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Villamor E, Borges-Luján M, González-Luis G. Association of patent ductus arteriosus with fetal factors and endotypes of prematurity. Semin Perinatol 2023; 47:151717. [PMID: 36914506 DOI: 10.1016/j.semperi.2023.151717] [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
During fetal life, the ductus arteriosus (DA) acquires the mechanisms for its postnatal closure following a thorough developmental program. This program can be interrupted by preterm birth and is also susceptible to alteration during fetal life by numerous physiological and pathological stimuli. In this review, we aim to summarize the evidence on how physiological and pathological factors affect DA development, eventually leading to patent DA (PDA). Specifically, we reviewed the associations of sex, race, and pathophysiological pathways leading to very preterm birth (endotypes) with PDA incidence and pharmacological closure. Summary of evidence suggests that there are no male-female differences in the incidence of PDA among very preterm infants. In contrast, risk of developing PDA appears to be higher in infants exposed to chorioamnionitis or who are small for gestational age. Finally, hypertensive disorders of pregnancy may be associated with a better response to pharmacological treatment of PDA. All of this evidence comes from observational studies and therefore associations do not imply causation. The current trend for many neonatologists is to wait for the natural evolution of preterm PDA. Continued research is needed to identify which fetal and perinatal factors modulate the eventual late closure of PDA in very and extremely preterm infants.
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Affiliation(s)
- Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), School for Oncology and Reproduction (GROW), University of Maastricht, P. Debyelaan 25. P.O. Box 5800, Maastricht, AZ 6202, the Netherlands.
| | - Moreyba Borges-Luján
- Department of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil (CHUIMI) de Canarias, Las Palmas de Gran Canaria, Spain
| | - Gema González-Luis
- Department of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil (CHUIMI) de Canarias, Las Palmas de Gran Canaria, Spain
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Borges-Lujan M, Gonzalez-Luis GE, Roosen T, Huizing MJ, Villamor E. Sex Differences in Patent Ductus Arteriosus Incidence and Response to Pharmacological Treatment in Preterm Infants: A Systematic Review, Meta-Analysis and Meta-Regression. J Pers Med 2022; 12:jpm12071143. [PMID: 35887640 PMCID: PMC9321725 DOI: 10.3390/jpm12071143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
A widely accepted concept in perinatal medicine is that boys are more susceptible than girls to complications of prematurity. However, whether this ‘male disadvantage of prematurity’ also involves persistent patent ductus arteriosus (PDA) has been scarcely investigated. Our aim was to conduct a systematic review and meta-analysis on studies addressing sex differences in the risk of developing PDA among preterm infants. We also investigated whether the response to pharmacological treatment of PDA differs between boys and girls. PubMed/Medline and Embase databases were searched. The random-effects male/female risk ratio (RR) and 95% confidence interval (CI) were calculated. We included 146 studies (357,781 infants). Meta-analysis could not demonstrate sex differences in risk of developing any PDA (37 studies, RR 1.03, 95% CI 0.97 to 1.08), hemodynamically significant PDA (81 studies, RR 1.00, 95% CI 0.97 to 1.02), or in the rate of response to pharmacological treatment (45 studies, RR 1.01, 95% CI 0.98 to 1.04). Subgroup analysis and meta-regression showed that the absence of sex differences was maintained over the years and in different geographic settings. In conclusion, both the incidence of PDA in preterm infants and the response rate to pharmacological treatment of PDA are not different between preterm boys and girls.
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Affiliation(s)
- Moreyba Borges-Lujan
- Department of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil (CHUIMI) de Canarias, 35016 Las Palmas de Gran Canaria, Spain; (M.B.-L.); (G.E.G.-L.)
| | - Gema E. Gonzalez-Luis
- Department of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil (CHUIMI) de Canarias, 35016 Las Palmas de Gran Canaria, Spain; (M.B.-L.); (G.E.G.-L.)
| | - Tom Roosen
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), School for Oncology Reproduction (GROW), 6202 Maastricht, The Netherlands; (T.R.); (M.J.H.)
| | - Maurice J. Huizing
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), School for Oncology Reproduction (GROW), 6202 Maastricht, The Netherlands; (T.R.); (M.J.H.)
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), School for Oncology Reproduction (GROW), 6202 Maastricht, The Netherlands; (T.R.); (M.J.H.)
