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Chen YX, Xiao TT, Chen HY, Chen X, Wang YQ, Ni Q, Wu BB, Wang HJ, Lu YL, Hu LY, Cao Y, Cheng GQ, Wang LS, Xiao FF, Yang L, Dong XR, Zhou WH. Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors. World J Pediatr 2023; 19:1192-1202. [PMID: 37318723 DOI: 10.1007/s12519-023-00733-7] [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: 01/04/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hemodynamically significant patent ductus arteriosus (hsPDA) is associated with increased comorbidities in neonates. Early evaluation of hsPDA risk is critical to implement individualized intervention. The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions. METHODS We enrolled infants who were diagnosed with PDA and performed exome sequencing. The collapsing analyses were used to find the risk gene set (RGS) of hsPDA for model construction. The credibility of RGS was proven by RNA sequencing. Multivariate logistic regression was performed to establish models combining clinical and genetic features. The models were evaluated by area under the receiver operating curve (AUC) and decision curve analysis (DCA). RESULTS In this retrospective cohort study of 2199 PDA patients, 549 (25.0%) infants were diagnosed with hsPDA. The model [all clinical characteristics selected by least absolute shrinkage and selection operator regression (all CCs)] based on six clinical variables was acquired within three days of life, including gestational age (GA), respiratory distress syndrome (RDS), the lowest platelet count, invasive mechanical ventilation, and positive inotropic and vasoactive drugs. It has an AUC of 0.790 [95% confidence interval (CI) = 0.749-0.832], while the simplified model (basic clinical characteristic model) including GA and RDS has an AUC of 0.753 (95% CI = 0.706-0.799). There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice. The AUC of the models was improved by RGS, and the improvement was significant (all CCs vs. all CCs + RGS: 0.790 vs. 0.817, P < 0.001). DCA demonstrated that all models were clinically useful. CONCLUSIONS Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life. Genetic features might further improve the model performance. Video Abstract (MP4 86834 kb).
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Affiliation(s)
- Yu-Xi Chen
- Center for Molecular Medicine of Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai, China
| | - Tian-Tian Xiao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hui-Yao Chen
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xiang Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ya-Qiong Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Bing-Bing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Hui-Jun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yu-Lan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Li-Yuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guo-Qiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lai-Shuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Fei-Fan Xiao
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Lin Yang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xin-Ran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Wen-Hao Zhou
- Center for Molecular Medicine of Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai, China.
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Ishida S, Yamaguchi A, Ooka M, Kenmochi M, Nakanishi H. Evaluation of postoperative complications for patent ductus arteriosus in extremely-low-birthweight infants. Pediatr Int 2022; 64:e14759. [PMID: 33930217 DOI: 10.1111/ped.14759] [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: 11/30/2020] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patent ductus arteriosus (PDA), which disrupts the hemodynamics early after birth, causes intraventricular hemorrhage and neonatal necrotizing. Unlike medical treatment for hemodynamically significant PDA, there are institutional disparities in the criteria for surgical treatment METHODS: We aimed to clarify the postoperative indications of surgery for hemodynamically significant PDA and the postoperative complications associated with surgery. RESULTS Thirty-six extremely-low-birthweight infants (median gestational age 25.2 weeks, median birthweight 699 g) required video-assisted thoracoscopic surgery for PDA (VATS-PDA). The treatment indication of VATS-PDA was resistance to medical treatment in 17 cases, relapsed PDA in 15 cases, and no additional administration of indomethacin because of severe side effects in four cases. Complications with VATS-PDA occurred in eight of 36 cases. There were three cases of pneumothorax, two of thoracotomy transition, two of pulmonary hemorrhage, and four of post-ligation cardiac syndrome (PLCS). VATS-PDA-related death occurred in two cases due to PLCS. The frequency of four or more administrations of indomethacin, with or without postoperative complications, was 88% vs. 39%, respectively (P = 0.04). CONCLUSIONS All postoperative deaths were caused by PLCS, which had the highest risk of poor prognosis. VATS-PDA should be considered for unclosed PDA after one course of indomethacin administration.
