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Kuo CM, Su PC, Yang ST, Chung HW, Chen HL. Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:610. [PMID: 38790605 PMCID: PMC11119670 DOI: 10.3390/children11050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Ductus arteriosus closure may be delayed in preterm infants, and prostaglandin, a vasodilator, can affect ductal patency. Furosemide can increase renal prostaglandin synthesis, so its net effect on patent ductus arteriosus (PDA) is uncertain. Our goal is to explore the relationship between furosemide and spontaneous ductal closure in very-low-birth-weight preterm infants. Our treatment for PDA involves fluid restriction initially and furosemide administration for hemodynamically significant PDA until closure is confirmed by the echocardiogram. We enrolled 105 infants from 1 January 2019 to 30 June 2022 and evaluated the impact of furosemide on ductal closure, including exposure duration and cumulative dose. There is no correlation between furosemide exposure and spontaneous ductal closure (p = 0.384). Furosemide exposure does not delay the postmenstrual age at which spontaneous ductal closure occurs (p = 0.558). The time for spontaneous ductal closure is positively associated with furosemide prescription days (coefficient value = 0.547, p = 0.026) and negatively with gestational age (coefficient value = -0.384, p = 0.062). The prescription of furosemide does not impact the probability or time duration of ductus arteriosus spontaneous closure. The cumulative dose of furosemide has minimal impact on ductal closure. The correlation between furosemide exposure duration and ductal patency duration is likely due to our treatment protocol, with gestational age being a significant factor.
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Affiliation(s)
- Chi-Mei Kuo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Pin-Chun Su
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Shu-Ting Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
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2
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Pugnaloni F, Doni D, Lucente M, Fiocchi S, Capolupo I. Ductus Arteriosus in Fetal and Perinatal Life. J Cardiovasc Dev Dis 2024; 11:113. [PMID: 38667731 PMCID: PMC11050351 DOI: 10.3390/jcdd11040113] [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: 02/15/2024] [Revised: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
The ductus arteriosus represents an essential vascular structure connecting the pulmonary artery and the aorta. Over the past decades, there has been substantial advancement in our understanding of both the fundamental and clinical aspects of the ductus arteriosus. In particular, the clarification of the regulatory mechanisms governing ductal patency in critical stages such as the fetal and the perinatal period has enabled optimal management of both physiological and pathological conditions in which the ductus arteriosus plays a crucial role. Furthermore, a more in-depth understanding of the regulatory mechanisms controlling this fundamental structure has facilitated the development of advanced therapeutic strategies and personalized interventions. In the present review, we provide a comprehensive overview of the ductus arteriosus during fetal and perinatal life, encompassing its physiological functions, pathological conditions, and clinical implications. Through this examination, we aim to contribute to a broader understanding of the ductus arteriosus' role in these critical developmental stages and its significance in clinical practice.
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Affiliation(s)
- Flaminia Pugnaloni
- Neonatal Intensive Care Unit, Fetal Neonatal and Cardiological Science Research Area, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, 20900 Monza, Italy;
| | - Mariella Lucente
- Neonatal Intensive Care Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy;
| | - Stefano Fiocchi
- Pediatric Department, G. Fornaroli Hospital, 20013 Magenta, Italy;
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Fetal Neonatal and Cardiological Science Research Area, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
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3
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van Haren JS, Delbressine FLM, Schoberer M, te Pas AB, van Laar JOEH, Oei SG, van der Hout-van der Jagt MB. Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure. Front Pediatr 2024; 12:1360111. [PMID: 38425664 PMCID: PMC10902175 DOI: 10.3389/fped.2024.1360111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
To improve care for extremely premature infants, the development of an extrauterine environment for newborn development is being researched, known as Artificial Placenta and Artificial Womb (APAW) technology. APAW facilitates extended development in a liquid-filled incubator with oxygen and nutrient supply through an oxygenator connected to the umbilical vessels. This setup is intended to provide the optimal environment for further development, allowing further lung maturation by delaying gas exposure to oxygen. This innovative treatment necessitates interventions in obstetric procedures to transfer an infant from the native to an artificial womb, while preventing fetal-to-neonatal transition. In this narrative review we analyze relevant fetal physiology literature, provide an overview of insights from APAW studies, and identify considerations for the obstetric procedure from the native uterus to an APAW system. Lastly, this review provides suggestions to improve sterility, fetal and maternal well-being, and the prevention of neonatal transition.
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Affiliation(s)
- Juliette S. van Haren
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
- Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | | | - Mark Schoberer
- Institute for Applied Medical Engineering and Clinic for Neonatology, University Hospital Aachen, Aachen, Germany
| | - Arjan B. te Pas
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Judith O. E. H. van Laar
- Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - S. Guid Oei
- Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - M. Beatrijs van der Hout-van der Jagt
- Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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4
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Jang YJ, Park BY, Tae HJ, Sim J, Ahn D. Whole-exome sequencing analysis of patent ductus arteriosus in a Japanese macaque (Macaca fuscata). J Med Primatol 2024; 53:e12686. [PMID: 37990472 DOI: 10.1111/jmp.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
We performed whole-exome sequencing using a human exome capture kit to analyze the potential genetic factors related to patent ductus arteriosus in Japanese macaques. Compared with the reference sequences of other primates, we identified potential missense variants in five genes: ADAM15, AZGP1, CSPG4, TNFRSF13B, and EPOR.