- Correspondence:
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Schenone CV, Argoti P, Goedecke P, Mari G. Neonatal blood pressure before and after delayed umbilical cord clamping. J Matern Fetal Neonatal Med 2021; 35:5260-5264. [PMID: 33478292 DOI: 10.1080/14767058.2021.1876656] [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: 10/22/2022]
Abstract
OBJECTIVE To describe values of blood pressure (BP) before and after delayed cord clamping (DCC) in healthy term neonates born to low risk pregnancies, examine differences in the temporal patterns of BP during this transition, and assess potential correlation of these parameters with maternal and perinatal clinical and demographic variables. METHODS Prospective observational study of term infants eligible for DCC born vaginally from uncomplicated pregnancies. Neonatal BP was estimated noninvasively before DCC, at 30 min and 24 h of life. Median, minimum, maximum, mean and standard deviation, as well as percentiles for BP values were calculated. Pearson correlation assessed the correlation between demographic and clinical variables and BP measurements. Spearman correlation studied the association between BP parameters prior to DCC and Apgar scores. Repeated measures ANOVA and Tukey post hoc analyses were used to compare BP measurements over time. A p-value of <.05 was considered significant. RESULTS A total of 54 patients were included. Mean neonatal birthweight was 3185 g and gestational age 39/3 weeks. The mean values for the systolic, diastolic, and mean BP prior to DCC were 97 ± 24.9 mmHg, 58 ± 21.9 mmHg and 67 ± 27.7 mmHg respectively. A statistically significant difference was detected when comparing BP values obtained before DCC with those measured afterwards (Figure 1). A positive correlation was found between SBP and MAP prior to DCC and Apgar scores at 1 min. [Figure: see text]. CONCLUSION We describe novel values of BP before DCC in healthy term infants following vaginal delivery. Data suggest that neonates whose cord is clamped in a delayed fashion experience an increase blood pressures immediately after birth, followed by a significant drop within 30 min to levels that remain unchanged at 24 h of life. BP values obtained after DCC in our study are similar to those found by previous authors. Further studies are needed to determine the clinical significance of these findings and assess the potential of BP prior to DCC to evaluate immediate postnatal adaptation. LIMITATIONS Results generalizability may have been limited by varying degrees of neonatal resuscitation, inability to perform more than one measurement before cord clamping ensued, as well as an unequal distribution of self-reported race in our cohort. Also, noninvasive BP estimates have proven less accurate that invasive methods. Finally, our cohort was comprised by a relatively small sample and larger studies will be required to corroborate our findings.
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Affiliation(s)
- Claudio V Schenone
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pedro Argoti
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patricia Goedecke
- Department of Biostatistics, Epidemiology and Research Design, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Giancarlo Mari
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics and Gynecology, Cleveland Clinic, Women's Health Institute, Cleveland, OH, USA
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Lavoie JC, Chessex P. Parenteral nutrition and oxidant stress in the newborn: A narrative review. Free Radic Biol Med 2019; 142:155-167. [PMID: 30807828 DOI: 10.1016/j.freeradbiomed.2019.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 01/27/2023]
Abstract
There is strong evidence that oxidant molecules from various sources contaminate solutions of parenteral nutrition following interactions between the mixture of nutrients and some of the environmental conditions encountered in clinical practice. The continuous infusion of these organic and nonorganic peroxides provided us with a unique opportunity to study in cells, in vascular and animal models, the mechanisms involved in the deleterious reactions of oxidation in premature infants. Potential clinical impacts of peroxides infused with TPN include: a redox imbalance, vasoactive responses, thrombosis of intravenous catheters, TPN-related hepatobiliary complications, bronchopulmonary dysplasia and mortality. This is a narrative review of published data.
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Affiliation(s)
- Jean-Claude Lavoie
- Centre de Recherche Hôpital Ste-Justine, Department of Nutrition, University of Montreal, Montreal, QC, Canada
| | - Philippe Chessex
- Division of Neonatology, Department of Pediatrics, Children's and Women's Health Center of British Columbia, University of British Columbia, Vancouver, BC, Canada.
