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Patent ductus arteriosus in preterm infant

Hannes Sallmon, Sven C Weber, Juliane Dirks, Tamara Schiffer, Tamara Klippstein, Anja Stein, Ursula Felderhoff-Müser, Boris Metze, Georg Hansmann, Christoph Bührer, Malte Cremer, Petra Koehne
Background: The role of platelets for mediating closure of the ductus arteriosus in human preterm infants is controversial. Especially, the effect of low platelet counts on pharmacological treatment failure is still unclear. Methods: In this retrospective study of 471 preterm infants [<1,500 g birth weight (BW)], who were treated for a patent ductus arteriosus (PDA) with indomethacin or ibuprofen, we investigated whether platelet counts before or during pharmacological treatment had an impact on the successful closure of a hemodynamically significant PDA...
2018: Frontiers in Pediatrics
R A Shanmugha Priya, R Krishnamoorthy, Vinod Kumar Panicker, Binu Ninan
BACKGROUND: Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study. AIM: To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks. SETTINGS AND DESIGN: This is a cross-sectional study conducted over a period of 2 years in a tertiary care center. MATERIALS AND METHODS: This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit...
January 2018: Asian Journal of Transfusion Science
W P de Boode, M Kluckow, P J McNamara, S Gupta
Neonatologist-performed echocardiography (NPE) is an indispensable tool in the haemodynamic management of critically ill newborn infants. NPE is used to facilitate timely diagnosis of a patent ductus arteriosus (PDA) in preterm infants and to assess its haemodynamic significance. Before treatment is considered, it is obligatory to confirm structural cardiac normality. Importantly, NPE offers the ability to guide therapeutic interventions, allowing an individualised haemodynamic management approach to the PDA...
March 7, 2018: Seminars in Fetal & Neonatal Medicine
Sigrid Baumgartner, Monika Olischar, Martin Wald, Tobias Werther, Angelika Berger, Thomas Waldhör, Georg Fischer, Ulrike Salzer-Muhar
BACKGROUND: Postnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition-adaptation we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant PDA (hPDA) by applying a pump model. METHODS: Pumping was characterized by EA (effective arterial elastance, reflecting afterload), EES (endsystolic LV elastance, reflecting contractility), EA /EES -coupling ratios, descriptive EA :EES relations and EA /EES -graphs...
March 14, 2018: Pediatric Research
Deonne Dersch-Mills, Belal Alshaikh, Amuchou S Soraisham, Albert Akierman, Kamran Yusuf
Background: There is no injectable ibuprofen product marketed to treat patent ductus arteriosus (PDA) in newborns in Canada. The authors' institution has used ibuprofen arginine in the past. In the absence of published evidence supporting use of this salt form of ibuprofen for neonatal PDA, a retrospective analysis was undertaken. Objective: To compare the effectiveness and adverse effects of ibuprofen arginine, ibuprofen tromethamine, and indomethacin in the treatment of PDA...
January 2018: Canadian Journal of Hospital Pharmacy
Tamorah R Lewis, Elaine L Shelton, Sara L Van Driest, Prince J Kannankeril, Jeff Reese
Patent ductus arteriosus (PDA) is a frequent, complex, and difficult to treat clinical syndrome among preterm infants in the neonatal intensive care unit. In addition to known clinical risk factors, there are emerging data about genetic predisposition to PDA in both animal and human models. Clinical response and toxicity from drugs used to treat PDA are highly variable. Developmental and genetic aspects of pharmacokinetics and pharmacodynamics influence exposure and response to pharmacologic therapies. Given the variable efficacy and toxicity of known drug therapies, novel therapeutic targets for PDA treatment offer the promise of precision medicine...
February 24, 2018: Seminars in Fetal & Neonatal Medicine
Biagio Castaldi, Giulia Bordin, Valentina Favero, Daniel Nardo, Francesca Previati, Sabrina Salvadori, Eugenio Baraldi, Ornella Milanesi
BACKGROUND AND AIMS: Preterm newborns undergo hemodynamic challenges in the postnatal period. The aim of this study was to investigate myocardial mechanics changes in the postnatal period in preterm infants using speckle tracking echocardiography (STE). MATERIAL AND METHODS: Thirty-nine preterm infants ≤34 weeks' gestation underwent cardiac ultrasound evaluation during the first 96 hours of life. A repeated echocardiogram at 3 weeks of age was performed. Echocardiographic assessment involved left ventricular ejection fraction, mitral E/A ratio, S' and E' velocities, E/E' ratio, tricuspid annular plane systolic excursion (TAPSE), left atrium-to-aorta ratio, ductal diameter and ductal shunt pattern...
