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Golombek SG, Rodríguez S, Montes Bueno MT, Mir R, Fariña D, Cardetti M, Sola A. Nutrition of the Healthy and Sick Newborn: Twelfth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN). Neoreviews 2022; 23:716-737. [PMID: 36316252 DOI: 10.1542/neo.23-10-e716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Sola A, Mir R, Lemus L, Fariña D, Ortiz J, Golombek S. Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN). Neoreviews 2020; 21:e505-e534. [PMID: 32737171 DOI: 10.1542/neo.21-8-e505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics.
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Affiliation(s)
- Augusto Sola
- Medical Director, Ibero-American Society of Neonatology, Wellington, FL
| | - Ramón Mir
- Neonatology Department Chief in Hospital de Clìnicas Universidad Nacional de Asunciòn, Paraguay
| | - Lourdes Lemus
- Departamento de Neonatología, Hospital de Pediatría UMAE, Instituto Mexicano del Seguro Social, Guadalajara Jalisco, México
| | - Diana Fariña
- Director of the Neonatal Intensive Care Unit, Hospital de Pediatría, Buenos Aires, Argentina
| | - Javier Ortiz
- Ángeles del Pedregal Hospital, Mexico City, Mexico
| | - Sergio Golombek
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
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Sola A, Rodríguez S, Young A, Lemus Varela L, Villamayor RM, Cardetti M, Pleitez Navarrete J, Favareto MV, Lima V, Baquero H, Velandia Forero L, Venegas ME, Davila C, Dominguez Dieppa F, Germosén TM, Oviedo Barrantes AN, Alvarez Castañeda AL, Morgues M, Avila A, Fariña D, Oliva JL, Sosa E, Golombek S. CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN). Int J Neonatal Screen 2020; 6:21. [PMID: 33073018 PMCID: PMC7422978 DOI: 10.3390/ijns6010021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022] Open
Abstract
Congenital heart disease (CHD) is among the four most common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. Here, we describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN), as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve the neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we have participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges in implementing POS, significant progress has been made. We conclude that universal POS is not easy to implement in Latin America but, when executed, has not only been of significant value for babies with CHD, but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential for reducing the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns' lives in Latin America.
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Affiliation(s)
- Augusto Sola
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Susana Rodríguez
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Alejandro Young
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Lourdes Lemus Varela
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ramón Mir Villamayor
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Marcelo Cardetti
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Jorge Pleitez Navarrete
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - María Verónica Favareto
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Victoria Lima
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Hernando Baquero
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
- Dean School of Medicine, Universidad del Norte, Km. 5 Vía Puerto Colombia, Barranquilla 081007, Colombia
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - Lorena Velandia Forero
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - María Elena Venegas
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - Carmen Davila
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Fernando Dominguez Dieppa
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Taína Malena Germosén
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ada Nidia Oviedo Barrantes
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ana Lorena Alvarez Castañeda
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Mónica Morgues
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Aldana Avila
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Diana Fariña
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Jose Luis Oliva
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Erika Sosa
- Pediatric Cardiology, Children's Hospital, Hermosillo 83100, Mexico;
| | - Sergio Golombek
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
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Impacto sobre la función ventricular izquierda del cierre quirúrgico de ductus arterioso persistente en recién nacidos de menos de 1.500 g. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gálvez-Cuitiva E, Lonngi-Rojas G. Uso del paracetamol para el cierre del conducto arterioso en recién nacidos con edad gestacional menor a 35 semanas. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Repercusión hemodinámica en pacientes neonatos con conducto arterioso persistente: factores asociados. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:248-251. [DOI: 10.1016/j.acmx.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 11/21/2022] Open
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Jimenez-Aceituna A, Arribas-Leal JM, Perez-Andreu J, Canovas-Lopez SJ. Escala de riesgo Aristóteles como factor predictor de mortalidad en el cierre quirúrgico de persistencia de ductus arterioso en prematuros. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Montaner Ramón A, Galve Pradel Z, Fernández Espuelas C, Jiménez Montañés L, Samper Villagrasa MP, Rite Gracia S. Usefulness of brain natriuretic propeptide in the diagnosis and management of patent ductus arteriosus. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cordero-González G, Gómez-Tamayo T, Santillán-Briceño V, Machuca-Vaca A, Fernández-Carrocera L. Experiencia con ibuprofeno para el tratamiento de la persistencia de conducto arterioso en un hospital de tercer nivel en la Ciudad de México. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Montaner Ramón A, Galve Pradel Z, Fernández Espuelas C, Jiménez Montañés L, Samper Villagrasa MP, Rite Gracia S. [Usefulness of brain natriuretic propeptide in the diagnosis and management of patent ductus arteriosus]. An Pediatr (Barc) 2016; 86:321-328. [PMID: 26936584 DOI: 10.1016/j.anpedi.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA. PAIENTS AND METHODS A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. RESULTS Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33338±34494.47pg/mL; p=.000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8±14910.9; p=.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs -12.22±99.4%; p=.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%). CONCLUSIONS ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.