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Laborie S, Denis A, Dassieu G, Bedu A, Tourneux P, Pinquier D, Kermorvant E, Millet V, Klosowski S, Patural H, Clamadieu C, Brunhes A, Walther M, Jaisson-Hot I, Mandy B, Claris O. Shielding Parenteral Nutrition Solutions From Light. JPEN J Parenter Enteral Nutr 2014; 39:729-37. [DOI: 10.1177/0148607114537523] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Sophie Laborie
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
- Hospices Civils de Lyon-Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Gilles Dassieu
- Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Antoine Bedu
- Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | - Didier Pinquier
- Centre Hospitalier Universitaire–Hôpital Charles-Nicolle, Rouen, France
| | - Elsa Kermorvant
- Assistance Publique/Hôpitaux de Paris-Hôpital Necker-Enfants Malades, Paris, France
- Université Paris Descartes, Paris, France
| | - Véronique Millet
- Assistance Publique–Hôpitaux de Marseille–Hôpital de la Conception, Marseille, France
| | | | - Hugues Patural
- Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | | | | | | | - Bruno Mandy
- Hospices Civils de Lyon, Hôpital René Sabran, Giens, France
| | - Olivier Claris
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
- Hospices Civils de Lyon-Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- Université Claude Bernard Lyon 1, Lyon, France
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Elremaly W, Rouleau T, Lavoie JC. Inhibition of hepatic methionine adenosyltransferase by peroxides contaminating parenteral nutrition leads to a lower level of glutathione in newborn Guinea pigs. Free Radic Biol Med 2012; 53:2250-5. [PMID: 23085223 DOI: 10.1016/j.freeradbiomed.2012.10.541] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/24/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022]
Abstract
Premature newborn infants on total parenteral nutrition (TPN) are at risk of oxidative stress because of peroxides contaminating TPN and low glutathione level. Low cysteine availability limits glutathione synthesis. In this population, the main source of cysteine derives from the hepatic conversion of methionine. The first enzyme of this conversion, methionine adenosyltransferase (MAT), contains redox-sensitive cysteinyl residues. We hypothesize that inhibition of MAT by peroxides contaminating TPN leads to a lower availability of cysteine for glutathione synthesis. At 3 days of life, animals were fitted with a jugular catheter for intravenous infusion. Four groups were compared by ANOVA (P<0.05): (1) Control, without surgery, fed regular chow; (2) Sham, fitted with an obstructed catheter, fed orally regular chow; (3) TPN, fed exclusively TPN (dextrose, amino acids, fat, vitamins) containing 350 μM peroxides; (4) H2O2, fed regular chow orally and infused with 350 μM H2O2. Four days later, MAT activity and glutathione in liver and blood were lower in TPN and H2O2 groups. The redox potential was more oxidized in blood and liver of the TPN group. In conclusion, peroxides generated in TPN inhibit methionine adenosyltransferase activity with, among consequences, a low level of glutathione and a more oxidized redox potential.
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Affiliation(s)
- Wesam Elremaly
- Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5; Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5
| | - Thérèse Rouleau
- Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5; Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5
| | - Jean-Claude Lavoie
- Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5; Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5.
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Influence of shielding TPN from photooxidation on the number of early blood transfusions in ELBW premature neonates. J Pediatr Gastroenterol Nutr 2012; 55:398-402. [PMID: 22487951 DOI: 10.1097/mpg.0b013e318258761b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The smallest premature neonates often receive blood transfusions early in life. Nonrestrictive transfusion policies are linked to deleterious outcomes. Exposure of total parenteral nutrition (TPN) to ambient light generates oxidation products associated with haemolysis in vitro. Shielding TPN from light limits oxidation. Our hypothesis was protecting TPN from light decreases haemolysis and therefore the need for early blood transfusions. METHODS Comparison of haemolysis between animals fed enterally and those receiving TPN, and exploratory case-control retrospective analysis of transfusion counts in premature infants receiving light-exposed or light-protected TPN. The statistical analysis was analysis of variance and longitudinal binomial regression model adjusting for potential covariables of transfusion counts. RESULTS In animals, TPN is associated with higher (P<0.05) haemolysis compared with enteral feeds; photoprotection induces lower peroxide load with no effect on the level of haemolysis. In premature infants, light-exposed (n=76) or light-protected (n=57) populations exhibited similar clinical characteristics. Initial haematocrit, gestational age, and index of disease severity had a significant effect on the number of transfusions. When adjusting for these covariables, photoprotection was no longer significant. CONCLUSIONS Even though peroxides are associated in vitro with haemolysis, shielding TPN from light to reduce infused peroxides does not significantly decrease the need for early transfusions in premature infants.