March 6, 2018: Echocardiography
Víctor Lago Leal, Loida Pamplona Bueno, Lucía Cabanillas Vilaplana, Estefanía Nicolás Montero, Mónica Martín Blanco, Cristina Fernández Romero, Sara El Bakkali, Tamara Pradillo Aramendi, Lara Sobrino Lorenzano, Paula Castellano Esparza, Esther Ballesteros Benito, Nieves Rayo Navarro, Pablo Del Barrio Fernández, Vanesa Ocaña Martínez, Luis Martínez Cortés
OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0...
March 5, 2018: Fetal Diagnosis and Therapy
Ines Tofe, Maria Dolores Ruiz-González, Maria Dolores Cañete, Asuncion Pino, Rosa Lorena Rueda, Maria Jose Parraga, Juan Luis Perez-Navero
Background: Standard medical treatment for patent ductus arteriosus (PDA) closure has been indomethacin/ibuprofen or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous paracetamol for closing PDA in preterm neonates presenting contraindication to ibuprofen or ibuprofen had failed and no candidates for surgical ligation because of huge instability. Materials and methods: We conducted a retrospective case series study in a neonatal intensive care unit from a tertiary hospital...
2018: Frontiers in Pediatrics
Smita Akkinapally, Shilpa G Hundalani, Madhulika Kulkarni, Caraciolo J Fernandes, Antonio G Cabrera, Binoy Shivanna, Mohan Pammi
BACKGROUND: Prostaglandin E1 (PGE1) is used to keep the ductus arteriosus patent and can be life-saving in neonates with ductal-dependent cardiac lesions. PGE1 is used to promote mixing of pulmonary and systemic blood flow or improve pulmonary or systemic circulations, prior to balloon atrial septostomy or surgery. PGE1 therapy may cause several short-term and long-term adverse effects. The efficacy and safety of PGE1 in neonates with ductal-dependent cardiac lesions has not been systematically reviewed...
February 27, 2018: Cochrane Database of Systematic Reviews
Yang Hu, Hongfang Jin, Yi Jiang, Junbao Du
Patent ductus arteriosus (PDA) is a morbid condition commonly seen in premature infants. Cyclooxygenase (COX) inhibitors, such as indomethacin and ibuprofen, are often used for the treatment of PDA in preterm infants, and they work by reducing the production of prostaglandin. However, as observed in clinical practice, not all PDAs in preterm infants can be closed using COX inhibitors. Some studies have demonstrated that gestational age, birth weight, B-type natriuretic peptide (BNP), and ductal diameter can predict the therapeutic responsiveness to COX inhibitors...
February 21, 2018: Pediatric Cardiology
Timothy J B Ulrich, Taylor P Hansen, Kimberly J Reid, Michael A Bingler, Steven L Olsen
OBJECTIVE: The influence of post-ligation cardiac syndrome (PLCS), a complication of patent ductus arteriosus (PDA) ligations, on neonatal outcomes is unknown. The purpose of this study was to determine the risks of PLCS on severe pulmonary morbidity and severe retinopathy of prematurity (ROP). STUDY DESIGN: Retrospective cohort study of infants who underwent a PDA ligation between 2006 and 2015. Data were collected on patients with and without PLCS. The primary outcome was the difference in severe bronchopulmonary dysplasia (BPD) between groups...
February 16, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Christoph E Schwarz, Antonio Preusche, Martin Wolf, Christian F Poets, Axel R Franz
BACKGROUND: What constitutes a hemodynamically relevant patent ductus arteriosus (hrPDA) in preterm infants is unclear. Different clinical and echocardiographic parameters are used, but a gold standard definition is lacking. Our objective was to evaluate associations between regional cerebral tissue oxygen saturation (rcStO2 ), fraction of tissue oxygen extraction (rcFtO2 E) measured by frequency domain near-infrared spectroscopy (fd-NIRS) and their correlation to echocardiographic, Doppler-ultrasound, and clinical parameters in preterm infants with and without a hrPDA...
