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Patent ductus arteriosus treatment trends and associated morbidities in neonates. Sci Rep 2021; 11:10689. [PMID: 34021202 PMCID: PMC8139968 DOI: 10.1038/s41598-021-89868-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/28/2021] [Indexed: 01/28/2023] Open
Abstract
To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.
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Slaughter JL, Cua CL, Notestine JL, Rivera BK, Marzec L, Hade EM, Maitre NL, Klebanoff MA, Ilgenfritz M, Le VT, Lewandowski DJ, Backes CH. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation. BMC Pediatr 2019; 19:333. [PMID: 31519154 PMCID: PMC6743099 DOI: 10.1186/s12887-019-1708-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. METHODS Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. DISCUSSION The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in "high-risk" infants most likely to receive benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT03782610. Registered 20 December 2018.
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Affiliation(s)
- Jonathan L Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Clifford L Cua
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer L Notestine
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian K Rivera
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Laura Marzec
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erinn M Hade
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Ilgenfritz
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA
| | - Vi T Le
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dennis J Lewandowski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carl H Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA. .,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA. .,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA. .,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
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Engeseth MS, Olsen NR, Maeland S, Halvorsen T, Goode A, Røksund OD. Left vocal cord paralysis after patent ductus arteriosus ligation: A systematic review. Paediatr Respir Rev 2018; 27:74-85. [PMID: 29336933 DOI: 10.1016/j.prrv.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/18/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Extremely premature (EP) infants are at increased risk of left vocal cord paralysis (LVCP) following surgery for patent ductus arteriosus (PDA). OBJECTIVE A Systematical Review was conducted to investigate the incidence and outcomes of LVCP after PDA ligation in EP born infants. DATA SOURCES Searches were performed in Cochrane, Medline, Embase, Cinahl and PsycInfo. STUDY SELECTION Studies describing EP infants undergoing PDA surgery and reporting incidence of LVCP were included. DATA EXTRACTION AND SYNTHESIS Study details, demographics, incidence of LVCP, diagnostic method and reported outcomes were extracted. DerSimonian and Laird random effect models with inverse variance weighting were used for all analyses. STUDY APPRAISAL The Newcastle-Ottawa scale for observational studies was used for quality assessment. RESULTS 21 publications including 2067 infants were studied. The overall pooled summary estimate of LVCP incidence was 9.0% (95% CI 5.0, 15.0). However, the pooled incidence increased to 32% when only infants examined with laryngoscopy were included. The overall risk ratio for negative outcomes was higher in the LVCP group (2.20, 95% CI 1.69, 2.88, p = 0.01) compared to the non-LVCP-group. CONCLUSIONS Reported incidence of LVCP varies widely. This may be explained by differences in study designs and lack of routine vocal cords postoperative assessment. LVCP is associated with negative outcomes in EP infants. The understanding of long-term outcomes is scarce. Routine laryngoscopy may be necessary to identify all cases of LVCP, and to provide correct handling for infants with LVCP.
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Affiliation(s)
- Merete Salveson Engeseth
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Clinical Science, Section for Paediatrics, University of Bergen, Norway
| | - Nina Rydland Olsen
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Silje Maeland
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Uni Research Health, Uni Research, Bergen, Norway
| | - Thomas Halvorsen
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Section for Paediatrics, University of Bergen, Norway
| | - Adam Goode
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Ola Drange Røksund
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
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Chung YS, Cho DY, Kang H, Lee NM, Hong J. Neonatal Patent Ductus Arteriosus Ligation Operations Performed by Adult Cardiac Surgeons. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:242-246. [PMID: 28795028 PMCID: PMC5548199 DOI: 10.5090/kjtcs.2017.50.4.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
Background Patent ductus arteriosus (PDA) ligation is usually performed by congenital cardiac surgeons. However, due to the uneven distribution of congenital cardiac surgeons in South Korea, many institutions depend solely on adult cardiac surgeons for congenital cardiac diseases. We report the outcomes of PDA ligations performed by adult cardiac surgeons at our institution. Methods The electronic medical records of 852 neonates at Chung-Ang University Hospital, Seoul, South Korea from November 2010 to May 2014 were reviewed to identify patients with PDA. Results Of the 111 neonates with a diagnosis of PDA, 26 (23%) underwent PDA ligation. PDAs were ligated within 28 days of birth (mean, 14.5±7.8 days), and the mean gestational age of these patients was 30.3±4.6 weeks (range, 26 to 40 weeks) with a mean birth weight of 1,292.5±703.5 g (range, 480 to 3,020 g). No residual shunts through the PDA were found on postoperative echocardiography. There was 1 case of 30-day mortality (3.8%) due to pneumonia, and 6 cases of in-hospital mortality (23.1%) after 30 days, which is comparable to results from other centers with congenital cardiac surgery programs. Conclusion Although our outcomes may not be generalizable to all hospital settings without a congenital cardiac surgery program, in select centers, PDA ligations can be performed safely by adult cardiac surgeons if no congenital cardiac surgery program is available.
