLUSIONS Reproducibility and accuracy of LVO quantification by echo were better when aortic diameter was measured at AV.
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Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena Bonafiglia
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonella Gangemi
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessia Cappelleri
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Paolo Biban
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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12
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Lin Y, Zhao HF, Xue MH, Xie BJ, Zeng LC, Jiang X. Ultra-slim flexible bronchoscopy-guided topical hemostatic drugs administration for the management of life-threatening refractory pulmonary hemorrhage in a preterm infant: Case report. Front Pediatr 2022; 10:981006. [PMID: 36330371 PMCID: PMC9623275 DOI: 10.3389/fped.2022.981006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hemorrhage (PH) is a rare acute catastrophic event with high mortality among neonates, especially preterm infants. Primary treatments included pulmonary surfactant, high-frequency oscillatory ventilation, epinephrine, coagulopathy management, and intermittent positive pressure ventilation. However, there are still challenges in diagnosing and treating refractory or focal pulmonary hemorrhages. Ultra-slim bronchoscopy has been widely used in the field of critically ill children and is increasingly being done in neonates with critical respiratory disease in recent years. In this study, we report a case with refractory pulmonary hemorrhage in premature infants, which was finally diagnosed as localized hemorrhage in the upper left lobe and cured by ultra-slim bronchoscopy-guided topical hemostatic drug administration. Bronchoscopy is an optional, safe, and practicable technique for early diagnosis and direct injection therapy of neonatal PH in managing life-threatening PH.
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Affiliation(s)
- Yan Lin
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Hong-Fang Zhao
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Meng-Hua Xue
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Bing-Jie Xie
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ling-Chao Zeng
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xun Jiang
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
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13
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Wang L, Zhao LL, Xu JJ, Yu YH, Li ZL, Zhang FJ, Wen HM, Wu HH, Deng LP, Yang HY, Li L, Ding LL, Wang XK, Zhang CY, Wang H. Association between pulmonary hemorrhage and CPAP failure in very preterm infants. Front Pediatr 2022; 10:938431. [PMID: 36160772 PMCID: PMC9500376 DOI: 10.3389/fped.2022.938431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study. METHODS This was a multicenter case-control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24-32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses. RESULTS A total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48). CONCLUSIONS In this multicenter case-control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.
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Affiliation(s)
- Li Wang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li-Li Zhao
- Liaocheng People's Hospital, Liaocheng, China
| | - Jia-Ju Xu
- Yantai Yuhuangding Hospital, Yantai, China
| | - Yong-Hui Yu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Feng-Juan Zhang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hui-Min Wen
- Hebei PetroChina Central Hospital, Langfang, China
| | - Hai-Huan Wu
- Baogang Third Hospital of Hongci Group, Baotou, China
| | | | - Hui-Yu Yang
- Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Li Li
- Linyi People's Hospital, Linyi, China
| | - Lan-Lan Ding
- Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Xiao-Kang Wang
- Central Hospital of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Hui Wang
- Hebei PetroChina Central Hospital, Langfang, China
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14
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Saha AK, Sardar SK, Majhi B, Chatterjee S. Clinical and echocardiographic characteristics associated with evolution of patent ductus arteriosus in preterm neonates: A prospective cohort study. J Neonatal Perinatal Med 2022; 15:537-544. [PMID: 35599501 DOI: 10.3233/npm-210930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously closed (within 7 days) and persistent PDA. RESULT We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates.
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Affiliation(s)
- A K Saha
- Department of Neonatology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
| | - S K Sardar
- Department of Neonatology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
| | - B Majhi
- Department of Cardiology, Bankura Sammilani Medical College and Hospital, Bankura, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
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15
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Yeung T, Shahroor M, Jain A, Weisz D, Jasani B. Efficacy and safety of high versus standard dose ibuprofen for patent ductus arteriosus treatment in preterm infants: A systematic review and meta-analysis. J Neonatal Perinatal Med 2022; 15:501-510. [PMID: 35404294 DOI: 10.3233/npm-210968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several small randomized controlled trials (RCTs) and observational studies have compared high (15-20/7.5-10/7.5-10 mg/kg/dose) versus standard dose (10/5/5 mg/kg/dose) ibuprofen for patent ductus arteriosus (PDA) closure, with limited evidence on efficacy and safety. OBJECTIVE To systematically review and meta-analyze studies of high versus standard dose ibuprofen for the closure of PDA in preterm infants. METHODS Databases were searched for RCTs and observational studies assessing high compared to standard dose of ibuprofen for PDA closure for preterm infants until August 2021. The primary outcome was failure of PDA closure after the first course of ibuprofen. The secondary outcomes were the failure of PDA closure after a second course of ibuprofen, rates of PDA ligation, all-cause mortality prior to hospital discharge, bronchopulmonary dysplasia, necrotizing enterocolitis, bleeding disorders, oliguria, and serum creatinine after treatment. RESULTS There were 6 studies with 369 patients (3 RCT, N = 190; 3 observational studies, N = 179). Compared to standard dose, high dose ibuprofen did not significantly decrease the failure rate of PDA closure in preterm infants after the first course (Relative risk (RR) 0.74, 95% confidence interval (CI) 0.53 -1.03, 6 studies, N = 369). High dose ibuprofen significantly decreased the rates of PDA ligation compared to standard dose (RR 0.33, 95% CI 0.16 -0.70, 5 studies, N = 309). INTERPRETATION Based on low-grade evidence, high dose ibuprofen may more effectively reduce rates of PDA ligation compared to standard dose with no increase in adverse effects, neonatal morbidities and mortality.
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Affiliation(s)
- T Yeung
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Windsor Regional Hospital, Windsor, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - M Shahroor
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Sunny brook Health Sciences Centre, Toronto, Canada
| | - A Jain
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - D Weisz
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Sunny brook Health Sciences Centre, Toronto, Canada
| | - B Jasani
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
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16
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Alsafadi T. Outcome of conservative and pharmacological treatment of hemodynamically significant patent ductus arteriosus in preterm infants less than 34 weeks. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Hemodynamic consequences of respiratory interventions in preterm infants. J Perinatol 2022; 42:1153-1160. [PMID: 35690691 PMCID: PMC9436777 DOI: 10.1038/s41372-022-01422-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
Advances in perinatal management have led to improvements in survival rates for premature infants. It is known that the transitional period soon after birth, and the subsequent weeks, remain periods of rapid circulatory changes. Preterm infants, especially those born at the limits of viability, are susceptible to hemodynamic effects of routine respiratory care practices. In particular, the immature myocardium and cardiovascular system is developmentally vulnerable. Standard of care (but essential) respiratory interventions, administered as part of neonatal care, may negatively impact heart function and/or pulmonary or systemic hemodynamics. The available evidence regarding the hemodynamic impact of these respiratory practices is not well elucidated. Enhanced diagnostic precision and therapeutic judiciousness are warranted. In this narrative, we outline (1) the vulnerability of preterm infants to hemodynamic disturbances (2) the hemodynamic effects of common respiratory practices; including positive pressure ventilation and surfactant therapy, and (3) identify tools to assess cardiopulmonary interactions and guide management.
