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Patent Ductus Arteriosus In Preterm

Tim Hundscheid, Wes Onland, Bart van Overmeire, Peter Dijk, Anton H L C van Kaam, Koen P Dijkman, Elisabeth M W Kooi, Eduardo Villamor, André A Kroon, Remco Visser, Daniel C Vijlbrief, Susanne M de Tollenaer, Filip Cools, David van Laere, Anne-Britt Johansson, Catheline Hocq, Alexandra Zecic, Eddy Adang, Rogier Donders, Willem de Vries, Arno F J van Heijst, Willem P de Boode
BACKGROUND: Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28 weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality...
August 4, 2018: BMC Pediatrics
David van Laere, Bart van Overmeire, Samir Gupta, Afif El Khuffash, Marilena Savoia, Patrick J McNamara, Christoph E Schwarz, Willem P de Boode
In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes...
July 2018: Pediatric Research
Robert B Flint, Rob Ter Heine, Edwin Spaans, David M Burger, Johan C A de Klerk, Karel Allegaert, Catherijne A J Knibbe, Sinno H P Simons
PURPOSE: Ibuprofen is the drug of choice for treatment of patent ductus arteriosus (PDA). There is accumulating evidence that current ibuprofen-dosing regimens for PDA treatment are inadequate. We aimed to propose an improved dosing regimen, based on all current knowledge. METHODS: We performed a literature search on the clinical pharmacology and effectiveness of ibuprofen. (R)- and (S)-ibuprofen plasma concentration-time profiles of different dosing regimens were simulated using a population pharmacokinetic model and evaluated to obtain a safe, yet likely more efficacious ibuprofen exposure...
July 28, 2018: European Journal of Clinical Pharmacology
M A Farooqui, Y Elsayed, M M Jeyaraman, O Dingwall, M Tagin, R Zarychanski, R Rabbani, A M Abou-Setta
BACKGROUND: A clinically significant patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in premature newborns. Symptomatic PDAs are often treated with prostaglandin synthesis inhibitors (PSI), but controversy remains if PSIs should also be used to manage early, asymptomatic PDAs. OBJECTIVE: To systematically identify, critically appraise, and evaluate the efficacy and safety of pharmacological management of pre-symptomatic PDA in preterm newborns after confirmed patency by echocardiography...
July 19, 2018: Journal of Neonatal-perinatal Medicine
Pedro C Marques, Gustavo Rocha, Filipa Flor-De-Lima, Hercília Guimarães
BACKGROUND: Extrauterine growth restriction (EUGR) remains a serious problem among very low birth weight (VLBW) infants and is a marker of severe nutritional deficit during the first weeks of life. It can lead to a higher risk of growth impairment during childhood and long-term medical problems. The aim of this study is to determine the prevalence and risk factors of EUGR in preterm infants below 1500 grams. METHODS: Descriptive retrospective study of all preterm infants with birth weight below 1500 grams who were born at and discharged from our center, from January 1, 2012 to December 31, 2016...
July 23, 2018: Minerva Pediatrica
Seigo Okada, Jun Muneuchi, Yusaku Nagatomo, Chie Yokota, Junya Ohmura, Junko Yamamoto, Mamie Watanabe, Chiaki Iida, Hiromitsu Shirouzu, Yasuhiko Takahashi
Hemodynamically significant patent ductus arteriosus (PDA) in preterm infants increases morbidity and mortality. Here we describe a 12-day-old neonate with a huge PDA who developed pulmonary hemorrhage following disseminated intravascular clotting and multiple organ failure. Medical treatment or surgical ligation could not be performed because of the patient's poor condition. Transcatheter closure using a commercially available device (Amplatzer Vascular Plug II) successfully treated the huge PDA without major complications...
July 15, 2018: International Heart Journal
Sally Mashally, Lynne E Nield, Patrick J McNamara, Fernando F Martins, Afif El-Khuffash, Amish Jain, Dany E Weisz
OBJECTIVE: The study objective was to evaluate the association of oral acetaminophen therapy versus immediate surgical ligation with neonatal outcomes in infants with persistent patent ductus arteriosus. METHODS: We performed a retrospective cohort study of preterm infants born 28+6  weeks or less gestational age with persistent large patent ductus arteriosus being considered for surgical ligation after unsuccessful medical therapy. Infants in epoch 1 (July 2009 to June 2012) were immediately referred for ligation, and infants in epoch 2 (July 2012 to June 2015) were treated with oral acetaminophen and referred for ligation in the absence of improvement...