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Affiliation(s)
- Yoon Sang Chung
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital
| | - Dai Yun Cho
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University Hospital
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital
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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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Albayrak G, Aykut K, Karacelik M, Soylar R, Karaarslan K, Abud B, Guzeloglu M, Hazan E. Bedside surgery to treat patent ductus arteriosus in low-birth-weight premature infants. Open J Cardiovasc Surg 2014; 7:1-4. [PMID: 25512700 PMCID: PMC4251059 DOI: 10.4137/ojcs.s16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is commonly seen in premature infants with low birth weights (LBW). It is a condition that has high mortality and morbidity rates. Early closure of the ductus arteriosus may require surgery or medical treatment. However, the decision of first medical approach for symptomatic PDA closure is still debated. In this study, we compared the surgical and medical treatments for the closure of PDA in premature LBW infants. METHODS This study included 27 premature infants whose birth weights were lower than 1500 g, who were born in the period between 2011 and 2013 and had symptomatic PDA. Patients were separated into two groups: groups A and B. Group A included patients whose PDAs were closed with medical treatment (n = 16), and group B included patients who had undergone surgical operations for PDA closure (n = 11). RESULTS There were no statistically significant differences between groups A and B when the groups were compared in terms of birth weight, gestational age, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and pneumothorax. Although the mortality rate was determined to be lower in group B (2 out of 11, 18.1%) than in group A (7 out of 16, 43.7%), no statistically significant difference was found between the two groups. A statistically significant increase was determined in the incidence of kidney function loss in patient group that received Ibuprofen, a medical treatment, in comparison to the patients who had surgery. CONCLUSION In conclusion, surgery is a safe method to repair PDA in premature LBW infants. Although there is no remarkable difference between surgery and medical treatment, we suggest that a surgical approach may be used as a first choice to repair PDA considering the lower rate of mortality and morbidity and higher rate of closure compared to medical treatment.
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Affiliation(s)
- Gökhan Albayrak
- Department of Cardiovascular Surgery, Izmir University, Medical Park Hospital, Izmir, Turkey
| | - Koray Aykut
- Department of Cardiovascular Surgery, Izmir University, Medical Park Hospital, Izmir, Turkey
| | - Mustafa Karacelik
- Department of Cardiovascular Surgery, Dr. Behcet Uz Children Hospital, Izmir, Turkey
| | - Ramazan Soylar
- Department of Pediatry, Izmir University, Medical Park Hospital, Izmir, Turkey
| | - Kemal Karaarslan
- Department of Cardiovascular Surgery, Tepecik Research Hospital, Izmir, Turkey
| | - Burçin Abud
- Department of Cardiovascular Surgery, Tepecik Research Hospital, Izmir, Turkey
| | - Mehmet Guzeloglu
- Department of Cardiovascular Surgery, Izmir University, Medical Park Hospital, Izmir, Turkey
| | - Eyup Hazan
- Department of Cardiovascular Surgery, Izmir University, Medical Park Hospital, Izmir, Turkey
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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.
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Affiliation(s)
- Dany E Weisz
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Toronto, Canada
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Jenkins IA, Kelly Ugarte LR, Mancuso TJ. Where should we operate on the preterm neonate? Paediatr Anaesth 2014; 24:127-36. [PMID: 24289318 DOI: 10.1111/pan.12311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2013] [Indexed: 11/29/2022]
Abstract
The ideal venue for neonatal surgical procedures has been the subject of a contentious debate between the leading pediatric hospitals throughout the world. Bias toward the location of neonatal surgery tends to be based on institutional practices. The following opposing viewpoints from two leading pediatric institutions in the United Kingdom and the United States highlight the relevant issues.
