scholarly journals Related Factors of Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Chang Liu ◽  
Xingwang Zhu ◽  
Dinggang Li ◽  
Yuan Shi
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Related Factor ◽  
Related Factors ◽  
Distribution Width ◽  
Antenatal Steroids ◽  
Standard Mean Difference ◽  
Patent Ductus

Background: Patent ductus arteriosus (PDA) is a dramatically harmful disease in the neonatal period, in particular common in preterm infants, and our study was to determine related factors of PDA in preterm infants.Methods: A comprehensive literature review was conducted in PubMed, EMBASE, and Web of Science. The pooled odds ratio and standard mean difference were calculated to compare dichotomous and continuous variables, respectively. In addition, we also assessed the heterogeneity and publication bias and carried out sensitivity analysis for each related factor.Results: We included 45 studies with 87,419 individuals. After the primary analysis and a series of adjustments, results showed chorioamnionitis, lower gestational age, lower birth weight, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, sepsis, surfactant treatment, ventilation, and lower platelet count had a positive correlation with PDA, while small for gestational age decreased the incidence of PDA in preterm infants. Besides, premature rupture of membranes, preeclampsia, antenatal steroids, male gender, mean platelet volume, and platelet distribution width were found to have no statistically significant relationship with PDA.Conclusion: Preterm infants with more immature characteristics generally have a higher likelihood to develop PDA. The prevention, diagnosis, and management of PDA may depend on these results, and effective measures can be taken accordingly.

scholarly journals A High Ductal Flow Velocity Is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22–27 Weeks Gestational Age

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Karl Wilhelm Olsson ◽  
Anders Jonzon ◽  
Richard Sindelar
Keyword(s):  
Patent Ductus Arteriosus ◽  
Flow Velocity ◽  
Gestational Age ◽  
Pharmacological Treatment ◽  
Ductus Arteriosus ◽  
Newborn Infants ◽  
Cyclooxygenase Inhibitors ◽  
Antenatal Steroids ◽  
Ductal Closure ◽  
Patent Ductus

Objective. To identify factors affecting closure of patent ductus arteriosus (PDA) in newborn infants born at 22–27 weeks gestational age (GA) during pharmacological treatment with cyclooxygenase inhibitors.Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed.Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4weeks versus24+3weeks;P=0.047),and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s;P=0.023). Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04;P=0.049).Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.

scholarly journals CYP2C9*2 is associated with indomethacin treatment failure for patent ductus arteriosus

2019 ◽  
Vol 20 (13) ◽  
pp. 939-946
Author(s):  
Sydney R Rooney ◽  
Elaine L Shelton ◽  
Ida Aka ◽  
Christian M Shaffer ◽  
Ronald I Clyman ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Treatment Failure ◽  
Preterm Infants ◽  
Gestational Age ◽  
Genetic Factors ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Multicenter Cohort Study ◽  
Patent Ductus ◽  
Indomethacin Treatment

Aims: To identify clinical andgenetic factors associated with indomethacin treatment failure in preterm neonates with patent ductus arteriosus (PDA). Patients & Methods: This is a multicenter cohort study of 144 preterm infants (22–32 weeks gestational age) at three centers who received at least one treatment course of indomethacin for PDA. Indomethacin failure was defined as requiring subsequent surgical intervention. Results: In multivariate analysis, gestational age (AOR 0.76, 95% CI 0.60–0.96), surfactant use (AOR 9.77, 95% CI 1.15–83.26), and CYP2C9*2 (AOR 3.74; 95% CI 1.34–10.44) were each associated with indomethacin failure. Conclusion: Age, surfactant use, and CYP2C9*2 influence indomethacin treatment outcome in preterm infants with PDA. This combination of clinical and genetic factors may facilitate targeted indomethacin use for PDA.