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Affiliation(s)
- Young-Jin Jang
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan-si, Jeollabuk-do, South Korea
| | - Byung-Yong Park
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan-si, Jeollabuk-do, South Korea
| | - Hyun-Jin Tae
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan-si, Jeollabuk-do, South Korea
| | - Jeoungha Sim
- Department of Nursing, College of Medical Science, Jeonju University, Jeonju-si, Jeollabuk-do, South Korea
| | - Dongchoon Ahn
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan-si, Jeollabuk-do, South Korea
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5
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Luo H, He J, Xu X, Chen H, Shi J. The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis. PeerJ 2024; 12:e16591. [PMID: 38304184 PMCID: PMC10832619 DOI: 10.7717/peerj.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
Background This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse events when administering medications to premature infants with patent ductus arteriosus (PDA). Method The protocol for this review has been registered with PROSPERO (CRD 42022324598). We searched relevant studies in PubMed, Embase, Cochrane, and the Web of Science databases from March 26, 1996, to January 31, 2022. Results A total of six randomized controlled trials (RCTs) and five observational studies were included for analysis, involving 630 premature neonates in total. Among these infants, 480 were in the ibuprofen group (oral vs. intravenous routes), 78 in the paracetamol group (oral vs. intravenous routes), and 72 in the ibuprofen group (rectal vs. oral routes). Our meta-analysis revealed a significant difference in the rate of PDA closure between the the initial course of oral ibuprofen and intravenous ibuprofen groups (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.13-1.44]; P < 0.0001, I2 = 0%). In contrast, the meta-analysis of paracetamol administration via oral versus intravenous routes showed no significant difference in PDA closure rates (RR = 0.86, 95% CI [0.38-1.91]; P = 0.71, I2 = 76%). However, there was no statistically significant difference in the risk of adverse events or the need for surgical intervention among various drug administration methods after the complete course of drug therapy. Conclusion This meta-analysis evaluated the safety and effectiveness of different medication routes for treating PDA in premature infants. Our analysis results revealed that compared with intravenous administration, oral ibuprofen may offer certain advantages in closing PDA without increasing the risk of adverse events. Conversely, the use of paracetamol demonstrated no significant difference in PDA closure and the risk of adverse events between oral and intravenous administration.
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Affiliation(s)
- Hanwen Luo
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jianghua He
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoming Xu
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Hongju Chen
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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6
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Iwanaga J, Choudhury H, Yu A, Matsuo K, Kawai H, Han A, Tabira Y, Saga T, Watanabe K, Loukas M, Tubbs RS. A histological study of the adult ligamentum arteriosum: Novel findings with application to a patent ductus arteriosus. Clin Anat 2024; 37:140-146. [PMID: 37792451 DOI: 10.1002/ca.24122] [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: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
The ligamentum arteriosum (LA) is the vestigial fibrous remnant of the ductus arteriosus (DA), a fetal vessel arising from the left dorsal segment of the sixth aortic arch that connects the left pulmonary artery to the aortic arch. Incomplete obliteration of the DA results in a patent ductus arteriosus (PDA), causing the shunting of oxygen-rich blood to recirculate to the lungs, which can lead to pulmonary hypertension. The current study aims to further elucidate the structural characteristics of the LA via histological analysis with data gathered from adult cadaveric specimens. The LA was harvested and histologically observed with Hematoxylin and Eosin, van Gieson, and Masson's trichrome staining. Fibrous and muscle tissues were observed in all 25 specimens. The LA was categorized into three types based on the morphological features of the LA. Type I (vessel-like structure), type II (fibrotic tissue with duct-like structure), and type III (no duct-like structure) were found in 4.0%, 80.0%, and 16.0%, respectively. Finally, the remnant of a valve in the LA was also observed at the junction between the AA and LA. We suggest that this valve be called the "pulmonary-aortic valve." In the majority of the adult LAs, a duct-like structure was still present. These data could better elucidate our understanding of the pathology and etiology of a PDA.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Humza Choudhury
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron Yu
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Katsuhisa Matsuo
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Aya Han
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Yoko Tabira
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Tsuyoshi Saga
- Domain of Anatomy, Kurume University School of Nursing, Kurume, Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- University of Queensland, Brisbane, Queensland, Australia
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7
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Chen Y, Wu Y, Feng W, Luo X, Xiao B, Ding X, Gu Y, Lu Y, Yu Y. Vav2 promotes ductus arteriosus anatomic closure via the remodeling of smooth muscle cells by Rac1 activation. J Mol Med (Berl) 2023; 101:1567-1585. [PMID: 37804474 DOI: 10.1007/s00109-023-02377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