July 11, 2018: Journal of Thoracic and Cardiovascular Surgery
Daniela Doni, Giuseppe Paterlini, Anna Locatelli, Sara Arnoldi, Maria Chiara Magri, Davide Bernasconi, Maria Grazia Valsecchi, Paolo Emilio Tagliabue
Premature birth is a leading cause of neonatal morbidity and mortality. Since gestational age at birth is the most important predictive factor of adverse neonatal outcomes, strategies to postpone premature labor are of major importance. Studies on tocolytic drugs show that COX inhibitors such as indomethacin are superior to others in terms of efficiency in delaying birth, but results concerning neonatal outcomes associated with prenatal exposure to these drugs show controversial results. Indomethacin is also used in the postnatal age for pharmacologic treatment of patent ductus arteriosus (PDA), but no data concerning the effects of antenatal exposure on postnatal ductal patency are available...
July 9, 2018: Journal of Maternal-fetal & Neonatal Medicine
Buse Özer Bekmez, Cüneyt Tayman, Mehmet Büyüktiryaki, Aslıhan Köse Çetinkaya, Ufuk Çakır, Turan Derme
BACKGROUND: The role of red cell distribution width-to-platelet ratio (RPR) has not previously been mentioned in reports on patent ductus arteriosus (PDA). Our objective was to evaluate whether RPR would have a role in the diagnosis and/or prediction of pharmacological closure of PDA. METHODS: Preterm infants' gestational age ≤30 weeks and ≤1500 g who were given first ibuprofen treatment in the first week of life for hemodynamically significant PDA (hsPDA) were included in the study...
July 6, 2018: Journal of Clinical Laboratory Analysis
Elaine L Shelton, Nahid Waleh, Erin J Plosa, John T Benjamin, Ginger L Milne, Christopher W Hooper, Noah J Ehinger, Stanley Poole, Naoko Brown, Steven Seidner, Donald McCurnin, Jeff Reese, Ronald I Clyman
BACKGROUND: Although studies involving preterm infants ≤34 weeks gestation report a decreased incidence of patent ductus arteriosus after antenatal betamethasone, studies involving younger gestation infants report conflicting results. METHODS: We used preterm baboons, mice, and humans (≤276/7 weeks gestation) to examine betamethasone's effects on ductus gene expression and constriction both in vitro and in vivo. RESULTS: In mice, betamethasone increased the sensitivity of the premature ductus to the contractile effects of oxygen without altering the effects of other contractile or vasodilatory stimuli...
July 6, 2018: Pediatric Research
Martina Persson, Prakesh S Shah, Franca Rusconi, Brian Reichman, Neena Modi, Satoshi Kusuda, Liisa Lehtonen, Stellan Håkansson, Junmin Yang, Tetsuya Isayama, Marc Beltempo, Shoo Lee, Mikael Norman
Importance: Diabetes in pregnancy is associated with a 2-times to 3-times higher rate of very preterm birth than in women without diabetes. Very preterm infants are at high risk of death and severe morbidity. The association of maternal diabetes with these risks is unclear. Objective: To determine the associations between maternal diabetes and in-hospital mortality, as well as neonatal morbidity in very preterm infants with a birth weight of less than 1500 g. Design, Setting, Participants: This retrospective cohort study was conducted at 7 national networks in high-income countries that are part of the International Neonatal Network for Evaluating Outcomes in Neonates and used prospectively collected data on 76 360 very preterm, singleton infants without malformations born between January 1, 2007, and December 31, 2015, at 24 to 31 weeks' gestation with birth weights of less than 1500 g, 3280 (4...
July 2, 2018: JAMA Pediatrics
Cynthia R Amirtharaj, Lynn C Palmeri, Gideon Gradwohl, Yair Adar, Meir Nitzan, Dorota Gruber, Andrew Blaufox, David B Meyer, Elena N Kwon, Robert Koppel
OBJECTIVE: We aimed to correlate photoplethysmographic parameters with stroke volume in infants with PDA. Photoplethysmography constitutes the optical signal in pulse oximetry. STUDY DESIGN: Stroke volume was determined echocardiographically. Pulse transit time, right hand to foot arrival time difference, and relative amplitude were measured from pulse oximeter and ECG waveforms. Photoplethysmographic parameters before and after PDA closure were compared with stroke volume...
