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Preterm PDA

P Thakore, A E Dunbar, E B Lindsay
A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant's initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted...
December 1, 2018: Journal of Neonatal-perinatal Medicine
Maria Gillam-Krakauer, Jeff Reese
Preterm infants are at increased risk for patent ductus arteriosus (PDA). Prolonged exposure to PDA may be deleterious and has been associated with neonatal morbidity and mortality. Although the molecular mechanisms underlying regulation of postnatal ductus arteriosus closure are not fully understood, clinical experience and research trials have informed recent changes in PDA management strategies and refocused treatment strategies on smaller subsets of infants who require intervention. This review examines current diagnostic and management approaches to PDA in preterm neonates...
July 2018: NeoReviews
Chen-Hong Wang, Li-Ping Shi, Xiao-Lu Ma, Li-Zhong DU
OBJECTIVE: To study the clinical features and prognosis of bronchopulmonary dysplasia (BPD) complicated by pulmonary hypertension (PH) in preterm infants. METHODS: A retrospective analysis was performed on the clinical data of 191 preterm infants with BPD. RESULTS: In the 191 preterm infants with BPD, 37 (19.4%), all with moderate or severe BPD, developed PH beyond 36 weeks' corrected age. The incidence rates of PH in infants with moderate and severe BPD were 5...
November 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Kai-Hsiang Hsu, Pierre Wong, Ram Kumar Subramanyan, Julie Evans, Shahab Noori
OBJECTIVE: To characterize preterm infants that demonstrates respiratory improvement 7 days after ligation of a patent ductus arteriosus (PDA). STUDY DESIGN: We performed a 2-phase study of preterm infants (birthweight <1500 g between 2010 and 2016). We first did a retrospective analysis using regression modeling of ligation population. We then performed a case-control study comparing a ligation group with infants matched by gestational age, postnatal age, and preligation respiratory condition (ventilator mode, mean airway pressure [MAP], and fraction of inspired oxygen [FiO2 ])...
October 19, 2018: Journal of Pediatrics
Ronald I Clyman, Melissa Liebowitz, Joseph Kaempf, Omer Erdeve, Ali Bulbul, Stellan Håkansson, Johanna Lindqvist, Aijaz Farooqi, Anup Katheria, Jason Sauberan, Jaideep Singh, Kelly Nelson, Andrea Wickremasinghe, Lawrence Dong, Denise C Hassinger, Susan W Aucott, Madoka Hayashi, Anne Marie Heuchan, William A Carey, Matthew Derrick, Erika Fernandez, Meera Sankar, Tina Leone, Jorge Perez, Arturo Serize
OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial...
October 16, 2018: Journal of Pediatrics
Gamze Demirel, Aslan Yılmaz, Binay Vatansever, Ayhan Tastekin
AIM: To determine whether there is any association between platelet indices within the first hours of life and hemodynamically significant patent ductus arteriosus (hsPDA) in preterm newborns. PATIENT AND METHODS: A total of 100 preterm infants, gestational age < 32 weeks and birth weight < 1500 grams were analyzed in the study. Complete blood counts obtained within the first 6 hours of life were evaluated for platelet parameters and compared for patent ductus arteriosus (PDA) status...
October 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Ufuk Cakir, Cuneyt Tayman
OBJECTIVE:  Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. STUDY DESIGN:  Our study was conducted between January 2013 and December 2017. Premature infants, birth weight <1,500 g and gestational age <32 weeks were included in the study...
October 6, 2018: American Journal of Perinatology
Karl Wilhelm Olsson, Anders Larsson, Anders Jonzon, Richard Sindelar
BACKGROUND: Early identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants. METHODS: Infants born at 22-27 weeks' gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen...
September 18, 2018: Pediatric Research
R Thomas Collins, Robert E Lyle, Mallikarjuna Rettiganti, Jeffrey M Gossett, James M Robbins, Patrick H Casey
OBJECTIVE: To evaluate whether the presence of patent ductus arteriosus (PDA) in preterm infants worsens long-term neurodevelopmental outcomes. STUDY DESIGN: This was a secondary observational analysis of data from 1090 preterm low-birthweight infants in the Infant Health and Development Program (IHDP), a multicenter longitudinal cohort study of outcomes assessed from 3 to 18 years of age. Multivariable analysis was adjusted for IHDP treatment group (intervention or follow-up), birth weight, maternal race, maternal education, infant sex, maternal preconception weight, Home Observation Measurement of the Environment (HOME) total score at 12 months, neonatal health index, and gestational age...