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Affiliation(s)
- Shuji Ishida
- Department of Pediatrics, Kitasato University Hospital, Kanagawa, Japan
| | - Ayano Yamaguchi
- Department of Pediatrics, Kitasato University Hospital, Kanagawa, Japan
| | - Mari Ooka
- Department of Pediatrics, Kitasato University Hospital, Kanagawa, Japan
| | - Manabu Kenmochi
- Department of Pediatrics, Kitasato University Hospital, Kanagawa, Japan
| | - Hidehiko Nakanishi
- Department of Pediatrics, Kitasato University Hospital, Kanagawa, Japan.,Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
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Wang H, Jain A, Weisz DE, Moraes TJ. Trends in patent ductus arteriosus ligation in neonates and changes in outcomes: A 10-year multicenter experience. Pediatr Pulmonol 2021; 56:3250-3257. [PMID: 34288596 DOI: 10.1002/ppul.25576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022]
Abstract
RATIONALE The management of neonates with patent ductus arteriosus (PDA) has changed over time. METHODS We conducted a single-city, retrospective review of neonates who underwent PDA ligation over a 10-year time period and compared infants from the first 5 years to the second 5 years to evaluate how clinical characteristics changed over this time. RESULTS Infants from the second 5-year epoch were older at time of ligation (38 vs. 30 days), had a higher ligation weight (1432 vs. 1121 g) and a lower incidence of postligation cardiac syndrome (1.9% vs. 11.5%). No differences in mortality, length of hospital-stay or major morbidities were seen. Compared to neonates who underwent PDA ligation at ≤28 days of life, those with a ligation age >28 days had a higher ligation weight (1421 vs. 1039 g), a higher proportion of COX inhibitor use (92.5% vs. 83.8%), and a higher incidence of moderate-severe bronchopulmonary dysplasia (BPD) (60.4% vs. 44.4%). Only 10.7% (25/233) patients were evaluated by laryngoscopy, in which the incidence of vocal cord paralysis (VCP) was 36.0%; 2 patients were clinically diagnosed with VCP for a total 4.7% incidence of VCP (11/233). CONCLUSIONS Over the 10 years examined, neonates underwent PDA ligation at an older age in the second 5-year time period; this change was not associated with a change in the incidence of major morbidities. Ligation age >28 days was associated with an increase incidence of moderate-severe BPD. The overall incidence of documented VCP post-PDA ligation was relatively low but was seen in over 1/3 who were evaluated by laryngoscopy.
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Affiliation(s)
- Huanhuan Wang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Amish Jain
- Division of Neonatal/Perinatal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dany E Weisz
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Cayabyab RG, Song A, Ramanathan R, Friedlich P, Lakshmanan A. Proportion of Retinopathy of Prematurity That Was Treated across Regions in the United States. Am J Perinatol 2021; 38:581-589. [PMID: 31739361 DOI: 10.1055/s-0039-1700855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Retinopathy of prematurity (ROP) is the leading preventable cause of blindness in children worldwide. Major eye and visual problems are strongly linked to ROP requiring treatment. Objectives of the study are to: (1) evaluate the trends and regional differences in the proportion of treated ROP, (2) describe risk factors, and (3) examine if treated ROP predicts mortality. STUDY DESIGN Retrospective data analysis was conducted using the Kids' Inpatient Database from 1997 to 2012. ROP was categorized into treated ROP (requiring laser photocoagulation or surgical intervention) and nontreated ROP. Bivariate and multivariate logistic regression analyses were performed. RESULTS Out of 21,955,949 infants ≤ 12 months old, we identified 70,541 cases of ROP and 7,167 (10.2%) were treated. Over time, the proportion of treated ROP decreased (p = < 0.001). While extremely low birth weight infants cared for in the Midwest was associated with treated ROP (adjusted odds ratio [aOR] = 29.05; 95% confidence interval [CI]: 10.64-79.34), black race (aOR = 0.57; 95% CI: 0.51-0.64) care for in the birth hospital (aOR = 0.44; 95% CI: 0.41-0.48) was protective. Treated ROP was not associated with mortality. CONCLUSION The proportion of ROP that is surgically treated has decreased in the United States; however, there is variability among the different regions. Demographics and clinical practice may have contributed for this variability.
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Affiliation(s)
- Rowena G Cayabyab
- Division of Neonatalogy, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashley Song
- Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatalogy, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Philippe Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashwini Lakshmanan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Keck School of Medicine, University of Southern California, Los Angeles, California
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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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Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1500g: a 9-year single center experience. J Cardiothorac Surg 2020; 15:144. [PMID: 32552772 PMCID: PMC7298442 DOI: 10.1186/s13019-020-01191-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management. METHODS Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 preterm neonates weighing less than 1500g with HSPDA were enrolled in our study. Of these preterm neonates, 134 underwent surgical ligation and were subdivided into the early ligation group (n = 49; within 10 days of age) and the late ligation group (n = 85; after 10 days of age). RESULTS The mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group (p < 0.001). PDA ductal diameter > 2.0 mm (p < 0.001), low Apgar score at 5 min (p = 0.033), and chorioamnionitis (p = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis (p = 0.004), mechanical ventilator time > 4 weeks (p = 0.007), necrotizing enterocolitis stage (NEC) ≥ III (p = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III (p = 0.035). CONCLUSIONS Early surgical ligation minimizes the adverse effects of HSPDA in predicted preterm neonates who subsequently require surgical treatment for PDA. This result suggests that in preterm neonates weighing less than 1500g with HSPDA that is unresponsive to medical treatment, delayed ductal closure should be avoided to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.
