Long-Term Variability of Heart Rate Increases with Successful Closure of Patent Ductus arteriosus in Preterm Infants

Neonatology ◽  
1992 ◽  
Vol 61 (3) ◽  
pp. 142-149 ◽  
Author(s):  
Viola Prietsch ◽  
Rolf Maier ◽  
Lothar Schmitz ◽  
Michael Obladen
Keyword(s):  
Heart Rate ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Patent Ductus

Long-Term Neurodevelopment of Low-Birthweight, Preterm Infants with Patent Ductus Arteriosus

2018 ◽  
Vol 203 ◽  
pp. 170-176.e1 ◽  
Author(s):  
R. Thomas Collins ◽  
Robert E. Lyle ◽  
Mallikarjuna Rettiganti ◽  
Jeffrey M. Gossett ◽  
James M. Robbins ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Patent Ductus

scholarly journals Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jonathan L. Slaughter ◽  
Clifford L. Cua ◽  
Jennifer L. Notestine ◽  
Brian K. Rivera ◽  
Laura Marzec ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Brain Natriuretic Peptide ◽  
Preterm Infants ◽  
Prospective Cohort ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Delay ◽  
Ductal Closure ◽  
Postmenstrual Age ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. Methods Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. Discussion The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in “high-risk” infants most likely to receive benefit. Trial registration ClinicalTrials.gov NCT03782610. Registered 20 December 2018.

scholarly journals Assessing patent ductus arteriosus in preterm infants from standard neonatal intensive care monitoring

2021 ◽  
Author(s):  
Charalampos Kotidis ◽  
David Wertheim ◽  
Michael Weindling ◽  
Heike Rabe ◽  
Mark A. Turner
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Time Analysis ◽  
Intensive Care Monitoring ◽  
Patent Ductus

AbstractMonitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. The aim of this pilot study was to investigate whether PDA status could be assessed from standard neonatal intensive care monitoring. Electrocardiography (ECG) and blood pressure (BP) waveforms were acquired from extremely preterm infants using standard neonatal monitors. We developed software using MATLAB to analyse ECG and BP waveforms and their interrelationships in terms of pulse transit time (PTT) and pulse wave velocity (PWV). The times from peak systolic BP to diastolic trough (BPFt) and from the diastolic trough to peak systolic BP (BPRt) were also calculated. PTT, BPFt and BPRt were normalised for heart rate (HR) termed NPTT, NBPFt and NBPRt, respectively. ECG, invasive aortic BP monitoring and echocardiography were performed in 14 preterm infants < 29 weeks’ gestation in the first 3 days after birth. The median (range) birth weight of the infants was 0.90 (0.48–1.31) kg, gestation 26.6 (24.0–28.7) weeks, PDA diameter 1.6 (0.8–3.6) mm and mean BP 32 (16–40) mmHg. We found a significant positive correlation between PDA diameter and NPTT (r = 0.69, P = 0.007) as well as NBPFt (r = 0.65, P = 0.012) and NBPRt (r = 0.71, P = 0.005). No relationship was found between PDA diameter and pulse pressure.Conclusions: Interrelationships between ECG and BP traces as well as BP waveform time analysis are straightforward to measure and associated with PDA diameter. The results of this pilot study suggest that this approach may help provide biomarkers for continuous monitoring PDA diameter and function. What is Known:• Patent ductus arteriosus (PDA) in premature infants is associated with increased risk of developing chronic lung disease, necrotising enterocolitis and cerebral injury.• Currently PDA is assessed intermittently using echocardiography which requires considerable expertise and sometimes is not well tolerated by critically ill preterm infants. What is New:• Blood pressure (BP) and ECG waveform interrelation and BP trace time analysis, taking account of heart rate, relate to PDA diameter.• ECG and BP waveform phase difference as well as BP waveform time analysis may be useful in the continuous assessment of PDA function.

Patent Ductus Arteriosus in Preterm Infants, Part 1: Understanding the Pathophysiologic Link Between the Patent Ductus Arteriosus and Clinical Complications

2017 ◽  
Vol 36 (5) ◽  
pp. 265-272 ◽  
Author(s):  
Yasser N. Elsayed ◽  
Debbie Fraser
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Outcome ◽  
Neonatal Outcomes ◽  
Current Evidence ◽  
Clear Understanding ◽  
Compensatory Mechanisms ◽  
Patent Ductus

AbstractThe clinical guidelines for treating patent ductus arteriosus (PDA) have significantly evolved over the last decades from treating any ductal shunt to more conservative management where only the hemodynamically significant patent ductus arteriosus (HSPDA) is treated. This shift has resulted largely from a lack of evidence from randomized controlled trials supporting a relationship between treating a PDA and improving long-term neonatal outcomes. However, there are many unresolved issues. There is no consensus on the precise definition of HSPDA requiring treatment or a clear understanding of when to treat HSPDA. Moreover, the current evidence shows worsening of the long-term neurodevelopmental outcome for infants undergoing surgical PDA ligation.The presence of physiologic variability among preterm infants, and the presence of different compensatory mechanisms may make it difficult to establish a link between pathophysiology and long-term outcomes. That is, the physiologic variability cannot be simply assessed by randomly assigning infants into two arms of a study. Relying on research from animal and human studies, this article explains the link between the pathophysiology of a PDA and neonatal outcomes.

ASSOCIATION OF PATENT DUCTUS ARTERIOSUS SIZE WITH CLINICAL FEATURES AND SHORT-TERM OUTCOMES IN PRETERM INFANTS LESS THAN 34 WEEKS

2020 ◽  
Vol 07 (03) ◽  
pp. 105-108
Author(s):  
Chandrakala Bada Shekharappa ◽  
Edison Albert Balakrishnan Elizabeth ◽  
Bharathi Balachander
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Clinical Features ◽  
Ductus Arteriosus ◽  
Short Term ◽  
Patent Ductus
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