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18
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Bozkaya A, Yurttutan S, Özkars MY, Doğaner A. Respiratory problems in preterm infants with pulmonary hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7505-7510. [PMID: 34384331 DOI: 10.1080/14767058.2021.1951207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM Pulmonary hemorrhage is an important cause of morbidity and mortality in premature infants. There are few studies on pulmonary hemorrhage and associated morbidities observed in premature. The aim of this study was to investigate the possible relationship between pulmonary hemorrhage and respiratory problems in premature infants. MATERIAL AND METHOD Premature infants aged 25-32 weeks who were born between January 2014 and January 2018 in the neonatal intensive care unit were included to the study. Of these premature infants, 28 were patients diagnosed as pulmonary hemorrhage and 56 were control cases with the same demographic characteristics without pulmonary hemorrhage. From the medical records of infants; clinical course characteristics such as duration of ventilation, duration of oxygen supplementation, hospital stay were detailed. The data was analyzed statistically. RESULTS The duration of mechanical ventilation was significantly longer in the pulmonary bleeding group than in the control group (p: .001). There was a significant difference between the groups in terms of moderate and severe bronchopulmonary dysplasia (BPD) and the rate of BPD in the pulmonary hemorrhage group was higher than in the control group (17.2%-53.6%; p: .001). In addition, pulmonary hemorrhage group had significant patent ductus arteriosus (PDA) and preterm retinopathy (ROP) rate compared with control group. DISCUSSION This study implicated that, pulmonary hemorrhage is related with respiratory morbidities in preterm infants such as BPD and prolonged respiratory support. At the same time, the other morbidities such as ROP prolonged hospitalization are higher in infants with pulmonary hemorrhage. CONCLUSION In the follow-up of patients with pulmonary hemorrhage, defining respiratory problems and treatment and prophylaxis of comorbid conditions may be planned sooner.
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Affiliation(s)
- Aydın Bozkaya
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Sadık Yurttutan
- Department of Neonatology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Mehmet Yaşar Özkars
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Adem Doğaner
- Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
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19
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Chen YJ, Chu WY, Yu WH, Chen CJ, Chia ST, Wang JN, Lin YC, Wei YJ. Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant. CHILDREN-BASEL 2021; 8:children8070545. [PMID: 34202886 PMCID: PMC8304301 DOI: 10.3390/children8070545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
Indomethacin has been widely used in preterm infants with hemodynamically significant patent ductus arteriosus (PDA). Gastrointestinal complications of indomethacin have been reported in 5% of treated neonates. However, massive gastric mucosa hemorrhage is a rarely reported complication. To the best of our knowledge, the infant in this report is the smallest reported in the literature to have undergone successful surgery for such a complication. A male preterm infant weighing 566 g was born at 252/7 weeks of gestational age without a complicated maternal history. Soon after birth, he received nasal noninvasive respiratory support and minimal feeding. PDA was observed since the first day of life (DOL), treatments were initiated on the second DOL for the hemodynamical significance, and PDA was closed after two courses of indomethacin therapy (0.2 mg/kg). At midnight on the seventh DOL, generalized pallor, bloody gastric drainage, and a distended stomach were observed. Massive gastric bleeding was suspected. He suffered from intermittent hypotension, which was corrected with blood products and fluid resuscitation under monitoring with a radial arterial line. Gastric lavage with cooling saline was performed twice but in vain. Prior to surgical consultation, intravascular volume transfusion was given twice. An exploratory laparotomy was arranged after obtaining the parents' consent. Blood oozing from the gastric mucosa was observed through gastrostomy and was successfully stopped via epinephrine-soaked gauze compression. After the operation, his clinical course remained uneventful, and he was discharged without neurological anomaly at two-year follow-up. Physicians need to be cautious of indomethacin's effect on platelet dysfunction in preterm infants with multiple predisposing factors. The tendency for mucosal bleeding should be continuously monitored after indomethacin therapy.
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Affiliation(s)
- Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 704302, Taiwan; (Y.-J.C.); (W.-H.Y.); (J.-N.W.)
| | - Wei-Ying Chu
- Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan 700007, Taiwan;
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 704302, Taiwan; (Y.-J.C.); (W.-H.Y.); (J.-N.W.)
| | - Chau-Jing Chen
- Department of Surgery, Tainan Sinlau Hospital, Tainan 701002, Taiwan;
- Department of Surgery, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan;
| | - Shu-Ti Chia
- Department of Surgery, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan;
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 704302, Taiwan; (Y.-J.C.); (W.-H.Y.); (J.-N.W.)
| | - Yung-Chieh Lin
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
- Correspondence: (Y.-C.L.); (Y.-J.W.); Tel.: +81-052-853-8244 (Y.-C.L.); +886-62-353-535 (ext. 4189) (Y.-J.W.)
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 704302, Taiwan; (Y.-J.C.); (W.-H.Y.); (J.-N.W.)
- Correspondence: (Y.-C.L.); (Y.-J.W.); Tel.: +81-052-853-8244 (Y.-C.L.); +886-62-353-535 (ext. 4189) (Y.-J.W.)
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Warnock A, Szatkowski L, Lakshmanan A, Lee L, Kelsall W. Surgical management of patent ductus arteriosus in pre-term infants - a british paediatric surveillance study. BMC Pediatr 2021; 21:270. [PMID: 34107888 PMCID: PMC8187455 DOI: 10.1186/s12887-021-02734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 - 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome. RESULTS Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge. CONCLUSION This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.
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Affiliation(s)
- A Warnock
- Neonatal Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Szatkowski
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Lakshmanan
- Neonatal Unit, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - L Lee
- Neonatal Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - W Kelsall
- Neonatal Unit, Cambridge University Foundation Trust, Cambridge, CB2 2QQ, UK.
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21
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Transcatheter patent ductus arteriosus closure in extremely premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants. CHILDREN-BASEL 2021; 8:children8050398. [PMID: 34063345 PMCID: PMC8156843 DOI: 10.3390/children8050398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.
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23
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Li J, Xia H, Ye L, Li X, Zhang Z. Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study. Transl Pediatr 2021; 10:1324-1332. [PMID: 34189090 PMCID: PMC8193000 DOI: 10.21037/tp-21-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage is a potentially fatal event especially for preterm infants, which can lead to serious complications and even death. Many risk factors have been associated with the development of massive pulmonary hemorrhage. However, there is still no effective strategy to prevent massive pulmonary hemorrhage. The purpose of this study is to explore prediction model and survival strategies for massive pulmonary hemorrhage in premature infants. METHODS In this retrospective study, we included all premature infants with birth weight <1,500 g who were hospitalized in our neonatal intensive care unit (NICU) between January 01 2010 and December 31 2019. RESULTS Of 599 preterm infants, 51 developed massive pulmonary hemorrhage. The logistic regression analysis showed that patent ductus arteriosus [odds ratio (OR) =11.4, 95% confidence interval (CI): 4.79-27.0, P<0.0001], coagulopathy (OR =6.56, 95% CI: 2.83-15.2, P<0.0001), and 10-minute Apgar Score (OR =0.52, 95% CI: 0.37-0.73, P=0.0001) were risk factors for massive pulmonary hemorrhage. Whether or not surfactant is used, the positive predictive value of combined patent ductus arteriosus and coagulopathy for predicting massive pulmonary hemorrhage was 68.9% and 70.4%, respectively. Of the 51 preterm infants with massive pulmonary hemorrhage, 25 died and 26 survived. The survivors group had higher positive end-expiratory pressure compared with the deceased group after the onset of massive pulmonary hemorrhage. After adjusting for potential risk factors, the multiple logistic regression analysis showed that higher positive end-expiratory pressure levels are closely related to survival. CONCLUSIONS Patent ductus arteriosus combined with coagulopathy has a high predictive value for massive pulmonary hemorrhage. Higher positive end-expiratory pressure levels may reduce mortality in massive pulmonary hemorrhage.