February 16, 2018: BMC Pediatrics
Gerhard Pichler, Nina Höller, Nariae Baik-Schneditz, Bernhard Schwaberger, Lukas Mileder, Jasmin Stadler, Alexander Avian, Jasmin Pansy, Berndt Urlesberger
Introduction: Up to 50% of preterm infants admitted to intensive care units require cardiocirculatory support. The aim of the present study was to assess whether simultaneous monitoring of cerebral tissue oxygenation index (cTOI) and peripheral tissue oxygenation index (pTOI) using near-infrared spectroscopy (NIRS) in combination with dedicated intervention guidelines may help avoiding arterial hypotension and catecholamine administration in preterm neonates. Study design: Preterm neonates <37 weeks of gestation were included in a single center randomized controlled study...
2018: Frontiers in Pediatrics
Carlo Dani, Chiara Poggi, Ilaria Cianchi, Iuri Corsini, Venturella Vangi, Simone Pratesi
Paracetamol seems to have similar success rates compared with indomethacin and ibuprofen in closing patent ductus arteriosus (PDA) in preterm infants, but with a better safety profile. The aim of our study was to evaluate the possible effects of paracetamol on cerebral oxygenation and cerebral blood flow velocity (CBFV). Infants with gestational age < 32 weeks with hemodynamically significant PDA (hsPDA) were prospectively studied by near infrared spectroscopy (NIRS) after the first dose of paracetamol (15 mg/kg) or ibuprofen (10 mg/kg)...
January 25, 2018: European Journal of Pediatrics
Sarah Louise Harris, Kiran More, Bronwyn Dixon, Richard Troughton, Chris Pemberton, John Horwood, Nicola Ellis, Nicola Austin
This study aimed to investigate factors affecting N-terminal pro-B-type natriuretic peptide (NTproBNP) in preterm infants and the ability of NTproBNP to predict haemodynamically significant patent ductus arteriosus (HsPDA). Prospective cohort study of 51 infants < 30 weeks gestation. Blood NTproBNP and heart ultrasound were performed on day of life 3, 10, 28 and 36 weeks corrected age. NTproBNP levels analysed for prediction of HsPDA. The effect of gestational age, ventilation, hypoxia, bronchopulmonary dysplasia (BPD), creatinine and haemoglobin levels on NTproBNP levels were investigated...
January 19, 2018: European Journal of Pediatrics
Alice Héneau, Fabien Guimiot, Damir Mohamed, Aline Rideau Batista Novais, Corinne Alberti, Olivier Baud
OBJECTIVES: To investigate the relationship between histologic findings of the placenta and response to early postnatal hydrocortisone treatment used to prevent bronchopulmonary dysplasia (BPD) in extremely preterm infants. METHODS: In an exploratory analysis of the Early Low-Dose Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia in Extremely Preterm Infants (PREMILOC) trial, detailed placental analyses were performed on the basis of standardized macroscopic and histologic examinations...
February 2018: Pediatrics
Samuel J Gentle, Colm P Travers, Waldemar A Carlo
PURPOSE OF REVIEW: Caffeine use in preterm infants has endured several paradigms: from standard of care to possible neurotoxin to one of the few medications for which there is evidence of bronchopulmonary dysplasia (BPD) risk reduction. The purpose of the review is to analyze this dynamic trajectory and discuss controversies that still remain after decades of caffeine use. RECENT FINDINGS: Following concerns for caffeine safety in preterm infants, a large randomized controlled trial demonstrated a reduction in BPD and treatment for patent ductus arteriosus...
April 2018: Current Opinion in Pediatrics
Soo Jung Kang, Young Sun Cho, Seo Jung Hwang, Hyo Jin Kim
Background: To evaluate the outcomes of left ventricular (LV) function according to treatment response for a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. Methods: Echocardiograms of 21 preterm infants born at gestational age < 31 weeks obtained at term-equivalent age were retrospectively studied. Among preterm infants with a hsPDA, 9 underwent ligation after failure of pharmacological closure (ligation group) and 6 experienced successful pharmacological closure (medication group)...
December 2017: Journal of Cardiovascular Ultrasound
Jihye Hwang, Yu Seon Kim, Jeong Hee Shin, Byung Min Choi
BACKGROUND: In preterm infants, caffeine citrate is used to stimulate breathing before they are weaned from mechanical ventilation and to reduce the frequency of apnea. In recent studies, effects of caffeine on the cardiovascular system have been emphasized in preterm infants with patent ductus arteriosus (PDA). METHODS: This study aimed to assess the short-term hemodynamic effects on systemic blood flow and ductal shunting flow after loading standard doses of intravenous caffeine in preterm infants...
January 22, 2018: Journal of Korean Medical Science
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