Clinical Pharmacology of Ibuprofen and Indomethacin in Preterm Infants with Patent Ductus Arteriosus

2014 ◽  
Vol 10 (3) ◽  
pp. 216-237 ◽  
Author(s):  
Gian Maria Pacifici
Keyword(s):  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Prostaglandin E2 ◽  
Preterm Infants ◽  
Gestational Age ◽  
Urine Output ◽  
Ductus Arteriosus ◽  
Closure Rate ◽  
Term Infants ◽  
Patent Ductus

Background: Ibuprofen and indomethacin are potent non-selective cyclo-oxygenase inhibitors and inhibit prostaglandin E2 synthesis. The patent ductus arteriosus (PDA) occurs in more than 70% of preterm infants weighing <1500 g. Prostaglandin E2 relaxes smooth muscle, tends to inhibit the closure of PDA, yields vasodilatation of the afferent renal arterioles and maintains glomerular filtration rate (GFR). Ibuprofen and indomethacin inhibiting prostaglandin E2 synthesis close PDA and reduce GFR with consequent decrease of urine output and increase of serum creatinine concentrations. Aims: The aims of this study are to give the definitive estimates of PDA closure rate following ibuprofen or indomethacin treatment and to evaluate the extent of renal side effects following the administration of these drugs to preterm infants. Other aims are to review the metabolism and the pharmacokinetics of ibuprofen and indomethacin in preterm infants with PDA. Methods: The bibliographic search was performed using PubMed and EMBASE databases as search engines, January 2013 was the cutoff point. Results: The %PDA closed by ibuprofen (n=24) and indomethacin (n=24) is 77.7±14.1 and 77.3±11.0, respectively. For ibuprofen, the gestational age of the infants included in the study ranged from 25.0 to 39.0 weeks (mean±SD=29.3±3.1 weeks). The %PDA did not correlate with the gestational age (p=0.2516). For indomethacin, the gestational age of infants included in the study ranged from 25.0 and 39.0 weeks (mean±SD=29.4±2.9 weeks). The %PDA did not correlate with the gestational age (p=0.3742). The treatment with ibuprofen reduces the urine output and increases the serum creatinine concentrations less extensively than indomethacin. The half-life (t1/2) of ibuprofen and indomethacin is lengthened and the clearance is reduced in preterm infants as compared with fullterm infants. Conclusions. Ibuprofen and indomethacin are equally effective in closing PDA. Treatment with ibuprofen decreases the risk of renal failure. Ibuprofen has the most favourable risk/benefit ratio. The rate of metabolism is reduced and t1/2 is lengthened in prematures as compared with term infants.

Useful Platelet Indices for the Diagnosis and Follow-Up of Patent Ductus Arteriosus

2019 ◽  
Vol 36 (14) ◽  
pp. 1521-1527 ◽  
Author(s):  
Elif Guler Kazanci ◽  
Mehmet Buyuktiryaki ◽  
Handan Unsal ◽  
Cuneyt Tayman
Keyword(s):  
Risk Factors ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Pharmacological Treatment ◽  
Ductus Arteriosus ◽  
Control Group ◽  
Distribution Width ◽  
Platelet Indices ◽  
Patent Ductus ◽  
Platelet Mass

Objective The aim of this study was to assess the utility of early postnatal platelet indices in the prediction of hemodynamically significant patent ductus arteriosus (hsPDA) and its response to pharmacological treatment in preterm infants. Study Design The medical records of 971 infants with gestational age < 30 weeks and birth weight < 1,500 g were analyzed retrospectively. Infants with hsPDA comprised the study group and those without hsPDA comprised the control group. Complete blood count results were recorded, and red cell distribution width-to-platelet ratio (RPR) and platelet mass were calculated. Results A total of 481 infants, 169 in the hsPDA group and 312 in the control group, were included. In terms of platelet indices, the hsPDA group showed significantly lower mean platelet volume (MPV) and platelet mass, whereas RPR was significantly higher (p < 0.05, respectively). Multiple logistic regression analysis showed that RDS (relative ratio [RR]: 2.39; 95% confidence interval [CI]: 1.45–3.93; p < 0.001), MPV < 7.85 (RR: 3.71; 95% CI: 2.29–6.01; p < 0.001), and RPR > 0.070 (RR: 5.33; 95% CI: 3.28–8.65; p < 0.001) were independent risk factors for hsPDA. Conclusion Low MPV and platelet mass and high RPR in the first hours of life are risk factors for hsPDA and hsPDA refractive to pharmacological treatment with ibuprofen in preterm infants.