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Affiliation(s)
- Jing Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hejie Xia
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Ye
- Department of Neonatology, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
| | - Xiaoxia Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqun Zhang
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Godin R, Rodriguez JC, Kahn DJ. Oral Versus Intravenous Medications for Treatment of Patent Ductus Arteriosus in Preterm Neonates: A Cost-Saving Initiative. J Pediatr Pharmacol Ther 2021; 26:291-299. [PMID: 33833632 DOI: 10.5863/1551-6776-26.3.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/18/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of the study was to quantify cost savings after promoting oral pharmacotherapy for the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). METHODS This was a retrospective before-and-after time series quality improvement study. Oral ibuprofen and acetaminophen use criteria were developed and recommended, rather than the more costly intravenous equivalents. There were 24-month medication use reports generated for both the pre-criteria (Era-1) and the post-criteria (Era-2) implementation phases to identify neonates prescribed hsPDA medications in order to assess cost differences. RESULTS Era-1 had 190 treatment courses in 110 neonates for a total medication cost of $171,260.70. Era-2 had 210 courses in 109 patients for a total medication cost of $47,461.49, yielding savings of $123,799.21 ($61,899.61 annually) after criteria implementation. The reduction in intravenous ibuprofen use in Era-2 accounted for all the savings. CONCLUSION Preferentially prescribing lower-cost oral medications to treat hsPDA led to significant cost savings.
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Rios DR, Martins FDF, El-Khuffash A, Weisz DE, Giesinger RE, McNamara PJ. Early Role of the Atrial-Level Communication in Premature Infants with Patent Ductus Arteriosus. J Am Soc Echocardiogr 2021; 34:423-432.e1. [PMID: 33227390 PMCID: PMC8026594 DOI: 10.1016/j.echo.2020.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 10/23/2022]
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 the effects of a presumed hemodynamically significant patent ductus arteriosus (PDA) is poorly studied. The objective of this study was to characterize the relationship between early AC and echocardiographic indices of PDA shunt volume and clinical neonatal outcomes. METHODS A retrospective review of preterm infants (born at <32 weeks' gestation) who underwent echocardiography in the first postnatal week was performed. The cohort was divided into four groups on the basis of presence of a presumed hemodynamically significant PDA (≥1.5 vs <1.5 mm) and AC size (≤1 vs >1 mm), and echocardiographic measures of PDA shunt volume were then compared. Clinical outcomes, including chronic lung disease and intraventricular hemorrhage, were also compared among all four groups. RESULTS A total of 199 preterm infants (mean birth weight, 928 ± 632 g; mean gestational age, 26.6 ± 1.5 weeks) were identified; 159 infants had PDAs ≥ 1.5 mm, of whom 52 had ACs ≤ 1 mm and 107 had ACs > 1 mm. The remaining 40 infants had PDAs < 1.5 mm, of whom 23 had ACs ≤ 1 mm and 17 had ACs > 1 mm. Infants with PDAs ≥ 1.5 mm and ACs > 1 mm had higher pulmonary vein D-wave velocities (P < .05), higher left ventricular output (P < .005), higher PDA scores (P < .001), and increased rates of reversed diastolic flow in the descending aorta (P < .001), celiac artery (P < .001), and middle cerebral artery (P < .001) than infants with either PDAs < 1.5 mm or PDAs ≥ 1.5 mm and ACs ≤ 1 mm. There was no difference in the incidence of intraventricular hemorrhage, but infants with PDAs ≥ 1.5 mm and ACs > 1 mm had a higher risk for a composite outcome of chronic lung disease or death before hospital discharge (P < .05). CONCLUSIONS Echocardiographic evidence of ACs > 1 mm in patients with PDAs ≥ 1.5 mm during the first postnatal week may be a marker of a more pathologic hemodynamically significant PDA in premature infants. Future investigations should evaluate if early identification and treatment of patients with both high-volume PDAs and larger atrial-level communications may help mitigate adverse outcomes, such as chronic lung disease or death, in this high-risk patient population.
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Affiliation(s)
- Danielle R Rios
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
| | | | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dany E Weisz
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Regan E Giesinger
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Yu LF, Xu CK, Zhao M, Niu L, Huang XM, Zhang ZQ. Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus. World J Clin Cases 2021; 9:1827-1834. [PMID: 33748231 PMCID: PMC7953406 DOI: 10.12998/wjcc.v9.i8.1827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights. When PDA persists, interstitial lung water content increases, which could lead to abnormal circulation hemodynamics and pulmonary edema. It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA. AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA. METHODS From January 2018 to March 2020, 69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group. At the same time, 89 very low-weight preterm neonates without PDA were randomly selected as the control group. All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth. The clinical characteristics and main ultrasonography results were compared between the two groups. Pearson's analysis was used to analyze the correlation between lung ultrasonography score (LUS) and other related clinical and ultrasonography results in all neonates. In the PDA group, PDA diameters were recorded, and the correlation with LUS and left atrium to aortic (LA/AO) dimension ratio were also analyzed. LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA. When the ratio is ≥ 1.5, it suggests the possibility of hemodynamic changes in persistent PDA. A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa. RESULTS A total of 158 neonates were enrolled in this study, including 69 in the PDA group and 89 in the control group. There were no statistical differences in sex, gestational age, birth weight, ventilator dependence, hospitalization length and left ventricular ejection fraction between the two groups (P > 0.05). The LUS and LA/AO ratio in the PDA group were higher than those in the control group (P < 0.05), but there was no difference of LUS in neonates with or without use of the ventilator (t = 0.58, P = 0.16). In all cases, LUS was negatively correlated with gestational age (r = -0.28, P < 0.01) and birth weight (r = -0.36, P < 0.01), while positively correlated with the LA/AO ratio (r = 0.27, P < 0.01). In the PDA group, PDA diameter was positively correlated with the LA/AO ratio (r = 0.39, P < 0.01) and LUS (r = 0.31, P < 0.01). Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA (area under the curve = 0.741; sensitivity = 93.75%; specificity = 50.94%). CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.