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Yan H, Ma F, Li Y, Zhou K, Hua Y, Wan C. The optimal timing of surgical ligation of patent ductus arteriosus in preterm or very-low-birth-weight infants: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19356. [PMID: 32118777 PMCID: PMC7478603 DOI: 10.1097/md.0000000000019356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a particularly common problem in preterm infants. Although surgical ligation is rarely performed in many contemporary neonatal intensive care units, it remains a necessary treatment option for preterm infants with a large hemodynamically significant PDA under strict clinical criteria, and it can reduce mortality in preterm infants. However, the optimal timing of surgical ligation is still controversial. We conducted this systematic review and meta-analysis to compare the mortality and morbidity of early and late surgical ligation of PDA in preterm or very-low-birth-weight (VLBW) infants. METHODS This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019133686). We searched the databases of PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform up to May 2019. RESULTS This review included 6 retrospective studies involving 397 premature or VLBW infants with PDA. Pooled analysis showed that compared with the late ligation group, the early ligation group had a lower fraction of inspired oxygen (FiO2) at 24 hours postoperatively (mean difference [MD] -6.34, 95% confidence interval [CI] -9.45 to -3.22), fewer intubation days (MD -19.69, 95% CI -29.31 to -10.07), earlier date of full oral feeding (MD -22.98, 95% CI -28.63 to -17.34) and heavier body weight at 36 weeks of conceptional age (MD 232.08, 95% CI 57.28 to 406.88). No significant difference in mortality or other complications was found between the early and late groups. CONCLUSION Our meta-analysis implies that compared with late surgical ligation, early ligation might have a better respiratory outcome and nutritional status for PDA in preterm or VLBW infants. There was no difference in mortality or postoperative complications between early and late ligation. A randomized prospective clinical trial with a possible large sample size is urgently needed to reinvestigate this conclusion. PROSPERO REGISTRATION NUMBER CRD42019133686.
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Affiliation(s)
- Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University
| | - Fan Ma
- Department of Pediatrics
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yifei Li
- Department of Pediatrics
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Department of Pediatrics
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Department of Pediatrics
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chaomin Wan
- West China School of Medicine, Sichuan University
- Department of Pediatrics
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
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Mirza H, Garcia J, McKinley G, Hubbard L, Sensing W, Schneider J, Oh W, Wadhawan R. Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants. J Perinatol 2019; 39:1648-1655. [PMID: 31554913 DOI: 10.1038/s41372-019-0496-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/01/2019] [Accepted: 07/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To demonstrate the association between the duration of significant patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD) in extremely preterm infants. METHODS All extremely preterm infants (<29 weeks) treated in our Neonatal Intensive Care Unit from January 2013 to March 2016 were included if their PDA status was confirmed at <7 days of life. Infants with genetic syndromes, complex congenital anomalies and insignificant PDAs were excluded. Total duration of significant PDA was estimated by reviewing serial echocardiograms. Significant PDA was diagnosed using our scoring system that was based upon echocardiographic parameters and clinical status of the infants. Study cohort was divided into four groups based on the duration of significant PDA. Group A-No PDA, Group B-PDA <1-week, Group C- PDA 1-2 weeks, and Group D-PDA >2 weeks. ANOVA and multivariate analysis were performed to compare the groups. RESULTS There were 147 infants with no PDA (Group A), 50, 35, and 41 infants were enrolled in Groups B, C, and D, respectively. There were no differences in maternal and neonatal variables among groups except for the following: maternal smoking, chorioamnionitis, antenatal indomethacin, gestation, birth weight, mode of delivery and incidence of death or BPD. Logistic regression analysis showed that longer duration of significant PDA was associated with higher risk for death or BPD (adjusted OR 1.37, 95% CI 1.03-1.82). CONCLUSION Longer duration of significant PDA is associated with the higher risk for BPD/death in extremely preterm infants.
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Affiliation(s)
- Hussnain Mirza
- Center for Neonatal Care, Advent Health for Children/ UCF College of Medicine, Orlando, FL, USA.
| | - Jorge Garcia
- Division of Pediatric Cardiology, Advent Health for Children, Orlando, FL, USA
| | - Genevieve McKinley
- Pediatric Residency Program, Advent Health for Children, Orlando, Fl, USA
| | - Laura Hubbard
- Center for Neonatal Care, Advent Health for Children/ UCF College of Medicine, Orlando, FL, USA
| | - Wendla Sensing
- Pediatric Residency Program, Advent Health for Children, Orlando, Fl, USA
| | - Jordan Schneider
- Pediatric Residency Program, Advent Health for Children, Orlando, Fl, USA
| | - William Oh
- Office of Research Advancement and Support, Florida Hospital, Orlando, FL, USA
| | - Rajan Wadhawan
- Center for Neonatal Care, Advent Health for Children/ UCF College of Medicine, Orlando, FL, USA
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