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Lee WY, Yum SK, Seo YM, Kim S, Shin JA, Lee C. Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for an early operation? Eur J Cardiothorac Surg 2024; 65:ezae175. [PMID: 38724226 DOI: 10.1093/ejcts/ezae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The goal was to evaluate neonatal outcomes based on treatment strategies and time points for haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight preterm infants, with a particular focus on surgical closure. METHODS This retrospective study included very-low-birth-weight infants born between 2014 and 2021 who received active treatment for hsPDA. Neonatal outcomes were compared between (i) primary surgical closure versus primary ibuprofen; (ii) early (<14th post-natal day) versus late primary surgical closure (≥14th post-natal day); and (iii) primary versus secondary surgical closure after ibuprofen failure. Further analysis using 1:1 propensity score matching was performed. Logistic regression was conducted to analyse the risk factors for post-ligation cardiac syndrome (PLCS) and/or acute kidney injury (AKI). RESULTS A total of 145 infants with hsPDA underwent active treatment for closure. The in-hospital death rate and the incidence of severe bronchopulmonary dysplasia (BPD) were similar between the primary surgical closure group and the primary ibuprofen group in a 1:1 matched analysis. Severe BPD was significantly higher in the late surgical closure group than in the early primary surgical closure group with 1:1 propensity score matching (72.7% vs 40.9%, P=0.033). The secondary surgical closure group showed the mildest clinical condition; however, the probability of PLCS/AKI was highest (38.6%) compared to the early (15.2%) or the late primary surgical group (28.1%, P<0.001), especially in extremely premature infants (gestational age < 28 weeks). CONCLUSIONS Surgical patent ductus arteriosus closure is not inferior to pharmacologic treatment. Considering the harmful effect of a prolonged patent ductus arteriosus shunt exposure, a timely decision and timely efforts should be made to minimize the risk of severe BPD and PLCS/AKI after surgical closure.
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Affiliation(s)
- Won Young Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu-Mi Seo
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sol Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Ae Shin
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mirza H, Garcia J, Bell C, Jones K, Flynn V, Pepe J, Oh W. Fluid Intake in the First Week of Life and the Duration of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants. Am J Perinatol 2023; 40:1345-1350. [PMID: 34384119 DOI: 10.1055/a-1585-6093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to determine the association between daily fluid intake and the duration of hemodynamically significant patent ductus arteriosus (hsPDA). STUDY DESIGN This is a retrospective cohort study of extremely preterm infants (<29 weeks) admitted in the Neonatal Intensive Care Unit of the Advent Health for Children from January 2013 to March 2016, if hsPDA was diagnosed in first week of life and serial echocardiograms were available. Diagnosis of hsPDA was based on a scoring system and its duration was estimated from serial echocardiograms. Cohort was divided into two groups based on duration of hsPDA (<1week, group A and ≥1 week, group B). Daily fluid intake was categorized as prescribed and actual. Prescribed volume was ordered by clinicians based on birth weight, not including trophic feeds, intravenous (IV) boluses or transfusions, etc. Actual intake was calculated by the electronic medical records based on daily weights and included all enteral or parenteral fluids. Multivariate analysis was performed to determine an association between total daily fluid intake over the first week of life and the duration of hsPDA. Two groups were compared to observe the difference between prescribed and actual daily fluid intakes. RESULTS We enrolled 50 infants in group A and 76 in group B. Infants in group B were of significantly lower gestation and required prolonged ventilation and hospitalization. An association between higher fluid intake in the first 2 days of life and prolonged duration of hsPDA was confirmed by multivariate analysis. Actual fluid intake was significantly higher than prescribed total fluid intake in first 4 days of life for infants in both groups. CONCLUSION In extremely preterm infants, higher fluid intake in first 2 days of life is associated with prolonged duration of hsPDA. Actual daily fluid intake can be significantly higher than prescribed daily fluids due to daily weight changes and additional fluid administration. KEY POINTS · In preterm infants, actual daily fluid intake may be higher than prescribed volume.. · Higher daily fluid intake in first week of life is associated with prolonged duration of PDA.. · PDA scoring system can be helpful for objective assessment of PDA in preterm infants..