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Affiliation(s)
- Li-Fang Yu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chen-Ke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xian-Mei Huang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhi-Qun Zhang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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de Waal K, Phad N, Stubbs M, Chen Y, Kluckow M. A Randomized Placebo-Controlled Pilot Trial of Early Targeted Nonsteroidal Anti-Inflammatory Drugs in Preterm Infants with a Patent Ductus Arteriosus. J Pediatr 2021; 228:82-86.e2. [PMID: 32858033 DOI: 10.1016/j.jpeds.2020.08.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To establish the feasibility of a future large randomized trial to compare early treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) while awaiting spontaneous patent ductus arteriosus (PDA) closure. STUDY DESIGN Preterm infants at <29 weeks of gestation with a PDA diameter >1.5 mm and <72 hours after birth were randomized to NSAIDs vs placebo. No open-label NSAID treatment was allowed in either arm, but all infants with PDA volume load received supportive management, including optimization of airway pressure, careful fluid management, and diuretics as needed. The pilot outcomes were recruitment rate and incidence of open-label treatment. Secondary clinical outcomes included chronic lung disease or death, the planned primary outcome for a future large trial. RESULTS Overall, 54% of the approached parents consented to participate in the study. The median recruitment rate was 3 infants per month, and a total of 72 infants were randomized. One patient in each arm received open-label treatment. PDA closure rates were 74% for the NSAIDs arm vs 30% for the placebo arm, but this was not associated with significant changes in clinical outcomes. CONCLUSIONS This pilot trial showed that recruitment of more than one-half of eligible infants with a low incidence of open-label treatment is feasible. PDA closure rates and clinical outcomes were similar to those reported in previous PDA trials.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia.
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Michelle Stubbs
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Yan Chen
- Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
| | - Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
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Martini S, Galletti S, Kelsall W, Angeli E, Agulli M, Gargiulo GD, Chen SE, Corvaglia L, Singh Y. Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison. Eur J Pediatr 2021; 180:2261-2270. [PMID: 33713339 PMCID: PMC7955694 DOI: 10.1007/s00431-021-04004-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 01/30/2023]
Abstract
Patent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known: • Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation. • Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new: • The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery. • Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Silvia Galletti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - Wilf Kelsall
- Neonatal Intensive Care Unit, Department of Paediatrics, Addenbrooke’s Hospital, Cambridge, UK
| | - Emanuela Angeli
- Pediatric Cardiac Surgery Unit, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marta Agulli
- Anaesthesiology and Intensive Care Unit, Cardio-Thoracic-Vascular Department, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Si Emma Chen
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - Yogen Singh
- Neonatal Intensive Care Unit, Department of Paediatrics, Addenbrooke’s Hospital, Cambridge, UK
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Abstract
Primary function of cardiovascular system is to meet body's metabolic demands. The aim of inotrope therapy is to minimise adverse impact of cardiovascular compromise. Current use of inotropes is primarily guided by the pathophysiology of cardiovascular compromise and anticipated actions of inotropes. Lack of significant reduction in morbidity and mortality associated with cardiovascular compromise despite inotrope use, highlights major gaps in our understanding of circulatory targets, thresholds and choices of inotrope therapy. Thus far, prevention of cardiovascular compromise remains the most effective strategy to optimize outcomes. Studies of alternative design are needed for further advancement in cardiovascular therapy in neonates.
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Affiliation(s)
- Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital, Lookout Road, New Lambton Heights, New South Wales 2305, Australia; University of Newcastle, Newcastle, Australia.
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, Lookout Road, New Lambton Heights, New South Wales 2305, Australia; University of Newcastle, Newcastle, Australia
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Improved ventilation in premature babies after transcatheter versus surgical closure of patent ductus arteriosus. Int J Cardiol 2020; 311:22-27. [PMID: 32253052 DOI: 10.1016/j.ijcard.2020.03.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/08/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
AIMS Patent ductus arteriosus (PDA) is common in preterm infants and can contribute to morbidity and mortality. We aimed to compare results and outcome of transcatheter closure using the Amplatzer Piccolo Occluder versus surgical closure in 2 matched groups of preterm infants weighing <3000 g. METHODS AND RESULTS A total of 147 babies from three tertiary centres were retrospectively analysed. Sixty-four babies undergoing catheter closure were compared with 83 matched surgical cases. Patent ductus arteriosus closure was successful in all cases. During neonatal unit course, mortality was 6.3% (n = 4) after catheterization and 12% (n = 10) after surgery (p = 0.24). Median duration of mechanical ventilation was shorter after catheterisation than after surgery (3 vs 5 days, p = 0.035). Before 4 weeks of age the difference between transcatheter and surgical closure for mechanical ventilation was even more pronounced (3 vs 9 days, p = 0.022). Additionally, when catheterisation was performed before 4 weeks, babies were discharged home earlier as compared to those who underwent closure later in life (39+1 vs. 42+1 weeks, p = 0.021). Such difference was not found in the surgical group. CONCLUSIONS Transcatheter closure of patent ductus arteriosus is safe, effective and is associated with shorter mechanical ventilation than after surgery. Hospital stay might be shorter when performed earlier in life.
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Plasma B-type natriuretic peptide cannot predict treatment response to ibuprofen in preterm infants with patent ductus arteriosus. Sci Rep 2020; 10:4430. [PMID: 32157119 PMCID: PMC7064477 DOI: 10.1038/s41598-020-61291-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/24/2020] [Indexed: 11/26/2022] Open
Abstract
Plasma B-type natriuretic peptide (BNP) is a useful marker for diagnosis of hemodynamically significant PDA (hsPDA) and serial BNP measurement is also valuable for monitoring treatment response. This retrospective study was performed to evaluate whether plasma BNP level can predict treatment response to ibuprofen in preterm infants born at <30 weeks of gestation with hsPDA. Plasma BNP was measured before (baseline) and 12 to 24 h after (post-treatment) completion of the first (IBU1) and second (IBU2) course of ibuprofen. We compared the BNP levels of responders (closed or insignificant PDA) with those of non-responders (hsPDA requiring further pharmacologic or surgical closure) to each course of ibuprofen. The treatment response rates for IBU1 (n = 92) and IBU2 (n = 19) were 74% and 26%, respectively. In IBU1, non-responders had lower gestational age and birth weight than responders (both, P = 0.004), while in IBU2, non-responders had lower birth weight (P = 0.014) and platelet counts (P = 0.005) than responders; however, baseline BNP levels did not differ significantly between responders and non-responders in either IBU1 (median 1,434 vs. 1,750 pg/mL) or IBU2 (415 vs. 596 pg/mL). Post-treatment BNP was a useful marker for monitoring treatment efficacy of IBU1 and IBU2 for hsPDA with a cut-off value of 331 pg/mL (P < 0.001) and 423 pg/mL(P < 0.010), respectively. We did not identify a cut-off baseline BNP level that could predict treatment response to ibuprofen in preterm infants with hsPDA.
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Wang TT, Zhou M, Hu XF, Liu JQ. Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants. World J Pediatr 2020; 16:299-304. [PMID: 31686366 PMCID: PMC7312118 DOI: 10.1007/s12519-019-00322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/16/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Pulmonary hemorrhage (PH) is a life-threatening respiratory complication of extremely low-birth-weight infants (ELBWIs). However, the risk factors for PH are controversial. Therefore, the purpose of this study was to analyze the perinatal risk factors and short-term outcomes of PH in ELBWIs. METHODS This was a retrospective cohort study of live born infants who had birth weights that were less than 1000 g, lived for at least 12 hours, and did not have major congenital anomalies. A logistic regression model was established to analyze the risk factors associated with PH. RESULTS There were 168 ELBWIs born during this period. A total of 160 infants were included, and 30 infants were diagnosed with PH. Risk factors including gestational age, small for gestational age, intubation in the delivery room, surfactant in the delivery room, repeated use of surfactant, higher FiO2 during the first day, invasive ventilation during the first day and early onset sepsis (EOS) were associated with the occurrence of PH by univariate analysis. In the logistic regression model, EOS was found to be an independent risk factor for PH. The mortality and intraventricular hemorrhage rate of the group of ELBWIs with PH were significantly higher than those of the group of ELBWIs without PH. The rates of periventricular leukomalacia, moderate-to-severe bronchopulmonary dysplasia and severe retinopathy of prematurity, and the duration of the hospital stay were not significantly different between the PH and no-PH groups. CONCLUSIONS Although PH did not extend hospital stay or increase the risk of bronchopulmonary dysplasia, it increased the mortality and intraventricular hemorrhage rate in ELBWIs. EOS was the independent risk factor for PH in ELBWIs.
