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Preterm PDA

Fernando de Freitas Martins, Daniel Ibarra Rios, Maura Helena F Resende, Henna Javed, Dany Weisz, Amish Jain, Jose Maria de Andrade Lopes, Patrick J McNamara
OBJECTIVE: To define the technique of estimating ductal diameter (DD) that best correlates with echocardiographic markers of transductal shunt volume in preterm infants >7 days old with persistent patent ductus arteriosus (PDA). STUDY DESIGN: We conducted a retrospective study of 104 neonates born at <30 weeks gestation that had targeted neonatal echocardiography evaluation of PDA performed between 7 and 30 days. We used univariate analysis to determine the association of echocardiographic markers of shunt volume with ductal size definitions: DD, DD indexed to weight, and DD indexed to left pulmonary artery diameter...
August 13, 2018: Journal of Pediatrics
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
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
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
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
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
Sadık Yurttutan, Aydın Bozkaya, Füheda Hüdayioglu, Mehmet Yekta Oncel
OBJECTIVE: Hemodynamically significant PDA (hsPDA) is one of the most common problems in preterm infants. This study was conducted to investigate the effect of combined pharmacological (paracetamol + ibuprofen) therapy on monotherapy-resistant hsPDA in infants. SUBJECT AND METHODS: The study included infants with persistent hsPDA, unresponsive to monotherapy. Combined treatment (paracetamol + ibuprofen) was started as paracetamol at a dose of 15 mg/kg every 6 hours for 5 days, and ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours...
June 19, 2018: Journal of Maternal-fetal & Neonatal Medicine
Jane E Stremming, Clyde J Wright, Laura D Brown
No abstract text is available yet for this article.
June 6, 2018: Acta Paediatrica
Dimple Goel, Pankaj Gupta, Stephen Cooper, Jan Klimek
AIM: Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point-of-care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. METHODS: Medline, PubMed, EMBASE and the Internet were searched up to November 2017 for articles in English which included SPCs in preterm infants without CHD...
June 5, 2018: Acta Paediatrica
V Katheria, D M Poeltler, M Brown, K O Hassen, D Patel, W Rich, N N Finer, A C Katheria
BACKGROUND: The optimal thresholds for identification of preterm infants at greatest risk for adverse sequelae related to patent ductus arteriosus have not been well delineated. Our aim was to determine hemodynamic parameters in the first 24 hours using continuous non-invasive vital and structural measurements to predict which infants required PDA treatment in our institution. METHODS: Retrospective secondary analysis of data from infants born 23 to 32 weeks gestational age with cardiac output and stroke volume via electrical cardiometry, cerebral tissue oximetry measurements, mean arterial blood pressure (BP), heart rate, and oxygen saturation and functional echocardiography results at 12 hours of life were recorded when available (93 percent of subjects)...
May 23, 2018: Journal of Neonatal-perinatal Medicine
B Ezenwa, E Pena, A Schlegel, R Bapat, E G Shepherd, L D Nelin
AIM: To determine whether a decrease in patent ductus arteriosus (PDA) treatment or ligation in extremely preterm (EP) infants was associated with changes in rates of mortality and/or morbidities. METHODS: Observational study on EP infants admitted from 2008 to 2015. The small baby guidelines do not mandate ligation, however, in late 2010 the guidelines were amended based on new literature suggested that ligation may increase rates of morbidities. RESULTS: There were 717 EP infants admitted during the study period...
May 28, 2018: Acta Paediatrica
Silvia Rodriguez-Blanco, Ignacio Oulego-Erroz, Sandra Gautreaux-Minaya, Alejandro Perez-Muñuzuri, Maria Luz Couce-Pico
OBJECTIVE: To assess whether early NT-ProBNP can identify the need for echocardiographic assessment of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. STUDY DESIGN: Prospective observational study of infants with a gestational age ≤32 weeks. Echocardiographic assessment and NT-proBNP measurement were performed at 48-96 h. ROC curves were generated to assess optimal cutoffs to detect HsPDA and predict the need for treatment. RESULTS: Eighty-five patients were included...
July 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
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