1
|
Kikuchi N, Goto T, Katsumata N, Murakami Y, Shinohara T, Maebayashi Y, Sakakibara A, Saito C, Hasebe Y, Hoshiai M, Nemoto A, Naito A. Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome. J Cardiovasc Dev Dis 2024; 11:26. [PMID: 38248896 PMCID: PMC10816731 DOI: 10.3390/jcdd11010026] [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: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011-2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson's correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the "posture/motor" sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.
Collapse
Affiliation(s)
- Natsumi Kikuchi
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
- Department of Pediatrics, School of Medicine, Yamanashi University, Kofu 409-3821, Japan;
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan
| | - Nobuyuki Katsumata
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yasushi Murakami
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Tamao Shinohara
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yuki Maebayashi
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Aiko Sakakibara
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Chisato Saito
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yohei Hasebe
- Department of Pediatrics, School of Medicine, Yamanashi University, Kofu 409-3821, Japan;
| | - Minako Hoshiai
- Cardiovascular Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan;
| | - Atsushi Nemoto
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Atsushi Naito
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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: 8] [Impact Index Per Article: 4.0] [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.
Collapse
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:
| |
Collapse
|
4
|
Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus. BMC Pediatr 2021; 21:457. [PMID: 34663266 PMCID: PMC8523346 DOI: 10.1186/s12887-021-02920-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal management of haemodynamically significant patent ductus arteriosus (HsPDA) in premature babies remains controversial. Our aim is to compare death and/or adverse neurodevelopmental outcomes in extremely low birth weight (ELBW) infants with HsPDA who were managed with conservative [C], medical [M] and/or surgical [S] treatment, with secondary aim to examine short-term morbidities among [S] and [C] groups. The study also compared outcomes in very low birth weight (VLBW) infants with HsPDA and non-HsPDA. METHODS A retrospective study of VLBW preterm infants born before 29 weeks in Singapore from 2007 to 2016 was conducted. RESULTS A total of 474 VLBW infants were admitted in NUH from 2007 to 2016. Infants aged between 24 + 0 and 28 + 6 weeks of gestation, weighing ≤1500 g and diagnosed with patent ductus arteriosus (PDA) were included in the study, of which 172 infants (124 HsPDA and 48 non-HsPDA) were analyzed. Among infants with HsPDA, 17 infants were managed with [C], 83 with [M] and 24 with [S]. Mortality was not increased regardless of the presence of HsPDA or treatment received. Infants with non-HsPDA were less likely to have isolated speech delay (p < 0.05), but not global developmental delay (GDD). No significant differences in neurodevelopmental outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. [M + S] infants were at a higher risk of developing chronic lung disease (CLD) (OR 6.83, p < 0.05) and short-term growth failure compared to [C] infants. They were significantly shorter and had a smaller head circumference at discharge (p < 0.05). [M + S] infants also had elevated creatinine compared to those in group [C] (81.1 ± 24.1 vs 48.3 ± 11.8 umol/L, p < 0.000). CONCLUSIONS Compared to conservative management, infants requiring [M + S] treatment for HsPDA were more likely to have short-term complications such as CLD, elevated creatinine, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in infants managed with [M + S].
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants. Early Hum Dev 2017; 113:10-17. [PMID: 28697406 PMCID: PMC5654678 DOI: 10.1016/j.earlhumdev.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/23/2017] [Accepted: 07/02/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. AIM We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. STUDY DESIGN, SUBJECTS, AND OUTCOME MEASURES We studied infants 23-28weeks' gestation born 2006-2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<-2, -2 to -0.5, and >-0.5) and PDA surgery following pharmacologic treatment. RESULTS 5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>-0.5, PDA surgery was increased among infants with z-score -2 to -0.5 (OR=1.23; 95% CI 1.02-1.47) but not among infants with z-score<-2. CONCLUSION Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.
Collapse
|
8
|
Ito S, Matsuda T, Usuda H, Watanabe S, Kitanishi R, Hanita T, Watanabe T, Adachi O. Surgical Ligation for Patent Ductus Arteriosus in Extremely Premature Infants: Strategy to Reduce their Risk of Neurodevelopmental Impairment. TOHOKU J EXP MED 2017; 240:7-13. [PMID: 27558322 DOI: 10.1620/tjem.240.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical ligation for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBWIs) has been shown a possible association with neurodevelopmental impairment (NDI) because of its invasiveness. However, we have undergone surgical ligation for ELBWIs immediately after cyclooxygenase inhibitor failed to close a hemodynamically significant PDA (hsPDA) to maintain proper systemic circulation. We aimed to determine the effect of surgical ligation for hsPDA on NDI in ELBWIs. In enrolled 71 ELBWIs, the clinical parameters, including the developmental quotient (DQ), were collected and compared among three groups that were divided by closure mode: spontaneous closure (n = 11), cyclooxygenase inhibitor therapy (n = 37) and surgical ligation (n = 23). No significant differences in DQ at the age of 36 months among the three groups were found: Median (interquartile range): 92.0 (31.0), 89.0 (22.0) and 92.0 (24.5), respectively. In a comparison between groups of DQ < 70 (n = 15) and DQ ≥ 70 (n = 56), a significant difference was found in the parameters related to prematurity (p < 0.05 for each): gestational age [23.9 (1.70) vs. 25.4 (2.50) weeks], birth weight [595 (183) vs. 714 (192) g], Apgar score < 5 (1 min) (67% vs. 36%), and laser photocoagulation for retinopathy of prematurity (73% vs. 43%), but there was no significant association with hsPDA. Therefore, we propose that surgical ligation for hsPDA in ELBWIs should be immediately carried out for preventing future neurodevelopmental deterioration if the cyclooxygenase inhibitor failed to close hsPDA.