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Affiliation(s)
- Ting-Ting Wang
- grid.24516.340000000123704535Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204 China
| | - Ming Zhou
- grid.24516.340000000123704535Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204 China
| | - Xue-Feng Hu
- grid.24516.340000000123704535Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204 China
| | - Jiang-Qin Liu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204, China.
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D'Amato G, Errico G, Franco C, Brunetti G, Petrillo F, Faienza MF, Del Vecchio A. Ductal size indexed to weight and body surface area correlates with morbidities in preterm infants ≤32 weeks. J Matern Fetal Neonatal Med 2019; 34:3133-3139. [PMID: 31619099 DOI: 10.1080/14767058.2019.1678134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess ductal size correlated to spontaneous closure, pharmacological or surgical treatment; to index ductal diameter to body weight and body surface area; to evaluate the morbidities. STUDY DESIGN Retrospective study on preterms ≤32 weeks, birth weight ≤1500 g, extremely low birth weight (ELBW) and very low birth weight (VLBW). Inclusion criteria: patent ductus arteriosus (PDA) with a diameter ≥1 millimeter (mm) at 72 h from birth; need for ibuprofen treatment on the basis of a hemodynamically significant ductus arteriosus (HsPDA). RESULTS One hundred infants with the diagnosis of PDA have been included. We observed a prevalence of spontaneous closure in 34% of newborns (41.3% VLBW versus 26.7% ELBW). The percentage of response to a single course of ibuprofen was of 62% (68.5% ELBW versus 54.3% VLBW). The mean of absolute ductal diameter was of 2.26 ± 0.62 mm in ELBW and 2.18 ± 0.42 mm in VLBW. The indexing of ductus size to body weight demonstrated a higher value in ELBW than VLBW (2.76 ± 0.97 mm/kg versus 1.84 ± 0.40 mm/kg). CONCLUSIONS Our results confirmed that HsPDA can develop in presence of a ductus >1.5 mm as absolute value or >1.4 mm/kg as indexed to body weight. In ELBW infants the ductal size indexed for body weight and body surface area could be more predictive of spontaneous closure or need for pharmacological treatment compared to the absolute value of ductal size. A strong association between HsPDA and short- or long-term morbidities was confirmed particularly in ELBW.
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Affiliation(s)
| | | | - Caterina Franco
- Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Giacomina Brunetti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, University "A. Moro" of Bari, Bari, Italy
| | - Flavia Petrillo
- Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Bari, Italy
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Youn Y, Seo YM, Yum SK, Sung IK. Patent ductus arteriosus ligation on neurodevelopmental outcomes at corrected 2 years. Ital J Pediatr 2019; 45:110. [PMID: 31443661 PMCID: PMC6708147 DOI: 10.1186/s13052-019-0698-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Our aim in this study was to evaluate whether very low birth weight infants (VLBWI) ligated for patent ductus arteriosus (PDA) were associated with worse neurodevelopmental outcomes at corrected 2 years. The ligated group was subdivided into ≤2 weeks of life (early) and ligated > 2 weeks of life (late) groups and compared the in-hospital morbidities and long term outcomes. Methods Between Dec 2013 and Dec 2015, VLBWI diagnosed with hs PDA were evaluated. Results Of the 191 VLBW infants with hs PDA, 28 (14.7%) infants had surgical ligation for PDA; 11 (39%) infants had EL and 17 (61%) infants had LL. Surgical ligation of hs PDA group had higher morbidities and mortality. Among the142 (83.0%) infants of 171 VLBWI with PDA survived, infants who were ligated had significantly lower scores of Bayley Scales of Infant and Toddler Development III at corrected age of 18 months. However, among the ligated group, there was little evidence of differences between the EL and LL groups. In a multivariable logistic regression analysis, only longer exposure of hs PDA and mechanical ventilation were consistently associated with worse neurodevelopmental outcomes. Conclusion Our results suggest that surgical ligation for hs PDA may not increase risk for poor neurodevelopmental outcomes at corrected 2 years of age. The early surgical ligation may not be a risk factor.
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Affiliation(s)
- YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
| | - Yu-Mi Seo
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Sook-Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - In Kyung Sung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
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Kao RL, Huang W, Martin CM, Rui T. The effect of aerosolized indomethacin on lung inflammation and injury in a rat model of blunt chest trauma. Can J Surg 2019; 61:S208-S218. [PMID: 30418008 DOI: 10.1503/cjs.014318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Acute lung contusion from blunt chest trauma (BCT) is characterized by an intense inflammatory response in the pulmonary parenchyma, which is associated with acute lung injury (ALI), acute respiratory distress syndrome and ventilator-associated pneumonia. We hypothesized that aerosolized indomethacin may reduce pulmonary inflammation and ALI in a rat model of BCT. Methods Sprague-Dawley rats were anesthetized and received a tracheotomy for administration of aerosolized medication through a catheter. The BCT procedure involved free-dropping a hollow metal weight (200 g) from a height of 25.5, 38.3 or 51.2 cm onto the right thorax. We administered 1 mg/kg of indomethacin or 1 mL/kg of saline intratracheally 15 minutes after BCT. The sham group had a similar procedure without the exposure to BCT and treatment. Three hours postimpact, we obtained arterial blood gas and analyzed bronchoalveolar lavage for protein concentration, polymorphonuclear leukocytes (PMN) and cytokine levels, and lung tissue samples were taken for histopathological analysis. Results The rats’ mean arterial pressure and heart rate dropped immediately postimpact but recovered close to that of the sham group after 30 minutes in both control and treatment groups. Compared to BCT alone, indomethacin significantly reduced the total protein level in the lungs (1.06 ± 0.39 mg/mL v. 3.75 ± 1.95 mg/mL, p = 0.006) and alveolar FD-70 leak (0.23 ± 0.19 μg/mL v. 0.53 ± 0.19 μg/mL, p = 0.02). Indomethacin also significantly attenuated the acute inflammatory response in percent PMN (13.33 ±7.5% v. 28.0 ± 12.96%, p = 0.04). Tumour necrosis factor-α and interleukin-6 decreased in the indomethacin group, but the decreases were not significant compared with other groups. Conclusion Aerosolized indomethacin has a protective effect against alveloar tissue permeability and inflammatory response induced by BCT.