The ductus arteriosus (DA), bridging the aorta and pulmonary artery, immediately starts closing after birth. Remodeling of DA leads to anatomic obstruction to prevent repatency. Several histological changes, especially extracellular matrices (ECMs) deposition and smooth muscle cells (SMCs) migration bring to anatomic closure. The genetic etiology and mechanism of DA closure remain elusive. We have previously reported a novel copy number variant containing Vav2 in patent ductus arteriosus (PDA) patients, but its specific role in DA closure remains unknown. The present study revealed that the expression of Vav2 was reduced in human patent DA, and it was less enrichment in the adjacent aorta. Matrigel experiments demonstrated that Vav2 could promote SMC migration from PDA patient explants. Smooth muscle cells with Vav2 overexpression also presented an increased capacity in migration and downregulated contractile-related proteins. Meanwhile, SMCs with Vav2 overexpression exhibited higher expression of collagen III and lessened protein abundance of lysyl oxidase, and both changes are beneficial to DA remodeling. Overexpression of Vav2 resulted in increased activity of Rac1, Cdc42, and RhoA in SMCs. Further investigation noteworthily found that the above alterations caused by Vav2 overexpression were particularly reversed by Rac1 inhibitor. A heterozygous, rare Vav2 variant was identified in PDA patients. Compared with the wild type, this variant attenuated Vav2 protein expression and weakened the activation of downstream Rac1, further impairing its functions in SMCs. In conclusion, Vav2 functions as an activator for Rac1 in SMCs to promote SMCs migration, dedifferentiation, and ECMs production. Deleterious variant potentially induces Vav2 loss of function, further providing possible molecular mechanisms about Vav2 in PDA pathogenesis. These findings enriched the current genetic etiology of PDA, which may provide a novel target for prenatal diagnosis and treatment. KEY MESSAGES: Although we have proposed the potential association between Vav2 and PDA incidence through whole exome sequencing, the molecular mechanisms underlying Vav2 in PDA have never been reported. This work, for the first time, demonstrated that Vav2 was exclusively expressed in closed DAs. Moreover, we found that Vav2 participated in the process of anatomic closure by mediating SMCs migration, dedifferentiation, and ECMs deposition through Rac1 activation. Our findings first identified a deleterious Vav2 c.701C>T variant that affected its function in SMCs by impairing Rac1 activation, which may lead to PDA defect. Vav2 may become an early diagnosis and an effective intervention target for PDA clinical therapy.
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Affiliation(s)
- Yinghui Chen
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yizhuo Wu
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Weiqi Feng
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xueyang Luo
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Bing Xiao
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xiaowei Ding
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yongjia Gu
- Department of Stomatology, Shidong Hospital of Yangpu District, Shanghai, 200438, China.
| | - Yanan Lu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
| | - Yu Yu
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
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8
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Ali SK, Stanford AH, McNamara PJ, Gupta S. Surfactant and neonatal hemodynamics during the postnatal transition. Semin Fetal Neonatal Med 2023; 28:101498. [PMID: 38040585 DOI: 10.1016/j.siny.2023.101498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Surfactant replacement therapy (SRT) has revolutionized the management of respiratory distress syndrome (RDS) in premature infants, leading to improved survival rates and decreased morbidity. SRT may, however, be associated with hemodynamic changes, which can have both positive and negative effects on the immature cardiovascular system, during the transitional adaptation from fetal to extrauterine environment. However, there is a relative paucity of evidence in this domain, with most of them derived from small heterogeneous observational studies providing conflicting results. In this review, we will discuss the hemodynamic changes that occur with surfactant administration during this vulnerable period, focusing on available evidence regarding changes in pulmonary and systemic blood flow, cerebral circulation and their clinical implications.
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Affiliation(s)
- Sanoj Km Ali
- Division of Neonatology, Sidra Medicine, Doha, Qatar; University of Tasmania, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Amy H Stanford
- Pediatrics - Neonatology, Department of Pediatrics, University of Iowa, Iowa City, LW, USA.
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics and Internal Medicine, University of Iowa, Iowa City, LW, USA.
| | - Samir Gupta
- Department of Engineering, Durham University, United Kingdom; Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar.
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Yarboro MT, Boatwright N, Sekulich DC, Hooper CW, Wong T, Poole SD, Berger CD, Brown AJ, Jetter CS, Sucre JMS, Shelton EL, Reese J. A novel role for PGE 2-EP 4 in the developmental programming of the mouse ductus arteriosus: consequences for vessel maturation and function. Am J Physiol Heart Circ Physiol 2023; 325:H687-H701. [PMID: 37566109 PMCID: PMC10643004 DOI: 10.1152/ajpheart.00294.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
The ductus arteriosus (DA) is a vascular shunt that allows oxygenated blood to bypass the developing lungs in utero. Fetal DA patency requires vasodilatory signaling via the prostaglandin E2 (PGE2) receptor EP4. However, in humans and mice, disrupted PGE2-EP4 signaling in utero causes unexpected patency of the DA (PDA) after birth, suggesting another role for EP4 during development. We used EP4-knockout (KO) mice and acute versus chronic pharmacological approaches to investigate EP4 signaling in DA development and function. Expression analyses identified EP4 as the primary EP receptor in the DA from midgestation to term; inhibitor studies verified EP4 as the primary dilator during this period. Chronic antagonism recapitulated the EP4 KO phenotype and revealed a narrow developmental window when EP4 stimulation is required for postnatal DA closure. Myography studies indicate that despite reduced contractile properties, the EP4 KO DA maintains an intact oxygen response. In newborns, hyperoxia constricted the EP4 KO DA but survival was not improved, and permanent remodeling was disrupted. Vasomotion and increased nitric oxide (NO) sensitivity in the EP4 KO DA suggest incomplete DA development. Analysis of DA maturity markers confirmed a partially immature EP4 KO DA phenotype. Together, our data suggest that EP4 signaling in late gestation plays a key developmental role in establishing a functional term DA. When disrupted in EP4 KO mice, the postnatal DA exhibits signaling and contractile properties characteristic of an immature DA, including impairments in the first, muscular phase of DA closure, in addition to known abnormalities in the second permanent remodeling phase.NEW & NOTEWORTHY EP4 is the primary EP receptor in the ductus arteriosus (DA) and is critical during late gestation for its development and eventual closure. The "paradoxical" patent DA (PDA) phenotype of EP4-knockout mice arises from a combination of impaired contractile potential, altered signaling properties, and a failure to remodel associated with an underdeveloped immature vessel. These findings provide new mechanistic insights into women who receive NSAIDs to treat preterm labor, whose infants have unexplained PDA.