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Affiliation(s)
- Ian A Jenkins
- Departments of Anesthesiology and Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
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Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis. J Pediatr Surg 2013; 48:915-8. [PMID: 23701759 DOI: 10.1016/j.jpedsurg.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/03/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons. METHODS We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls. RESULTS The review identified 98 patients with a mean corrected GA and weight at repair of 29 weeks and 1122 g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes. CONCLUSIONS This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.
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10
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Bedside neonatal intensive care unit surgery- myth or reality! J Neonatal Surg 2013; 2:20. [PMID: 26023440 PMCID: PMC4420370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/24/2013] [Indexed: 12/02/2022] Open
Abstract
Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.
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Chang YS, Park WS. Strategies to Overcome the Limit of Viability of Microprimie. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.3.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Satpute MD, Donohue PK, Vricella L, Aucott SW. Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone. J Perinatol 2012; 32:685-9. [PMID: 22094490 DOI: 10.1038/jp.2011.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Following patent ductus arteriosus (PDA) ligation, preterm infants may develop profound hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, postulating these infants do not synthesize steroids because of an immature hypothalamic-pituitary-adrenal axis. The purpose of this study was to compare outcomes in infants who received stress HC before their PDA ligations to those who did not. STUDY DESIGN A retrospective chart review was performed of infants who underwent PDA ligations at our institution's neonatal intensive care unit. Data were collected on treatment with HC, and respiratory and cardiovascular support. RESULT Gestational age (GA) and birth weight were lower in the HC group (24 vs 25 weeks, 632 vs 790 g), but age at time of surgery was similar (26 vs 21 days). Cardiorespiratory support was comparable between the groups pre- and post-operatively. In regression models that adjusted for GA, HC treatment was not independently related to respiratory support postoperatively, but was associated with a decrease in postoperative dopamine (2.2 mcg kg(-1) min(-1); P=0.03). Respiratory support postoperatively was predicted by preoperative respiratory support. GA and age at surgery were not independently associated with outcome. CONCLUSION Preoperative stress HC was not associated with improved cardiorespiratory stability, regardless of GA. Further investigation is needed to identify infants who may benefit from this therapy.
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Affiliation(s)
- M D Satpute
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tantraworasin A, Woragidpoonpol S, Chuaratanapong S, Sittiwangkul R, Chittawatanarat K. Timing of surgical closure of patent ductus arteriosus in preterm neonates? Asian Cardiovasc Thorac Ann 2012; 20:12-8. [PMID: 22371936 DOI: 10.1177/0218492311430356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective cohort study was conducted on 115 preterm neonates who underwent patent ductus arteriosus ligation after failure of medical treatment, at Chiang Mai University Hospital between January 2003 and December 2010. Two groups were defined: an early surgery group (39.1%) treated with surgical closure within 21 days, and a late surgery group (60.9%) operated on >21 days after birth. There were significant differences between the 2 groups in terms of weight at surgery, birth weight, duration of intubation, ductal size, and preoperative indomethacin usage. The early surgery group had a longer intensive care unit stay, but differences in postoperative chronic lung disease, ductal size, and surfactant use were not significant. Babies with a low birth weight (<1,500 g) and those with a higher ductal gradient were more susceptible to chronic lung disease, but multivariate analysis showed no difference between early and late surgery patients in either early extubation or chronic lung disease. It was concluded that early patent ductus arteriosus ligation did not show more benefits than late surgery.
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Affiliation(s)
- Apichat Tantraworasin
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Yoo HS, Kim JE, Park SK, Seo HJ, Jeong YJ, Chio SH, Jeong SI, Kim SH, Yang JH, Huh J, Chang YS, Jun TG, Kang IS, Park WS, Park PW, Lee HJ. Clinical course and prognosis of hemodynamically significant congenital heart defects in very low birth weight infants. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hye Soo Yoo
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Kim
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ju Seo
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Jin Jeong
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo Heui Chio
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo In Jeong
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyuk Yang
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gook Jun
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I Seok Kang
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heung Jae Lee
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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