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Affiliation(s)
- Raymond L. Kao
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Weixiong Huang
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Claudio M. Martin
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Tao Rui
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
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Vaidya R, Wilson D, Paris Y, Madore L, Singh R. Use of acetaminophen for patent ductus arteriosus treatment: a single center experience. J Matern Fetal Neonatal Med 2019; 33:2723-2729. [PMID: 30563380 DOI: 10.1080/14767058.2018.1559810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Patent ductus arteriosus (PDA) continues to be one of the most common complications associated with preterm birth. Up to 70% of infants born before 28 weeks gestational age may require some form of medical or surgical treatment for PDA closure. Recent studies have suggested acetaminophen to be a promising new alternative to indomethacin and ibuprofen for closure of PDA with potentially fewer adverse effects. Our aim for the study was to report our experience regarding the efficacy of acetaminophen compared to indomethacin for treatment of hemodynamically significant PDA (hs-PDA) in infants born in our institution.Material and methods: Retrospective cohort study of all preterm infants born <34-week gestation with hs-PDA, treated with acetaminophen or indomethacin as the first line medication for hs-PDA. Primary outcome of successful PDA closure rate (small or no PDA) and secondary outcomes of short-term morbidities and immediate adverse events were compared between the two cohorts.Results: Of the 43 infants, 25 were treated with acetaminophen and 18 with indomethacin, as first line for hs-PDA. Successful PDA closure rate was slightly lower for acetaminophen compared to indomethacin, although statistically not significant (acetaminophen: 40% versus indomethacin: 55.5%, p = .31). No significant differences in short-term morbidities including necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), late onset sepsis (LOS), retinopathy of prematurity (ROP) and intraventricular hemorrhage (IVH), or immediate side effects including oliguria, hyponatremia, elevated BUN/creatinine, thrombocytopenia were found between the two cohorts.Conclusions: Acetaminophen treatment of hs-PDA resulted in similar successful PDA closure rate compared to indomethacin in our small cohort of patients.
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Affiliation(s)
- Ruben Vaidya
- Department of Pediatrics, Division of Newborn Medicine, University of Massachusetts Medical School- Baystate, Springfield, MA, USA
| | - Donna Wilson
- Epidemiology & Biostatistics, Office of Research University of Massachusetts Medical School- Baystate, Springfield, MA, USA
| | - Yvonne Paris
- Department of Pediatrics, Division of Pediatric Cardiology, University of Massachusetts Medical School- Baystate, Springfield, MA, USA
| | - Laura Madore
- Department of Pediatrics, Division of Newborn Medicine, University of Massachusetts Medical School- Baystate, Springfield, MA, USA
| | - Rachana Singh
- Department of Pediatrics, Division of Newborn Medicine, University of Massachusetts Medical School- Baystate, Springfield, MA, USA
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Ahmad KA, Bennett MM, Ahmad SF, Clark RH, Tolia VN. Morbidity and mortality with early pulmonary haemorrhage in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104:F63-F68. [PMID: 29374627 DOI: 10.1136/archdischild-2017-314172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are no large studies evaluating pulmonary haemorrhage (PH) in premature infants. We sought to quantify the clinical characteristics, morbidities and mortality associated with early PH. DESIGN Data were abstracted from the Pediatrix Clinical Data Warehouse, a large de-identified data set. For incidence calculations, we included infants from 340 Pediatrix United States Neonatal Intensive Care Units from 2005 to 2014 without congenital anomalies. Infants <28 weeks' gestation with PH within 7 days of birth were then matched with two controls for birth weight, gestational age, gender, antenatal steroid exposure, day of life 0 or 1 intubation and multiple gestation. RESULTS From 596 411 total infants, we identified 2799 with a diagnosis of PH. Peak incidence was 86.9 cases per 1000 admissions for neonates born at 24 weeks' gestation. We then identified 1476 infants <28 weeks' gestation with an early PH diagnosis at ≤7 days of age of which 1363 (92.3%) were successfully matched. Patients with early PH had significantly higher exposure to poractant alfa (35.4% vs 28%), diagnosis of shock (63.7% vs 51%) and grade IV intraventricular haemorrhage (20.8% vs 6%). Patients with PH also had significantly higher mortality rates at 7 days of age (40.6% vs 18.9%), 30 days of age (54% vs 28.8%) and prior to discharge (56.9% vs 33.7). CONCLUSION In this large cohort of premature infants, we found PH to be common among the most premature babies. Early PH was associated with significant morbidity and mortality in excess of 50%. A renewed focus on the underlying pathophysiology and prevention of PH is warranted.
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Affiliation(s)
- Kaashif Aqeeb Ahmad
- Pediatrix Medical Group, San Antonio, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, USA
| | | | - Samiya Fatima Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, USA
| | - Reese Hunter Clark
- Center for Research, Education, and Quality, Pediatrix Medical Group, Sunrise, Florida, USA
| | - Veeral Nalin Tolia
- Pediatrix Medical Group, Dallas, Texas, USA.,Department of Pediatrics, Baylor University Medical Center, Dallas, Texas, USA
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Ezenwa B, Pena E, Schlegel A, Bapat R, Shepherd EG, Nelin LD. Effects of practice change on outcomes of extremely preterm infants with patent ductus arteriosus. Acta Paediatr 2019; 108:88-93. [PMID: 29806710 DOI: 10.1111/apa.14423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/04/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine whether a decrease in patent ductus arteriosus (PDA) treatment or ligation in extremely preterm (EP) infants was associated with changes in rates of mortality and/or morbidities. METHODS Observational study on EP infants admitted from 2008 to 2015. The small baby guidelines do not mandate ligation, however, in late 2010 the guidelines were amended based on new literature suggested that ligation may increase rates of morbidities. RESULTS There were 717 EP infants admitted during the study period. There were no significant changes in gestational age, birthweight or annual admissions during the study period. The annual rate of PDA medical treatment declined significantly (R = 0.83, p = 0.01), while the annual rate of PDA ligation declined substantially (R = 0.88, p = 0.004). The annual mortality rate also declined significantly (R = 0.81, p = 0.014). The annual rates of bronchopulmonary dysplasia (BPD), necrotising enterocolitis and intraventricular haemorrhage did not change significantly. CONCLUSION In this cohort of EP patients, the rate of PDA ligation decreased substantially since 2010, with no apparent adverse effects on mortality or rates of BPD. These data are consistent with the concept that ligation does not improve outcomes in EP infants.
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Affiliation(s)
- B Ezenwa
- Department of Pediatrics Lagos University Teaching Hospital Lagos Nigeria
| | - E Pena
- Small Baby ICU Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - A Schlegel
- Small Baby ICU Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - R Bapat
- Small Baby ICU Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - E G Shepherd
- Small Baby ICU Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - L D Nelin
- Small Baby ICU Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
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Köksal N, Aygün C, Uras N. Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants. Turk Arch Pediatr 2018; 53:S76-S87. [PMID: 31236021 PMCID: PMC6568296 DOI: 10.5152/turkpediatriars.2018.01808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ductus arteriosus is a physiologic phenomenon in utero and it closes spontaneously in term babies. The closure is problematic in preterm infants due to the intrinsic properties of the preterm ductus arteriosus tissue. Although patent ductus arteriosus has been reported to be associated with many adverse outcomes in this population, treatment has not led to a decrease in outcomes such as bronchopulmonary dysplasia. Treatment modalities also have their own risks and restrictions. The aim of the "Turkish Neonatal Society guidelines for the management of patent ductus arteriosus in preterm babies" is to standardize the diagnosis and treatment of patent ductus arteriosus in preterm infants by combining the current scientific data and the resources of our country.