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Affiliation(s)
- Michael T Yarboro
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, United States
| | - Naoko Boatwright
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Deanna C Sekulich
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Christopher W Hooper
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ting Wong
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Stanley D Poole
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Courtney D Berger
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Alexus J Brown
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Christopher S Jetter
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jennifer M S Sucre
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Elaine L Shelton
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States
| | - Jeff Reese
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, United States
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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10
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Bentley RET, Hindmarch CCT, Archer SL. Using omics to breathe new life into our understanding of the ductus arteriosus oxygen response. Semin Perinatol 2023; 47:151715. [PMID: 36906478 DOI: 10.1016/j.semperi.2023.151715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
The ductus arteriosus (DA) connects the aorta to the pulmonary artery (PA), directing placentally oxygenated blood away from the developing lungs. High pulmonary vascular resistance and low systemic vascular resistance facilitate shunting of blood in utero from the pulmonary to the systemic circulation through the widely patent DA, thereby optimizing fetal oxygen (O2) delivery. With the transition from fetal (hypoxia) to neonatal (normoxia) oxygen conditions, the DA constricts while the PA dilates. This process often fails in prematurity, promoting congenital heart disease. Impaired O2-responsivness in the DA promotes persistent ductus arteriosus (PDA), the most common form of congenital heart disease. Knowledge of DA oxygen sensing has greatly advanced in the past few decades, however we still lack a complete understanding of the sensing mechanism. The genomic revolution of the past two decades has facilitated unprecedented discovery in every biological system. This review will demonstrate how multiomic integration of data generated from the DA can breathe new life into our understanding of the DA's oxygen response.
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Affiliation(s)
| | - Charles C T Hindmarch
- QCPU, Queen's Cardiopulmonary Unit, Translational Institute of Medicine (TIME), Department of Medicine, Queen's University, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen L Archer
- QCPU, Queen's Cardiopulmonary Unit, Translational Institute of Medicine (TIME), Department of Medicine, Queen's University, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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11
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The Association between Hemodynamically Significant Patent Ductus Arteriosus and 25-Hydroxyvitamin D Levels in Preterm Infants ≤32 Weeks Gestational Age. Fetal Pediatr Pathol 2023. [PMID: 37477281 DOI: 10.1080/15513815.2023.2178866] [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: 02/24/2023]
Abstract
INTRODUCTION We investigated the relationship between 25-hydroxyvitamin D (25-OHD) levels and the development of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. METHODS Newborns having a gestational age (GA) of ≤32 weeks with hsPDA consisted the study group (n = 25, 20%), while newborns ≤32 weeks of GA without PDA/hsPDA were the control group (n = 97, 80%). RESULTS The study group had lower GA, birth weight (BW) and 25-OHD levels (p < 0.0001, p = 0.002 and p = 0.003, respectively). After adjusting for the effects of GA, BW and the presence of respiratory distress syndrome, multivariable logistic regression analyses demonstrated that preterm infants with low 25-OHD levels were 6.407 (95% CI: 1.656-24.788, p = 0.007) times more likely to experience hsPDA than preterm infants with normal 25-OHD levels. Every 1 ng/mL increase in 25-OHD levels decreased the probability of hsPDA (OR: 0.894, 95% CI: 0.816-0.98, p = 0.016). Conclusion: Low 25-OHD levels may have a role in the development of hsPDA.
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12
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Zhang X, Zhang N, Song HC, Ren YY. Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: A case report. World J Clin Cases 2022; 10:13015-13021. [PMID: 36568995 PMCID: PMC9782928 DOI: 10.12998/wjcc.v10.i35.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum. In patients with ductal-dependent pulmonary blood flow, ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability, which need to be treated in perfect order.
CASE SUMMARY We present a male infant with a gestational age of 39 wk, and his fetal echocardiography showed pulmonary atresia. At 28 d of age, transcatheter pulmonary valvuloplasty with balloon dilatation was performed. Two hours after the operation, the patient's pulse oxygen saturation continued to decrease. The patient was then transferred to receive cardiac catheterization. During catheterization, the invasive blood pressure and pulse oxygen saturation suddenly decreased, and repeated aortography revealed partial occlusion of the ductus arteriosus. It no longer changed when pulse oxygen saturation rose to 51% after approximately 20 min of maintenance therapy. Therefore, a ductal stent was used for implantation. Hemodynamics and hypoxemia were improved.
CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization. Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.
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Affiliation(s)
- Xu Zhang
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Ning Zhang
- Department of Medical Technology, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Hai-Cheng Song
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Yue-Yi Ren
- Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
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13
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The Association of Patent Ductus Arteriosus with Inflammation: A Narrative Review of the Role of Inflammatory Biomarkers and Treatment Strategy in Premature Infants. Int J Mol Sci 2022; 23:ijms232213877. [PMID: 36430355 PMCID: PMC9699120 DOI: 10.3390/ijms232213877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process.