Collapse
Affiliation(s)
- Satoko Ito
- Center for Perinatal-Neonatal Medicine, Tohoku University Hospital
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
BACKGROUND AND OBJECTIVE Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks' gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01-2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98-3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62-3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38-0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58-1.57). CONCLUSIONS Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.
Collapse
Affiliation(s)
- Dany E Weisz
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Toronto, Canada
| | | | | | | |
Collapse
|
10
|
Dang D, Wang D, Zhang C, Zhou W, Zhou Q, Wu H. Comparison of oral paracetamol versus ibuprofen in premature infants with patent ductus arteriosus: a randomized controlled trial. PLoS One 2013; 8:e77888. [PMID: 24223740 PMCID: PMC3817181 DOI: 10.1371/journal.pone.0077888] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/11/2013] [Indexed: 02/02/2023] Open
Abstract
TRIAL DESIGN Oral ibuprofen has demonstrated good effects on symptomatic patent ductus arteriosus (PDA) but with many contraindications and potential side-effects. In the past two years, oral paracetamol administration to several preterm infants with PDA has been reported. Here, a randomized, non-blinded, parallel-controlled and non-inferiority trial was designed to evaluate the efficacy and safety profiles of oral paracetamol to those of standard ibuprofen for PDA closure in premature infants. METHODS One hundred and sixty infants (gestational age ≤ 34 weeks) with echocardiographically confirmed PDA were randomly assigned to receive either oral paracetamol (n = 80) or ibuprofen (n = 80). After the initial treatment course in both groups, the need for a second course was determined by echocardiographic evaluation. The main outcome was rate of ductal closure, and secondary outcomes were adverse effects and complications. RESULT The ductus was closed in 65 (81.2%) infants of the paracetamol group compared with 63 (78.8%) of the ibuprofen group. The 95% confidence interval of the difference between these groups was [-0.080,0.128], demonstrating that the effectiveness of paracetamol treatment was not inferior to that of ibuprofen. In fact, the incidence of hyperbilirubinemia or gastrointestinal bleeding in the paracetamol group was significantly lower than that of the ibuprofen group. No significant differences in other clinical side effects or complications were noted. CONCLUSION This comparison of drug efficacy and safety profiles in premature infants with PDA revealed that oral paracetamol was comparable to ibuprofen in terms of the rate of ductal closure and even showed a decreased risk of hyperbilirubinemia or gastrointestinal bleeding. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. TRIAL REGISTRATION ChiCTR.org ChiCTR-TRC-12002177.
Collapse
Affiliation(s)
- Dan Dang
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dongxuan Wang
- Department of Ultrasonic Diagnosis, The First Hospital of Jilin University, Changchun, China
| | - Chuan Zhang
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun, China
| | - Wenli Zhou
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Qi Zhou
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
- * E-mail:
| |
Collapse
|
11
|
Sallmon H, Weber SC, Hüning B, Stein A, Horn PA, Metze BC, Dame C, Bührer C, Felderhoff-Müser U, Hansmann G, Koehne P. Thrombocytopenia in the first 24 hours after birth and incidence of patent ductus arteriosus. Pediatrics 2012; 130:e623-30. [PMID: 22869835 DOI: 10.1542/peds.2012-0499] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Experimental studies suggest that platelet-triggered ductal sealing is critically involved in definite ductus arteriosus closure. Whether thrombocytopenia contributes to persistently patent ductus arteriosus (PDA) in humans is controversial. This was a retrospective study of 1350 very low birth weight (VLBW; <1500 g) infants, including 592 extremely low birth weight (ELBW; <1000 g) infants. METHODS All infants who had a platelet count in the first 24 hours after birth and an echocardiogram performed on day of life 4 to 5 were included. The incidence of thrombocytopenia was analyzed in infants with and without PDA, and in those who did or did not undergo PDA intervention. The impact of thrombocytopenia, gestational age, birth weight, gender, and sepsis on PDA was determined by receiver operating characteristic curve, odds ratio, and regression analyses. RESULTS Platelet numbers within the first 24 hours after birth did not differ between VLBW/ELBW infants with and without spontaneous ductal closure. Platelet numbers were not associated with subsequent PDA treatment. Low platelet counts were not related to failure of pharma-cologic PDA treatment and the need for subsequent surgical ligation. Lower gestational age or birth weight, male gender, and sepsis were linked to the presence of PDA in VLBW infants on day of life 4 to 5. CONCLUSIONS Thrombocytopenia in the first 24 hours after birth was not associated with PDA in this largest VLBW/ELBW infant cohort studied to date. Impaired platelet function, due to immaturity and critical illness, rather than platelet number, might play a role in ductus arteriosus patency.
Collapse
Affiliation(s)
- Hannes Sallmon
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|