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Affiliation(s)
- Nilgün Köksal
- Division of Neonatology, Department of Pediatrics, Uludağ University, Faculty of Medicine, Bursa, Turkey
| | - Canan Aygün
- Division of Neonatology, Department of Pediatrics, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Nurdan Uras
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Ankara, Turkey
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de Freitas Martins F, Ibarra Rios D, F Resende MH, Javed H, Weisz D, Jain A, de Andrade Lopes JM, McNamara PJ. Relationship of Patent Ductus Arteriosus Size to Echocardiographic Markers of Shunt Volume. J Pediatr 2018; 202:50-55.e3. [PMID: 30115452 DOI: 10.1016/j.jpeds.2018.06.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/30/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To define the technique of estimating ductal diameter (DD) that best correlates with echocardiographic markers of transductal shunt volume in preterm infants >7 days old with persistent patent ductus arteriosus (PDA). STUDY DESIGN We conducted a retrospective study of 104 neonates born at <30 weeks gestation that had targeted neonatal echocardiography evaluation of PDA performed between 7 and 30 days. We used univariate analysis to determine the association of echocardiographic markers of shunt volume with ductal size definitions: DD, DD indexed to weight, and DD indexed to left pulmonary artery diameter. RESULTS Two hundred echocardiograms were reviewed from 104 patients with a median gestational age of 25.4 weeks (range, 25-26.3 weeks) and a median birth weight of 810 g (range, 740-920 g). We found a weak correlation of each method of PDA size definition with individual echocardiographic markers of transductal shunt volume, of which nonindexed DD demonstrated the best correlation. The best correlation was found with markers of systemic hypoperfusion, such as diastolic flow reversal in the descending aorta (R2 = 0.24) and celiac artery (R2 = 0.21). Markers of pulmonary overcirculation, such as left ventricular end-diastolic diameter (R2 = 0.19) and left ventricular output (R2 = 0.17), showed fair correlation with nonindexed DD. CONCLUSION In preterm infants >7 days old with PDA, nonindexed DD demonstrated weak correlations with individual echocardiographic markers of shunt volume. These data highlight the need for comprehensive echocardiographic evaluation in addition to diameter measurements to provide a better understanding of the hemodynamic consequences of PDA.
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Affiliation(s)
- Fernando de Freitas Martins
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Neonatology Department, Fernandes Figueira Institute, Rio de Janeiro, Brazil.
| | - Daniel Ibarra Rios
- Neonatology Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Maura Helena F Resende
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Henna Javed
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dany Weisz
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Neonatology, Mount Sinai Hospital, New York, NY
| | | | - Patrick J McNamara
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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Abstract
The transition from intrauterine to extrauterine life represents a critical phase of physiological adaptation which impacts many organ systems, most notably the heart and the lungs. The majority of term neonates complete this transition without complications; however, dysregulation of normal postnatal adaptation may lead to acute cardiopulmonary instability, necessitating advanced intensive care support. Although not as well appreciated as changes in vascular resistances, the shunt across the DA plays a crucial physiologic role in the adaptive processes related to normal transitional circulation. Further, we describe key differences in the behavior of the ductal shunt during transition in preterm neonates and we postulate mechanisms through which the DA may modulate major hemodynamic complications during this vulnerable period. Finally, we describe the conditions in which preservation of ductal patency is a desired clinical goal and we discuss clinical factors that may determine adequate balance between pulmonary and systemic circulation.
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Elsayed YN, Fraser D. Patent Ductus Arteriosus in Preterm Infants, Part 1: Understanding the Pathophysiologic Link Between the Patent Ductus Arteriosus and Clinical Complications. Neonatal Netw 2018; 36:265-272. [PMID: 28847349 DOI: 10.1891/0730-0832.36.5.265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical guidelines for treating patent ductus arteriosus (PDA) have significantly evolved over the last decades from treating any ductal shunt to more conservative management where only the hemodynamically significant patent ductus arteriosus (HSPDA) is treated. This shift has resulted largely from a lack of evidence from randomized controlled trials supporting a relationship between treating a PDA and improving long-term neonatal outcomes. However, there are many unresolved issues. There is no consensus on the precise definition of HSPDA requiring treatment or a clear understanding of when to treat HSPDA. Moreover, the current evidence shows worsening of the long-term neurodevelopmental outcome for infants undergoing surgical PDA ligation.<br/> The presence of physiologic variability among preterm infants, and the presence of different compensatory mechanisms may make it difficult to establish a link between pathophysiology and long-term outcomes. That is, the physiologic variability cannot be simply assessed by randomly assigning infants into two arms of a study. Relying on research from animal and human studies, this article explains the link between the pathophysiology of a PDA and neonatal outcomes.
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Beausoleil TP, Janaillac M, Barrington KJ, Lapointe A, Dehaes M. Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life. Sci Rep 2018; 8:6511. [PMID: 29695729 PMCID: PMC5916916 DOI: 10.1038/s41598-018-24836-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/09/2018] [Indexed: 12/29/2022] Open
Abstract
Extremely preterm infants are at higher risk of pulmonary (PH) and intraventricular (IVH) haemorrhage during the transitioning physiology due to immature cardiovascular system. Monitoring of haemodynamics can detect early abnormal circulation that may lead to these complications. We described time-frequency relationships between near infrared spectroscopy (NIRS) cerebral regional haemoglobin oxygen saturation (CrSO2) and preductal peripheral perfusion index (PI), capillary oxygen saturation (SpO2) and heart rate (HR) in extremely preterm infants in the first 72 h of life. Patients were sub-grouped in infants with PH and/or IVH (N H = 8) and healthy controls (N C = 11). Data were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the percentage of time of significant cross-correlation, semblance, gain (transfer function) and coherence between signals. Ultra-low frequencies (<0.28 mHz) were analyzed as slow and prolonged periods of impaired circulation are considered more detrimental than transient fluctuations. Cross-correlation between CrSO2 and oximetry (PI, SpO2 and HR) as well as in-phase semblance and gain between CrSO2 and HR were significantly lower while anti-phase semblance between CrSO2 and HR was significantly higher in PH-IVH infants compared to controls. These differences may reflect haemodynamic instability associated with cerebrovascular autoregulation and hemorrhagic complications observed during the transitioning physiology.
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Affiliation(s)
- Thierry P Beausoleil
- Institute of Biomedical Engineering, University of Montréal, Montréal, Canada.,Research Centre, CHU Sainte-Justine, Montréal, Canada
| | - Marie Janaillac
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Keith J Barrington
- Research Centre, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Anie Lapointe
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Mathieu Dehaes
- Research Centre, CHU Sainte-Justine, Montréal, Canada. .,Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montréal, Montréal, Canada.