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14
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Kwan R, Vasanwala RF, Baral VR. Patent ductus arteriosus in a late preterm neonate: think congenital hypopituitarism. BMJ Case Rep 2022; 15:e248188. [PMID: 35981751 PMCID: PMC9394200 DOI: 10.1136/bcr-2021-248188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A late preterm female neonate presented with initial respiratory distress and heart murmur attributed to a haemodynamically significant patent ductus arteriosus (hsPDA) not responding to two courses of ibuprofen. Thyroid function performed for prolonged neonatal jaundice at 3 weeks of life suggested central hypothyroidism. Subsequent adrenocorticotropic hormone stimulation test showing hypocortisolism and MRI revealing adenohypophysis hypoplasia confirmed the diagnosis of congenital hypopituitarism (CH). Commencement of hydrocortisone followed by thyroxine replacement coincided with clinical closure of the hsPDA within 72 hours of treatment. Hypothyroidism and hypocortisolism may have contributed to persistent hsPDA. Thyroid hormone increases cytochrome P450 activity, endothelin-1 and fibronectin expression. Hydrocortisone decreases sensitivity of ductus arteriosus to PGE2 These mechanisms have been postulated to cause ductal constriction and closure. Our case supports this association. hsPDA in a term and near-term neonate with a protracted disease course or associated midline defects should prompt the clinician to suspect CH (hypothyroidism and/or hypocortisolism).
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Affiliation(s)
- Rui Kwan
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Rashida Farhad Vasanwala
- Endocrinology Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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15
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Kim CY, Chung SH. Single-dose prophylactic ibuprofen therapy for patent ductus arteriosus in preterm infants. Medicine (Baltimore) 2022; 101:e29915. [PMID: 35945745 PMCID: PMC9351839 DOI: 10.1097/md.0000000000029915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the short-term morbidities and efficacy of single-dose prophylactic intravenous ibuprofen for patent ductus arteriosus (PDA) on the first day of life in preterm infants. Data of 69 preterm infants with birth weight < 1250 g and gestational age < 30 weeks admitted to the neonatal intensive care unit were analyzed. Of these, 37 infants were assigned to the prophylactic treatment (PT) group and 32 were assigned to the nonprophylactic treatment (non-PT) group. Only the PT group administered intravenous ibuprofen (10 mg/kg) once within 6 hours after birth. Until postnatal day 7, ductal closure occurred in 11 (34.4%) infants in the non-PT group, and in 35 (94.6%) infants in the PT group, of which 30 (81.1%) infants had ductal closure on postnatal day 1. There were 2 (5.4%) infants in the PT group and 9 (28.1%) in the non-PT group who needed ibuprofen treatment due to moderate-to-large PDA after postnatal day 7. Preterm infants in the PT group were less likely to develop an intraventricular hemorrhage (≥grade 2) (adjusted odds ratio 0.007, 95% confidence interval 0.01-0.45), had a shorter duration of invasive ventilatory support and central venous catheter, and earlier postnatal age to achieve feeding of 50 and 100 mL/kg/day compared with those in the non-PT group. Single-dose prophylactic intravenous ibuprofen on the first day of life decreased the occurrence of a persistent PDA and intraventricular hemorrhage (≥grade 2), and reduced the duration of invasive ventilatory support, central venous catheter use, and hospital stay.
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Affiliation(s)
- Chae Young Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
- * Correspondence: Sung-Hoon Chung, MD, PhD, Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea (e-mail: )
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16
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Albarrán-Juárez J, Bentzon JF. Single-Cell Behavior in Closure of the Arterial Duct. Arterioscler Thromb Vasc Biol 2022; 42:743-744. [PMID: 35510554 DOI: 10.1161/atvbaha.122.317756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Jacob Fog Bentzon
- Department of Clinical Medicine, Aarhus University, Denmark (J.A.-J., J.F.B.).,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (J.F.B.)