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Affiliation(s)
- Alicia Montaner Ramón
- Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España.
| | - Zenaida Galve Pradel
- Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España
| | | | - Lorenzo Jiménez Montañés
- Unidad de Cardiología pediátrica, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España
| | | | - Segundo Rite Gracia
- Unidad de Neonatología, Servicio de Pediatría, Hospital Infantil Miguel Servet, Zaragoza, España
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Peña-Juárez RA, Medina-Andrade MA, Martínez-González MT, Gallardo-Meza AF, Cortez-Comparan D, Piña-Garay MA. Cierre de conducto arterioso con paracetamol: estudio piloto. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peña-Juárez RA, Medina-Andrade MA, Martínez-González MT, Gallardo-Meza AF, Cortez-Comparan D, Piña-Garay MA. Ductus Arteriosus Closure With Paracetamol: a Pilot Study. ACTA ACUST UNITED AC 2015; 68:441-2. [PMID: 25792285 DOI: 10.1016/j.rec.2014.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/24/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Rocío A Peña-Juárez
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico.
| | - Miguel A Medina-Andrade
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - María T Martínez-González
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Antonio F Gallardo-Meza
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Daniel Cortez-Comparan
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Miguel A Piña-Garay
- División de Pediatría, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
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González Pérez J, Orden Rueda C, de la Cuesta Martín CR, Galve Pradel Z, Rite Gracia S. [Cerebral oximetry in the management of ductus arteriosus]. An Pediatr (Barc) 2014; 82:54-5. [PMID: 24726627 DOI: 10.1016/j.anpedi.2014.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- J González Pérez
- Unidad de Neonatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Orden Rueda
- Unidad de Neonatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - Z Galve Pradel
- Unidad de Neonatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - S Rite Gracia
- Unidad de Neonatología, Hospital Universitario Miguel Servet, Zaragoza, España.
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Batlivala SP, Glatz AC, Gillespie MJ, Dori Y, Rome JJ. Ductal spasm during performance of transcatheter ductal occlusion. Catheter Cardiovasc Interv 2013; 83:762-7. [PMID: 23832584 DOI: 10.1002/ccd.25120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/30/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Transcatheter patent ductus arteriosus (PDA) occlusion is a staple of pediatric catheterization laboratories. We present the phenomenon of significant PDA spasm to prevent failure to occlude a hemodynamically significant duct. BACKGROUND Transcatheter techniques have evolved, allowing safe and effective occlusion of PDAs in younger and smaller patients. Neonatal care is evolving with increasing survival at younger gestational ages. Premature infants often have PDAs, so the proportion of formerly premature children referred for transcatheter ductal occlusion will likely rise. METHODS We reviewed all transcatheter PDA occlusions performed at our institution since 2001 (N = 331). Retrospective data included: gestational age, age at catheterization, precatheterization echocardiographic parameters, PDA size (after spasm relief), device specifications, and most recent follow-up data. RESULTS Seven cases were identified. Median age was 12 months, median gestational age was 28 weeks. All were born prematurely. All PDAs were restrictive and six had left-heart volume overload. All patients were examined by the interventional cardiologist and had ductal murmurs. When reauscultated (three of seven), murmurs were absent during spasm. Once spasm relieved, PDA diameters ranged from 1.5 to 8 (median 2) mm. All patients accommodated a 6-mm-or larger-Amplatzer device. No significant complications occurred and all patients were well at follow-up. CONCLUSIONS Ductal spasm occurs during transcatheter occlusion and may be an unrecognized cause of procedural failure. The phenomenon seems to occur in children born prematurely, and can occur after infancy. Loss of a continuous murmur confirms the diagnosis. Care should be taken to avoid device under-sizing when spasm occurs.