July 2, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
B Jasani, D E Weisz, P J McNamara
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and variable efficacy have highlighted a need for alternative options. Acetaminophen facilitates ductal closure via an alternate pathway of prostaglandin inhibition. Despite treatment with high doses, toxicity is uncommon in preterm infants, possibly due to immature hepatic metabolism. Pooled data from randomized clinical trials of early treatment demonstrate that acetaminophen has similar efficacy as cyclooxygenase inhibitors for PDA closure with a favorable side effect profile and without any apparent increase in adverse neonatal outcomes...
June 2018: Seminars in Perinatology
Vittorio Romagnoli, Annalisa Pedini, Monica Santoni, Grazia Scutti, Massimo Colaneri, Marco Pozzi, Paola E Cogo, Virgilio P Carnielli
AimThe aim of this study was to determine the spontaneous closure rate of patent ductus arteriosus at a 2-year follow-up, following failed medical therapy and beyond initial hospital discharge, and to evaluate in-hospital spontaneous or pharmacological closure rates.Materials and methodsA retrospective evaluation was conducted in a cohort of preterm infants admitted to the Neonatal ICU of Ancona between January, 2004 and June, 2013. Inclusion criteria were gestational age between 24+0 and 29+6 weeks or birth weight 1...
August 2018: Cardiology in the Young
David G Lehenbauer, Charles D Fraser, Todd C Crawford, Naru Hibino, Susan Aucott, Joshua C Grimm, Nishant Patel, J Trent Magruder, Duke E Cameron, Luca Vricella
OBJECTIVE: The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation. METHODS: All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed...
July 2018: World Journal for Pediatric & Congenital Heart Surgery
Itamar Nitzan, Cathy Hammerman, Daniel Fink, Meir Nitzan, Robert Koppel, Ruben Bromiker
OBJECTIVE: The ductus arteriosus is a blood vessel that connects the pulmonary artery to the descending aorta during fetal life and generally undergoes spontaneous closure shortly after birth. In premature neonates it often fails to close (patent ductus arteriosus-PDA), which can result in diversion of a significant part of the left-ventricular cardiac output to the pulmonary circulation. This left-to-right shunt may result in significant increase of pulmonary blood flow and decrease of systemic perfusion (hemodynamically significant PDA-hsPDA), which may lead to severe neonatal morbidity...
July 20, 2018: Physiological Measurement
Yu-Chi Hung, Jwu-Lai Yeh, Jong-Hau Hsu
The ductus arteriosus (DA) connects the main pulmonary artery and the aorta in fetal circulation and closes spontaneously within days after birth in normal infants. Abnormal patent DA (PDA) causes morbidities and mortality, especially in preterm infants. Closure of the DA is a complex interactive process involving two events: functional and anatomic closure. Functional closure by smooth muscle contraction was achieved through the regulatory factors of vaso-reactivity. These factors include oxygen sensing system, glutamate, osmolality, prostaglandin E₂, nitric oxide, and carbon monoxide...
June 25, 2018: International Journal of Molecular Sciences
Laura Cuzzolin, Flamina Bardanzellu, Vassilios Fanos
Patent ductus arteriosus (PDA) persistence is associated, in prematures, to several complications. The optimal PDA management is still under debate, especially regarding the best therapeutic approach and the time to treat. The available drugs are not exempt from contraindications and side effects; ibuprofen itself, although representing the first-choice therapy, can show nephrotoxicity and other complications. Paracetamol seems a valid alternative to classic nonsteroidal anti-inflammatory Drugs, with a lower toxicity...
July 2, 2018: Expert Opinion on Drug Metabolism & Toxicology
Xing-Wang Zhu, Yuan Shi, Li-Ping Shi, Ling Liu, Jiang Xue, Rangasamy Ramanathan
BACKGROUND: Invasive mechanical ventilation (IMV) is associated with the development of adverse pulmonary and non-pulmonary outcomes in very premature infants. Various modes of non-invasive respiratory support are increasingly being used to decrease the incidence of bronchopulmonary dysplasia. The aim of this trial is to compare the effect of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS) as a primary non-invasive ventilation support mode...
June 14, 2018: Trials
Jane E Stremming, Clyde J Wright, Laura D Brown
No abstract text is available yet for this article.
June 6, 2018: Acta Paediatrica
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