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IMAMURA TAKASHI, MOMOI NOBUO, GO HAYATO, OGASAWARA KEI, KANAI YUJI, SATO MAKI, GOTO AYA, HOSOYA MITSUAKI. EVALUATION OF ARTERIAL CATHETER MANAGEMENT IN VERY PRETERM NEONATES: PERIPHERAL ARTERY VERSUS UMBILICAL ARTERY. Fukushima J Med Sci 2012; 58:1-8. [DOI: 10.5387/fms.58.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kleiber N, Chessex P, Rouleau T, Nuyt AM, Perreault M, Lavoie JC. Neonatal exposure to oxidants induces later in life a metabolic response associated to a phenotype of energy deficiency in an animal model of total parenteral nutrition. Pediatr Res 2010; 68:188-92. [PMID: 20543762 DOI: 10.1203/pdr.0b013e3181ebb541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Failure to protect total parenteral nutrition (TPN) from ambient light exacerbates the generation of peroxides, which affects blood glucose and plasma triacylglyceride (TG) in neonates. Based on the concept that the origin of adult diseases can be traced back to perinatal life, it was hypothesized that neonatal exposure to peroxides may affect energy availability later in life. Three-day-old guinea pigs, fitted with a jugular catheter, were fed regular chow (sham) +/- i.v. 350 microM H2O2 (sham + H2O2) or nourished with light-protected TPN [TPN(-)L, 209 +/- 9 microM peroxides] or light-exposed TPN [TPN(+)L, 365 +/- 15 microM peroxides]. After 4 d, infusions were stopped and animals fed chow. Spontaneous ambulatory movements, fasting blood glucose, glucose tolerance, TG, hepatic activities of glucokinase, phosphofructokinase (key enzymes of glycolysis), and acetyl-CoA carboxylase (key enzymes of lipogenesis) were determined at 12-14 wk and compared by ANOVA (p < 0.05). Relative to sham, the animals from sham + H2O2, TPN(-)L and TPN(+)L groups had lower plasma TG explained for 36% by low phosphofructokinase activity; they had lower glucose tolerance, lower body weight, and lower physical activity. In conclusion, neonatal exposure to oxidant molecules such as peroxides has important consequences later in life on lipid and glucose metabolism leading to a phenotype of energy deficiency.
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Affiliation(s)
- Niina Kleiber
- Department of Pediatrics, CHU Sainte-Justine, University of Montréal, 3175 Chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
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Turcot V, Rouleau T, Tsopmo A, Germain N, Potvin L, Nuyt AM, Lavoie JC. Long-term impact of an antioxidant-deficient neonatal diet on lipid and glucose metabolism. Free Radic Biol Med 2009; 47:275-82. [PMID: 19409486 DOI: 10.1016/j.freeradbiomed.2009.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 03/31/2009] [Accepted: 04/23/2009] [Indexed: 01/29/2023]
Abstract
Newborn infants are at risk for oxidative stress leading to metabolic syndrome features. Oxidative stress can be induced by oxidant load such as oxygen supplementation, peroxides from intravenous nutrition, or low antioxidant defenses. We hypothesize that a modulation of antioxidant defenses during the neonatal period, without external oxidant challenge, will have a long-term influence on energy metabolism. Guinea pigs were fed between their third and their seventh day of life a regular chow leading to "mature" antioxidant defenses or a deficient chow leading to lower antioxidant defenses. Between weeks 1 and 14, the animals were fed regular chow. The hepatic oxidized redox status of glutathione associated with the deficient diet (-221 +/- 2 vs -228 +/- 1 mV, p < 0.01) was maintained until 14 weeks. At 13-14 weeks, animals fed the deficient diet presented lower plasma TG (479 +/- 57 vs 853 +/- 32 microM, p < 0.01), lower blood glucose (5.8 +/- 0.3 vs 6.9 +/- 0.3 mM, p < 0.05), and better tolerance to glucose (p < 0.05). Blood glucose correlated negatively with the redox status (r2 = 0.47, p < 0.01). Low antioxidant defenses during the neonatal period induce a better energy substrate profile associated with an oxidized redox status later in life. These findings suggest being aware of negative consequences when adopting "aggressive" antioxidant therapies in newborn infants.
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Affiliation(s)
- Valérie Turcot
- Department of Nutrition, CHU Sainte-Justine, Faculty of Medicine, University of Montréal, Montréal, QC, Canada H3T 1C5
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