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Affiliation(s)
- Sarosh P Batlivala
- Division of Cardiology, The Children's Hospital of Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania; Division of Cardiology, Batson Children's Hospital, Jackson, MS; Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
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Mitra S, Rønnestad A, Holmstrøm H. Management of patent ductus arteriosus in preterm infants--where do we stand? CONGENIT HEART DIS 2013; 8:500-12. [PMID: 24127861 DOI: 10.1111/chd.12143] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 01/25/2023]
Abstract
Patent ductus arteriosus (PDA) in preterm infants is a controversial topic in the management of preterm neonates. There are no generally accepted guidelines for diagnosis, treatment, and follow-up of PDA, and few publications have covered the whole topic or have been conclusively summarized to give a proper direction for the treating physician. Major issues remain to be clarified, both with respect to diagnosis and treatment. The definition of hemodynamic significance varies because of different use of echocardiographic criteria and uncertainty about the role of biomarkers. The detailed risks and benefits of available treatment alternatives are still under investigation. There has been a general shift in the management of PDA in preterm neonates from the "aggressive approach" to a more "conservative approach," but the effects of this strategy on morbidity in a longer time perspective are not fully known. An individualized therapeutic strategy with special emphasis on identification of hemodynamically significance seems to be the way forward. In this review we put forward the scientific background in favor of a seemingly growing body of evidence against active treatment, but we raise caution against shying away from all forms of treatment or instituting them too late. Finally, we try to integrate the current knowledge into suggestions for the management of PDA in premature infants.
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Affiliation(s)
- Souvik Mitra
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Saldeño YP, Favareto V, Mirpuri J. Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants. J Perinatol 2012; 32:953-8. [PMID: 22460543 DOI: 10.1038/jp.2012.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants ≤28 weeks or 1250 g. STUDY DESIGN This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl(-1) and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and χ (2). Significance was set at P<0.05. RESULT PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA. CONCLUSION A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.
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Affiliation(s)
- Y P Saldeño
- Division of Neonatal-Perinatal Medicine, BC Children's Hospital, Vancouver, BC, Canada.
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Fanos V, Pusceddu M, Dessì A, Marcialis MA. Should we definitively abandon prophylaxis for patent ductus arteriosus in preterm new-borns? Clinics (Sao Paulo) 2011; 66:2141-9. [PMID: 22189742 PMCID: PMC3226612 DOI: 10.1590/s1807-59322011001200022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/12/2011] [Indexed: 12/30/2022] Open
Abstract
Although the prophylactic administration of indomethacin in extremely low-birth weight infants reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage, it does not appear to provide any long-term benefit in terms of survival without neurosensory and cognitive outcomes. Considering the increased drug-induced reduction in renal, intestinal, and cerebral blood flow, the use of prophylaxis cannot be routinely recommended in preterm neonates. However, a better understanding of the genetic background of each infant may allow for individualized prophylaxis using NSAIDs and metabolomics.
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Affiliation(s)
- Vassilios Fanos
- Neonatal Intensive Care Unit, Puericulture Institute And Neonatal Section, AOU University of Cagliari, Italy
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Guimarães H, Rocha G, Vasconcellos G, Proença E, Carreira ML, Sossai MDR, Morais B, Martins I, Rodrigues T, Severo M. Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:419-30. [PMID: 20635057 DOI: 10.1016/s0873-2159(15)30039-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
UNLABELLED The pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc. AIM To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns. MATERIAL AND METHODS 256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <1250 g admitted in five Portuguese NICUs, between 2004 and 2006 were studied. A protocol was filled in based on clinical information registered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. RESULTS BPD prevalence was 12.9% (33/256). BPD risk decreased 46% per GA week and of 39% per 100g BW. BPD risk was significantly higher among newborns with low BW (adj OR= 0.73, 95% CI=0.57- 0.95), severe hyaline membrane disease (adj OR= 9.85, 95% CI=1.05-92.35), and those with sepsis (adj OR=6.22, 95% CI=1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p <0.001) and longer duration of FiO2>0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p <0.001). COMMENTS The most relevant risk factors were low birth weight, severe hyaline membrane disease, duration of respiratory support and oxygen therapy, and nosocomial sepsis. The implementation of potentially better practices to reduce lung injury in neonates must be addressed to improve practices to decrease these risk factors.
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Pérez-Yarza E, Cabañas F, García-Algar O, Valverde-Molina J. Año 2009: Anales de Pediatría estrena factor de impacto. An Pediatr (Barc) 2010. [DOI: 10.1016/j.anpedi.2010.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30026-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Guimarães H, Rocha G, Tomé T, Anatolitou F, Sarafidis K, Fanos V. Non-steroid anti-inflammatory drugs in the treatment of patent ductus arteriosus in European newborns. J Matern Fetal Neonatal Med 2009; 22 Suppl 3:77-80. [DOI: 10.1080/14767050903198314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bancalari E. Ductus arterioso permeable. An Pediatr (Barc) 2008. [DOI: 10.1157/13127991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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