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17
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Proença ICT, Miri MR, Marinho JP, Bock PM, de Abreu TM, Pinto MS, Blembeel AS, Ferreira AS, Andrades M, da Rosa Araújo AS, Funchal C, Pochmann D, Dani C. Gestational purple grape juice consumption does not change fetal ductus arteriosus constriction in Wistar rats. Birth Defects Res 2022; 114:525-535. [PMID: 35484956 DOI: 10.1002/bdr2.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Abstract
Grape juice consumption may influence the early occurrence of ductal constriction during pregnancy, since the consumption of foods rich in polyphenols can be linked to the premature constriction of the ductus arteriosus. This study aimed to evaluate the effect of purple grape juice consumption during gestation on fetal ductus arteriosus closure, prostaglandin levels, and oxidative stress markers in Wistar rats. We divided 18 pregnant rats into four groups: a control group (C), a single-dose grape juice group (SDGJ), a two-dose grape juice group (TDGJ) of 7 μl/g body weight per day, and an indomethacin group (I). Blood was collected on gestational day (GD) 0, 14, and 20. Prostaglandin levels were measured, and the livers and hearts were removed from the mothers and fetuses for oxidative stress analysis; histology of the fetal ductus arteriosus was performed. Prostaglandin levels (pg/ml) at GD 20 were (C:1462.10 ± 314.61); (SDGJ:987.66 ± 86.25); (TDGJ:1290.00 ± 221.57), and (I:584.75 ± 46.77). Fetal ductus arteriosus closure occurred only in the indomethacin group. Lipid peroxidation evaluated through thiobarbituric acid reactive substances (nmol/mg protein) in maternal livers was lower in the grape juice groups (C: 4.11 ± 0.76 nmol/mg protein), (SDGJ: 2.34 ± 0.36), (TDGJ: 1.52 ± 0.18), and (I: 4.20 ± 0.76). Sulfhydryls (nmol/mg protein) were lower in the TDGJ group (C:763.59 ± 61.38 nmol/mg protein), (SDGJ:978.88 ± 158.81), (TDGJ:385.32 ± 86.78), and (I:727.72 ± 49.12). Also, superoxide dismutase activity (USOD/mg protein) was higher in fetal hearts in this group: (C:5.29 ± 0.33), (SDGJ:4.48 ± 0.47), (TDGJ:7.35 ± 0.43), and (I:6.00 ± 0.18). We conclude that grape juice consumption in pregnancy does not induce ductus arteriosus closure in the fetus and presented potential antioxidant effects.
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Affiliation(s)
| | - Malena Rostirola Miri
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Jéssica Pereira Marinho
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | | | - Tamires Marques de Abreu
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Milene Santana Pinto
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Amanda Stolzenberg Blembeel
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Aimée Souto Ferreira
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Michael Andrades
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Cláudia Funchal
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Daniela Pochmann
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Caroline Dani
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
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18
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Proença ICT, de Abreu TM, Marinho JP, Miri MR, Vasques GF, Lopes LF, dos Santos M, Ortiz VD, Türck P, Araujo ASDR, Funchal C, Pochmann D, Dani C. The effect of consumption of purple grape juice in the gestational period on oxidative stress parameters in Wistar rat foetuses. INTERNATIONAL JOURNAL OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2021; 12:60-68. [PMID: 35103110 PMCID: PMC8784795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
This study aimed to evaluate the effects of purple grape juice consumption in pregnancy on oxidative stress parameters in Wistar rat fetuses. Twenty-four pregnant rats were divided into five groups: control group, indomethacin group (received a single dose of indomethacin in DG20), group grape juice DG14 (received an amount for 14 days/first and second gestational trim), group grape juice DG20 (received a dose throughout the gestational period), group grape juice two doses (received two doses, at morning and afternoon). On the 20th day of pregnancy (DG20), rats were anesthetized, and a cesarean section was performed to obtain the fetuses. A sample of liver, heart, and total brain of fetuses was collected for oxidative stress analyses. Values P<0.05 were considered significant. In fetuses' heart, we observed that the grape juice two dose group decreased sulfhydryl and increased SOD. In the liver, the grape juice decreased TBARS and SOD. There was a decrease in carbonyl and sulfhydryl in the indomethacin and grape juice one dose groups in the brain. We conclude that indomethacin altered oxidative stress parameters only in the fetal brain, and grape juice was presented as an important modulator of antioxidant capacity when consumed in a dose.
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Affiliation(s)
| | - Tamires Marques de Abreu
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Jessica Pereira Marinho
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Malena Rostirola Miri
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | | | - Luiz Fernando Lopes
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Manuela dos Santos
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Vanessa Duarte Ortiz
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul (UFRGS)Porto Alegre, RS, Brazil
| | - Patrick Türck
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul (UFRGS)Porto Alegre, RS, Brazil
| | - Alex Sander da Rosa Araujo
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul (UFRGS)Porto Alegre, RS, Brazil
| | - Claudia Funchal
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Daniela Pochmann
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
| | - Caroline Dani
- Biochemistry Laboratory, Research Center, Methodist University Center-IPAPorto Alegre, RS, Brazil
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19
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Hung YC, Liu YC, Wu BN, Yeh JL, Hsu JH. Cinaciguat Prevents Postnatal Closure of Ductus Arteriosus by Vasodilation and Anti-remodeling in Neonatal Rats. Front Physiol 2021; 12:661171. [PMID: 34393808 PMCID: PMC8358454 DOI: 10.3389/fphys.2021.661171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
Closure of the ductus arteriosus (DA) involves vasoconstriction and vascular remodeling. Cinaciguat, a soluble guanylyl cyclase (sGC) activator, was reported with vasodilatory and anti-remodeling effects on pulmonary hypertensive vessels. However, its effects on DA are not understood. Therefore, we investigated whether cinaciguat regulated DA patency and examined its underlying mechanisms. In vivo, we found that cinaciguat (10 mg/kg, i.p. at birth) prevented DA closure at 2 h after birth with luminal patency and attenuated intimal thickening. These anti-remodeling effects were associated with enhanced expression of cyclic guanosine monophosphate (cGMP) in DA. Ex vivo, cinaciguat dilated oxygen-induced DA constriction dose-dependently. Such vasodilatory effect was blunted by KT-5823, a PKG inhibitor. In DA smooth muscle cells (DASMCs), we further showed that cinaciguat inhibited angiotensin II (Ang II)-induced proliferation and migration of DASMCs. In addition, cinaciguat inhibited Ang II-induced mitochondrial reactive oxygen species (ROS) production. Finally, Ang II-activated MAPKs and Akt were also inhibited by cinaciguat. In conclusion, cinaciguat prevents postnatal DA closure by vasodilation and anti-remodeling through the cGMP/PKG pathway. The mechanisms underlying anti-remodeling effects include anti-proliferation and anti-migration, with attenuation of mitochondrial ROS production, MAPKs, and Akt signaling. Thus, this study implicates that sGC activation may be a promising novel strategy to regulate DA patency.