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Affiliation(s)
- Hussnain Mirza
- Center for Neonatal Care, University Central Florida College of Medicine, Advent Health for Children, Orlando, Florida
| | - Jorge Garcia
- Division of Pediatric Cardiology, Advent Health for Children, Orlando, Florida
| | - Chelsea Bell
- Clinical Nutrition Program, Advent Health for Children, Orlando, Florida
| | - Kristen Jones
- Pediatric Pharmacy Services, Advent Health for Children, Orlando, Florida
| | - Vicki Flynn
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
| | - Julie Pepe
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
| | - William Oh
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
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Wheeler CR, Vogel ER, Cusano MA, Friedman KG, Callahan R, Porras D, Ibla JC, Levy PT. Definitive Closure of the Patent Ductus Arteriosus in Preterm Infants and Subsequent Short-Term Respiratory Outcomes. Respir Care 2022; 67:594-606. [PMID: 35473850 PMCID: PMC9994254 DOI: 10.4187/respcare.09489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
A persistent patent ductus arteriosus (PDA) can have significant clinical consequences in preterm infants, depending on the degree of left-to-right shunting, its impact on cardiac performance, and associated perinatal risk factors that can mitigate or exacerbate the shunt. Although the best management strategy remains contentious, PDAs that have contraindications to, or have failed medical management have historically undergone surgical ligation. Recently smaller occluder devices and delivery systems have allowed for minimally invasive closure in the catheterization laboratory even in extremely premature infants. The present review summarizes the pathophysiologic manifestations, treatment options and management of hemodynamically significant PDA in preterm infants. Additionally, we review the available literature surrounding the respiratory support and outcomes of preterm infants following definitive PDA closure.
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Affiliation(s)
- Craig R Wheeler
- Department of Respiratory Care, Boston Children's Hospital, Boston, Massachusetts.
| | - Elizabeth R Vogel
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Cusano
- Department of Respiratory Care, Boston Children's Hospital, Boston, Massachusetts
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Juan C Ibla
- Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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Is early patent ductus arteriosus ligation helpful in premature neonates? A 10-year retrospective study. World J Pediatr 2022; 18:350-357. [PMID: 35254623 DOI: 10.1007/s12519-022-00527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND To compare short and long outcomes between early (≤ 28 days) (EL) and late ligation (LL) groups. To explore factors predicting early extubation (≤ 7 days) after patent ductus arteriosus (PDA) ligation. METHODS We conducted a single center, retrospective cohort study of preterm infants < 32 weeks who underwent surgical ligation over a 10-year period (2009-2019). RESULTS A total of 133 infants underwent PDA ligation, in the study period. Both groups had similar short-term outcome such as bronchopulmonary dysplasia (BPD) or death (96% vs. 98%, P = 0.64) and long-term clinical outcomes including Bayley's assessment at 2 years corrected age. Fewer infants in the EL group developed severe BPD (63% vs. 81%, P = 0.02). Age at ligation had adjusted odds ratio of 1.04 with over lapping confidence interval (95% CI 1.0-1.1, P = 0.02) for severe BPD/death. There was no difference in day of extubation between the EL and LL group (8 days vs. 7 days, P = 0.85). Left atrium/aortic root ratio of ≥ 1.75 would give sensitivity of 41% and 80% specificity for early extubation (area under the curve of 0.61). There was marginal reduction of hospital stay in the EL group [113 (105-121) days vs. 115 (107-123) days; log rank P = 0.026]. CONCLUSION EL can be delivered safely with a clinically important lower incidence of severe BPD and shorter duration of hospital stay compared to LL.