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Pan WW, Tong XM. [Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:255-260. [PMID: 29658447 PMCID: PMC7390026 DOI: 10.7499/j.issn.1008-8830.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the treatment and prognosis of pulmonary hemorrhage in preterm infants. METHODS A total of 106 preterm infants diagnosed with pulmonary hemorrhage, who were hospitalized in the neonatal ward of Peking University Third Hospital between 2007 and 2016, were enrolled. These patients were divided into 2007-2011 group (34 cases) and 2012-2016 group (72 cases) according to the time of hospitalization, divided into conventional-frequency ventilation group (43 cases) and high-frequency oscillatory ventilation (HFOV) group (63 cases) according to the respiratory support method used after the development of pulmonary hemorrhage, and divided into non-operation group (34 cases) and operation group (14 cases) according to whether PDA ligation was performed for the unclosed PDA before pulmonary hemorrhage. The general data, treatment, and prognosis were compared between different groups. RESULTS Compared with the 2007-2011 group, the 2012-2016 group had higher rates of HFOV and PDA ligation (P<0.05), a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05). Compared with the conventional-frequency ventilation group, the HFOV group had a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05). Compared with the non-operation group, the operation group had a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05). CONCLUSIONS The application of HFOV and PDA ligation can improve the survival rate of preterm infants with pulmonary hemorrhage, but the incidence of intracranial hemorrhage and bronchopulmonary dysplasia is also increased.
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Affiliation(s)
- Wei-Wei Pan
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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Endotracheal adrenaline use a newborn with pulmonary hemorrhage: A case report. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.396931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Surgical Ligation Versus Percutaneous Closure of Patent Ductus Arteriosus in Very Low-Weight Preterm Infants: Which are the Real Benefits of the Percutaneous Approach? Pediatr Cardiol 2018; 39:398-410. [PMID: 29119215 DOI: 10.1007/s00246-017-1768-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016. All the antenatal, perinatal, and postnatal characteristics were collected. The main outcome was the assessment of the pulmonary status before and after ductal closure using a pulmonary score. Secondary outcomes included moderate-severe disability in neurodevelopment, death before discharge, moderate-severe chronic lung disease, and morbidity at discharge. 25 patients with a mean weight of 1330 g (± 280) underwent percutaneous closure of PDA with ADO-II-AS, and a total of 53 underwent surgical ligation. 28/53 with similar gestational age, birth weight, and procedure weight to those in the percutaneous group, were selected to perform the comparative study. Ductal closure (percutaneous and surgical) resulted in improved respiratory status. However, percutaneous group achieved a fastest respiratory improvement, than surgical group. The surgical closure group associated higher morbidity among survivors (HIV, number of sepsis, need, and duration of inotropics post-interventionism). The incidence of recurrent laryngeal nerve palsy among the surgical group was 17%. Percutaneous closure of PDA in carefully selected low-weight preterm infants is a safe and reliable alternative to surgical ligation.
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Kluckow M. The Pathophysiology of Low Systemic Blood Flow in the Preterm Infant. Front Pediatr 2018; 6:29. [PMID: 29503814 PMCID: PMC5820306 DOI: 10.3389/fped.2018.00029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/31/2018] [Indexed: 11/13/2022] Open
Abstract
Assessment and treatment of the VLBW infant with cardiovascular impairment requires understanding of the underlying physiology of the infant in transition. The situation is dynamic with changes occurring in systemic blood pressure, pulmonary pressures, myocardial function, and ductal shunt in the first postnatal days. New insights into the role of umbilical cord clamping in the transitional circulation have been provided by large clinical trials of early versus later cord clamping and a series of basic science reports describing the physiology in an animal model. Ultrasound assessment is invaluable in assessment of the physiology of the transition and can provide information about the size and shunt direction of the ductus arteriosus, the function of the myocardium and its filling as well as measurements of the cardiac output and an estimate of the state of peripheral vascular resistance. This information not only allows more specific treatment but it will often reduce the need for treatment.
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Affiliation(s)
- Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
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Mehler K, Udink Ten Cate FE, Keller T, Bangen U, Kribs A, Oberthuer A. An Echocardiographic Screening Program Helps to Identify Pulmonary Hypertension in Extremely Low Birthweight Infants with and without Bronchopulmonary Dysplasia: A Single-Center Experience. Neonatology 2018; 113:81-88. [PMID: 29131022 DOI: 10.1159/000480694] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) affects 1 in 6 infants with a birthweight <1,000 g (extremely low birthweight; ELBW) and is frequently associated with bronchopulmonary dysplasia (BPD). If untreated, the mortality rates of the disease are high. OBJECTIVES The aim of this study was to characterize risk factors for PH in ELBW infants and to describe the timing of onset of the disease by setting up a screening program. METHODS ELBW infants treated at the Department of Neonatology (level III neonatal intensive care unit at the University of Cologne Medical Centre, Germany) between January 2010 and March 2015 were included. Echocardiography screening for PH was performed either before discharge or if BPD was diagnosed. Additionally, infants had at least 1 echocardiographic scan after discharge. Survival with PH, age at diagnosis of PH, and risk factors associated with PH were assessed. RESULTS In total, 34/188 (18%) infants had PH. Of these, 14 (41%) were identified after discharge. Another 11 (32%) were diagnosed with PH without suffering from moderate or severe BPD. The risk factors for diagnosis of PH were moderate (odds ratio, OR 4 [2-8]) or severe BPD (OR 13 [2-71]), prolonged rupture of membranes >7 days (OR 5 [1-19]), and birthweight below the 3rd percentile (OR 3 [1-9]). All infants with PH before discharge and 50% diagnosed after discharge were treated with sildenafil (2.0 mg/kg/day). PH resolved and sildenafil was discontinued in all patients after a median duration of 13 months (IQR 8-20). CONCLUSIONS An echocardiographic screening program may help to identify infants with PH. Examinations should include all ELBW infants irrespective of the presence of BPD and be continued after discharge.
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Affiliation(s)
- Katrin Mehler
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
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Urinary NT-proBNP levels and echocardiographic parameters for patent ductus arteriosus. J Perinatol 2017; 37:1319-1324. [PMID: 28906496 DOI: 10.1038/jp.2017.139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/30/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patent ductus arteriosus (PDA) is common in preterm infants and is associated with significant morbidities. B type natriuretic peptide (BNP) is synthesized in the ventricles secondary to volume overload and excreted as urinary N-terminal pro-brain natriuretic peptide (NT-proBNP). STUDY DESIGN We report an observational prospective study of 64 preterm infants with birth weight ⩽1000 g. Echocardiographic parameters were obtained from clinical echocardiograms performed in the first week of life. Urinary NT-proBNP/creatinine ratios (pg mg-1) were measured on the same day of the echocardiograms. RESULTS Infants with medium to large PDA (n=39) had significantly higher NT-proBNP/creatinine levels compared with infants with small PDA (n=10) (median (IQ range): 2333 (792-6166) vs 714 (271-1632) pg mg-1, P=0.01) and compared with infants with no PDA (n=15) (2333 (792-6166) vs 390 (134-1085) pg mg-1, P=0.0003). Urinary NT-proBNP/creatinine ratios were significantly lower post treatment if PDA closed (n=17), P=0.001 or if PDA became smaller after treatment (n=9), P=0.004. Urinary NT-proBNP/creatinine levels correlated with ductal diameter (P⩽0.0001), but not with LA/Ao ratio (P=0.69) or blood flow velocity through the ductus (P=0.06). CONCLUSION Our findings indicate that there is a positive correlation between ductal diameter and urinary NT-proBNP in preterm infants.
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Huvanandana J, Thamrin C, Tracy MB, Hinder M, Nguyen CD, McEwan AL. Advanced analyses of physiological signals in the neonatal intensive care unit. Physiol Meas 2017; 38:R253-R279. [DOI: 10.1088/1361-6579/aa8a13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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