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Affiliation(s)
- Yu-Chi Hung
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, St. Joseph Hospital, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bin-Nan Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jwu-Lai Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Bannan B, Aly S, Yoo SJ, Seed M, Lam CZ. The Many Faces of Neonatal Ductus Arteriosus Aneurysms: Multimodality Imaging with an Emphasis on CT and MRI Appearance. Radiol Cardiothorac Imaging 2021; 3:e210017. [PMID: 34235446 DOI: 10.1148/ryct.2021210017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022]
Abstract
Neonatal ductus arteriosus aneurysm (DAA) is a rare abnormality that is typically diagnosed at fetal third trimester or early postnatal echocardiography. While echocardiography is usually adequate for diagnosis and clinical decision-making, cross-sectional imaging, including CT or cardiac MRI, may be necessary to clarify the diagnosis or delineate associated complications. Severe complications include thromboembolism, infection, compression of adjacent structures, airway erosion, and aneurysm rupture. This imaging essay reviews the pathophysiology and depicts the spectrum of cross-sectional imaging appearances of neonatal DAAs. Most neonatal DAAs will spontaneously regress and can be managed conservatively. Keywords: CT, MRI, Cardiac, Aneurysms, Congenital Supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Badr Bannan
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Safwat Aly
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Mike Seed
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Christopher Z Lam
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
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21
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Medjedovic E, Begic Z, Begic E, Iglica A, Begic N, Muftic A, Stanojevic M. Premature fetal closure of the ductus arteriosus of unknown cause – could it be influenced by maternal consumption of large quantities of herbal chamomile tea – a case report? CASE REPORTS IN PERINATAL MEDICINE 2021. [DOI: 10.1515/crpm-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The aim of this article was to present a case of premature fetal closure of the ductus arteriosus (DA) of unknown cause.
Case presentation
A 32-year-old pregnant woman came for the regular prenatal visit at 36 + 1 weeks of gestation (WG) at which oligohydramnios and premature closure of DA were revealed. Use of non-steroidal anti-inflammatory drugs was excluded by the history, although the patient had the symptoms of common cold 2 weeks before the check-up taking more than 1,000 mL of strong chamomile tea daily till the day before the prenatal visit. The patient was hospitalized at 36 + 1 weeks of gestation due to premature closure of DA and oligohydramnios (amniotic fluid index = 4.5/3), which was the indication to deliver the baby by cesarean section at 36 + 6 WG (birth weight was 2,830 g, birth length 49 cm and head circumference 34 cm, Apgar score at 1 and 5 min were 9/9). Postnatal course was uneventful, and postnatal echocardiography at 12 h of life revealed functionally closed DA and mild dysfunction of the right ventricle, which completely resolved after 7 days. The mother and the baby were discharged home healthy, and were doing well 3 months after delivery.
Conclusions
Although the cause of premature closure of DA in most of the cases will remain undetected, thorough history sometimes with unexpected events should be taken under the consideration as possible causative factor for premature DA closure, as was drinking of high quantities of chamomile tea in our case.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical University Center Sarajevo , Sarajevo , Bosnia and Herzegovina
- Department of Gynecology , Obstetrics and Reproductive Medicine, School of Medicine, Sarajevo School of Science and Technology , Sarajevo , Bosnia and Herzegovina
| | - Zijo Begic
- Department of Cardiology , Peadiatric Clinic, Clinical University Center Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Edin Begic
- Department of Cardiology , General Hospital “Prim. Dr. Abdulah Nakas” , Sarajevo , Bosnia and Herzegovina
| | - Amer Iglica
- Intensive Care Unit , Clinic for Heart, Blood Vessels and Rheumatism, Clinical University Center Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Nedim Begic
- Department of Cardiology , Peadiatric Clinic, Clinical University Center Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Amela Muftic
- Clinic for Anesthesia and Reanimation, Clinical University Center Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Milan Stanojevic
- Department of Obstetrics and Gynecology , Medical School University of Zagreb, Sveti Duh Hospital , Zagreb , Croatia
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22
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de Waal K, Prasad R, Kluckow M. Patent ductus arteriosus management and the drift towards therapeutic nihilism - What is the evidence? Semin Fetal Neonatal Med 2021; 26:101219. [PMID: 33653600 DOI: 10.1016/j.siny.2021.101219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The published literature on patent ductus arteriosus (PDA) management is challenging to interpret due to poorly designed trials with high rates of open label treatments, homogenisation of patients with varying physiological subtypes, poor treatment efficacy, and spontaneous closure in more mature infants. The perceived lack of clinical benefit has led to a drift away from medical and surgical treatment of all infants with a PDA. This therapeutic nihilism as a default response to PDA management fails to recognise the physiological relevance of a left-to-right shunt with early haemodynamic instability after birth and subsequent pulmonary volume overload with prolonged exposure. Clinicians need to know if therapeutic nihilism is safe. This review will provide an overview of the available data on the efficacy of known PDA treatments, conservative management and supportive care measures that are currently applied.