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Grunenwald Gronier C, Benbrik N, Romefort B, Prigent S, Hauet Q, Baruteau AE. Off-label use of Lifetech KONAR-MF™ ventricular septal defect occluder for large patent ductus arteriosus closure in <6 kg infants. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2021.100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Al-Turkait A, Szatkowski L, Choonara I, Ojha S. Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001424. [PMID: 36053632 PMCID: PMC8928285 DOI: 10.1136/bmjpo-2022-001424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks' gestational age (GA) in England and Wales between 2010 and 2017. STUDY DESIGN Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017. RESULTS Among 58 108 infants born at <32 weeks' GA, 28.3% (n=16 440) had a PDA diagnosed clinically or with echocardiographic confirmation. Of these, 34.8% (n=5721; 9.8% of total <32 weeks' infants included) had PDA treatment including 7.6% (n=1255) with indomethacin, 23.5% (n=3857) with ibuprofen and 5.6% (n=916) with surgical closure. The highest incidence of PDA was among infants born at 24 and 25 weeks' GA (70.2% and 70.8%, respectively), decreasing to 6.1% among infants born at 31 weeks' GA. The percentage of infants with a PDA increased over the study period (25.5% in 2010 to 28.5% in 2017). The percentage of infants who received ibuprofen or indomethacin or had PDA surgery decreased from 41.3% in 2010 to 33.7% in 2017, with an increase in use of ibuprofen from 20.2% to 27.3% while use of indomethacin decreased from 20.0% to 8.8%. Surgical closure of PDA decreased from 9.1% to 3.0%. Indomethacin was used for median (IQR) 3 (2-5) days while ibuprofen was given for 3 (2-4) days, at a median of 8 and 10 days after birth, respectively; surgical treatment was used later at 33 (24-45) days after birth. CONCLUSIONS Ibuprofen is the preferred drug and surgical interventions are becoming less frequent for PDA closure among very preterm infants in England and Wales. TRIAL REGISTRATION NUMBER NCT03773289.
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Affiliation(s)
- Asma Al-Turkait
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.,Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Lisa Szatkowski
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Imti Choonara
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shalini Ojha
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK .,Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Mirza H, Garcia J, Bell C, Jones K, Flynn V, Pepe J, Oh W. Fluid Intake in the First Week of Life and the Duration of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants. Am J Perinatol 2021. [PMID: 34492721 DOI: 10.1055/s-0041-1735623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to determine the association between daily fluid intake and the duration of hemodynamically significant patent ductus arteriosus (hsPDA). METHODS This is a retrospective cohort study of extremely preterm infants (<29 weeks) admitted in the Neonatal Intensive Care Unit of the Advent Health for Children from January 2013 to March 2016, if hsPDA was diagnosed in first week of life and serial echocardiograms were available. Diagnosis of hsPDA was based on a scoring system and its duration was estimated from serial echocardiograms. Cohort was divided into two groups based on duration of hsPDA (<1week, group A and ≥1 week, group B). Daily fluid intake was categorized as prescribed and actual. Prescribed volume was ordered by clinicians based on birth weight, not including trophic feeds, intravenous (IV) boluses or transfusions, etc. Actual intake was calculated by the electronic medical records based on daily weights and included all enteral or parenteral fluids. Multivariate analysis was performed to determine an association between total daily fluid intake over the first week of life and the duration of hsPDA. Two groups were compared to observe the difference between prescribed and actual daily fluid intakes. RESULTS We enrolled 50 infants in group A and 76 in group B. Infants in group B were of significantly lower gestation and required prolonged ventilation and hospitalization. An association between higher fluid intake in the first 2 days of life and prolonged duration of hsPDA was confirmed by multivariate analysis. Actual fluid intake was significantly higher than prescribed total fluid intake in first 4 days of life for infants in both groups. CONCLUSION In extremely preterm infants, higher fluid intake in first 2 days of life is associated with prolonged duration of hsPDA. Actual daily fluid intake can be significantly higher than prescribed daily fluids due to daily weight changes and additional fluid administration. KEY POINTS · In preterm infants, actual daily fluid intake may be higher than prescribed volume.. · Higher daily fluid intake in first week of life is associated with prolonged duration of PDA.. · PDA scoring system can be helpful for objective assessment of PDA in preterm infants..
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Affiliation(s)
- Hussnain Mirza
- Center for Neonatal Care, University Central Florida College of Medicine, Advent Health for Children, Orlando, Florida
| | - Jorge Garcia
- Division of Pediatric Cardiology, Advent Health for Children, Orlando, Florida
| | - Chelsea Bell
- Clinical Nutrition Program, Advent Health for Children, Orlando, Florida
| | - Kristen Jones
- Pediatric Pharmacy Services, Advent Health for Children, Orlando, Florida
| | - Vicki Flynn
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
| | - Julie Pepe
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
| | - William Oh
- Office of Pediatric Research Advancement and Support, Advent Health, Orlando, Florida
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