September 26, 2018: Journal of Pediatrics
Arne Ohlsson, Rajneesh Walia, Sachin S Shah
BACKGROUND: Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to several organs. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective as indomethacin with fewer adverse effects. OBJECTIVES: To determine the effectiveness and safety of ibuprofen compared with indomethacin, other cyclo-oxygenase inhibitor(s), placebo, or no intervention for closing a patent ductus arteriosus in preterm, low-birth-weight, or preterm and low-birth-weight infants...
September 28, 2018: Cochrane Database of Systematic Reviews
James I Hagadorn, Mihoko V Bennett, Elizabeth A Brownell, Kurlen S E Payton, William E Benitz, Henry C Lee
OBJECTIVE: To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants. STUDY DESIGN: This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs...
September 20, 2018: Journal of Pediatrics
Bharathi Balachander, Nivedita Mondal, Vishnu Bhat, Bethou Adhisivam, Mahesh Kumar, Santhosh Satheesh, Mahalakshmi Thulasingam
BACKGROUND: Currently nonselective cyclooxygenase (COX) inhibitors, ibuprofen and indomethacin, are approved drugs for closure of patent ductus arteriosus but have potential toxicities. There are reports of the effectiveness of paracetamol in ductal closure. However, there is paucity of data comparing paracetamol to ibuprofen or indomethacin in relation to the efficacy and safety profile. METHODS: This randomized clinical trial was done in our tertiary care neonatal unit from October 2014 to January 2016 after clearance from ethical committee...
October 29, 2018: Journal of Maternal-fetal & Neonatal Medicine
Koert de Waal, Nilkant Phad, Andrew Boyle
BACKGROUND: Left atrium (LA) function can be assessed by volumetric measurements, conventional and tissue Doppler, and more recently, deformation imaging using two-dimensional speckle tracking echocardiography (2DSTE). 2DSTE allows for measurement of volume and deformation and can quantify the contribution of the reservoir, conduit, and contraction phase. A common cause for LA dysfunction in very preterm infants is volume overload with a patent ductus arteriosus (PDA). The aim of this study was to explore the feasibility and reliability of LA 2DSTE in preterm infants, and describe LA function with and without PDA volume load...
September 17, 2018: Echocardiography
Wen-Qiang Liu, Yan Xu, Ai-Min Han, Ling-Jian Meng, Jun Wang
OBJECTIVE: To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS). METHODS: Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation...
September 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Maaike A Hempenius, Elise A Verhagen, Jozien C Tanis, Christa Einspieler, Arend F Bos
OBJECTIVE: To determine the association between potential neonatal risk factors and the quality of general movements (GMs) in preterm infants. STUDY DESIGN: Prospective cohort study in 67 preterm infants. From video recordings made on Days 8 and 15, we scored the GMs as normal/abnormal and detailed aspects using the general movement optimality score (GMOS). Risk factors included respiratory insufficiency requiring mechanical ventilation, patent ductus arteriosus (PDA), and abnormal blood glucose levels...
November 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Nilüfer Okur, Cüneyt Tayman, Mehmet Büyüktiryaki, Gülsüm Kadıoğlu Şimşek, Buse Ozer Bekmez, Nahide Altuğ
OBJECTIVE: Serum lactate levels provide information on metabolic capacity at the cellular level. In addition, lactate reflects tissue perfusion and oxygenation status. The aim of this study was to determine the usefulness of high lactate levels as a marker in hemodynamically significant patent ductus arteriosus (hsPDA), which may lead to tissue perfusion defects. METHODS: Preterm infants with gestational age ≤32 weeks and birthweight ≤1500 g were included...
September 2, 2018: Journal of Clinical Laboratory Analysis
Brandon Michael Henry, Wan Chin Hsieh, Beatrice Sanna, Jens Vikse, Dominik Taterra, Krzysztof A Tomaszewski
Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis...
August 24, 2018: Pediatric Cardiology
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...
November 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
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