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Affiliation(s)
- Koert de Waal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle, NSW, Australia.
| | - Rahul Prasad
- Randwick Children's Hospital Department of Neonatology, Sydney, NSW, Australia
| | - Martin Kluckow
- Royal North Shore Hospital Department of Neonatology and University of Sydney, Sydney, NSW, Australia
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Molecular Mechanisms Underlying Remodeling of Ductus Arteriosus: Looking beyond the Prostaglandin Pathway. Int J Mol Sci 2021; 22:ijms22063238. [PMID: 33810164 PMCID: PMC8005123 DOI: 10.3390/ijms22063238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
The ductus arteriosus (DA) is a physiologic vessel crucial for fetal circulation. As a major regulating factor, the prostaglandin pathway has long been the target for DA patency maintenance or closure. However, the adverse effect of prostaglandins and their inhibitors has been a major unsolved clinical problem. Furthermore, a significant portion of patients with patent DA fail to respond to cyclooxygenase inhibitors that target the prostaglandin pathway. These unresponsive medical patients ultimately require surgical intervention and highlight the importance of exploring pathways independent from this well-recognized prostaglandin pathway. The clinical limitations of prostaglandin-targeting therapeutics prompted us to investigate molecules beyond the prostaglandin pathway. Thus, this article introduces molecules independent from the prostaglandin pathway based on their correlating mechanisms contributing to vascular remodeling. These molecules may serve as potential targets for future DA patency clinical management.
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Parkerson S, Philip R, Talati A, Sathanandam S. Management of Patent Ductus Arteriosus in Premature Infants in 2020. Front Pediatr 2021; 8:590578. [PMID: 33643964 PMCID: PMC7904697 DOI: 10.3389/fped.2020.590578] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.
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Affiliation(s)
- Sarah Parkerson
- Department of Pediatrics, University of Tennessee, Memphis, TN, United States
| | - Ranjit Philip
- Division of Pediatric Cardiology, University of Tennessee, Memphis, TN, United States
| | - Ajay Talati
- Division of Neonatology, University of Tennessee, Memphis, TN, United States
| | - Shyam Sathanandam
- Division of Pediatric Cardiology, University of Tennessee, Memphis, TN, United States
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25
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Bardanzellu F, Piras C, Atzei A, Neroni P, Fanos V. Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data. Front Pediatr 2020; 8:613749. [PMID: 33409262 PMCID: PMC7779766 DOI: 10.3389/fped.2020.613749] [Citation(s) in RCA: 4] [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: 10/03/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: In premature neonates, the persistence of hemodynamically significant ductus arteriosus (hsPDA) can be associated with short- and long-term consequences, impairing their outcome. The correct strategy of management for such condition is under debate, especially regarding contraindications and/or side effects. In recent years, metabolomics was applied to several perinatal, pediatric, and adult conditions to investigate potential biomarkers of disease, which have become useful for early diagnosis and/or therapeutic management. Aim of the Study: The main purpose of our exploratory study was to asses, through 1H-NMR metabolomics analysis of urinary samples at birth, possible metabolic pathways differentiating, with a significant predictive power, those preterm neonates who will subsequently develop hsPDA and neonates of comparable gestational age (GA) who will undergo spontaneous ductal closure or the persistence of an irrelevant PDA (no-hsPDA). Moreover, we investigated potential prenatal or perinatal clinical factors potentially influencing the development of hsPDA. Materials and Methods: We enrolled n = 35 preterm neonates with GA between 24 and 32 weeks; urinary samples were collected within the first 12 h of life. Patients were closely monitored regarding intensive care, respiratory support, fluid balance and administered drugs; an echocardiogram was performed at 48-72 h. Results: Our results reported a significant correlation between lower GA at birth and the development of hsPDA. Moreover, neonates with GA ≤ 30w developing hsPDA were characterized by lower Apgar scores at 1' and 5', higher rates of perinatal asphyxia, higher need of delivery room resuscitation and subsequent surfactant administration. Interestingly, metabolomics analysis at birth detected a clear separation between the 1H-NMR urinary spectra of subjects GA ≤ 30w not developing hsPDA (n = 19) and those of subjects born at GA ≤ 30w in which hsPDA was confirmed at 48-72 h of life (n = 5). Conclusions: This is the first study applying metabolomics to investigate the PDA condition. Although preliminary and conducted on a limited sample, our results reveal that metabolomics could be a promising tool in the early identification of hsPDA, potentially superior to the clinical or laboratory predictive tools explored to date and even to the clinical observations and correlations in our sample, through the detection of specific urinary metabolites.
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Affiliation(s)
- Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, Azienda Ospedaliero-Universitaria and University of Cagliari, Cagliari, Italy
| | - Cristina Piras
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandra Atzei
- Neonatal Intensive Care Unit, Department of Surgical Sciences, Azienda Ospedaliero-Universitaria and University of Cagliari, Cagliari, Italy
| | - Paola Neroni
- Neonatal Intensive Care Unit, Department of Surgical Sciences, Azienda Ospedaliero-Universitaria and University of Cagliari, Cagliari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, Azienda Ospedaliero-Universitaria and University of Cagliari, Cagliari, Italy
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