scholarly journals Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Gema González-Luis ◽  
Stefano Ghiradello ◽  
Pilar Bas-Suárez ◽  
Giacomo Cavallaro ◽  
Fabio Mosca ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Ductus Arteriosus ◽  
Distribution Width ◽  
Platelet Counts ◽  
Pooled Data ◽  
Clinical Stability ◽  
Patent Ductus ◽  
Platelet Mass

Background: A meta-analysis published in 2015 showed a significant association between low platelet counts in the first day(s) of life and risk of patent ductus arteriosus (PDA). The meta-analysis pooled data from 11 studies cohorts (3,479 preterm infants).Objective: To update the meta-analysis by adding new studies on the topic and including other platelet parameters different from platelet counts.Methods: PubMed/Medline and Embase databases were searched. Random-effects risk ratios (RR) and differences in means (DM) and 95% confidence intervals (CI) were calculated.Results: We included 31 studies (7,638 infants). Meta-analysis showed that the risk of developing any PDA was significantly associated with platelet counts&lt;150 × 109/L (11 studies, RR 1.58, 95% CI 1.28 to 1.95), and &lt;100 x 109/L (7 studies, RR 1.61, 95% CI 1.14 to 2.28), but not &lt;50 x 109/L (4 studies, RR 1.34, 95% CI 0.77 to 2.32). Risk of developing hemodynamically significant PDA (hsPDA) was significantly associated with platelet counts&lt;150 x 109/L (12 studies, RR 1.33, 95% CI 1.09 to 1.63), and &lt;100 x 109/L (7 studies, RR 1.39, 95% CI 1.06 to 1.82), but not &lt;50 x 109/L (6 studies, RR 1.24, 95% CI 0.86 to 1.79). Infants with hsPDA had significantly lower mean platelet counts (19 studies, DM 22.0 x 109, 95% CI 14.9 to 29.1) and platelet mass (11 studies, DM 214.4, 95% CI 131.2 to 297.5) and significantly higher platelet distribution width (PDW, 9 studies, DM −0.53, 95% CI −1.01 to −0.05) than infants without hsPDA. Meta-analysis could not demonstrate significant differences in mean platelet volume (MPV).Conclusion: Compared to the previous analysis, this updated meta-analysis included 21 additional studies that provide stronger evidence of the association between low platelet counts and PDA/hsPDA. Other platelet parameters such as platelet mass and PDW are also associated with hsPDA risk. However, the low number of platelets may be an epiphenomenon associated with the maturity and clinical stability of preterm infants rather than a contributing factor in the pathogenesis of PDA.

Wide Pulse Pressure Is Not Associated with Patent Ductus Arteriosus in the First Week of Life

2019 ◽  
Vol 36 (13) ◽  
pp. 1401-1404
Author(s):  
Alona Bin-Nun ◽  
Yair Kasirer ◽  
Francis Mimouni ◽  
Irina Schorrs ◽  
Daniel Fink ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Study Design ◽  
Gestational Age ◽  
Pulse Pressure ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Patent Ductus

Objectives Widened pulse pressure is generally associated with patent ductus arteriosus (PDA). Surprisingly, this is often not true for preterm infants during the first week of life when systolic and diastolic pressures are both reduced and pulse pressure may remain unchanged. Study Design This is a retrospective, observational review of individual blood pressure (BP) parameters preterm neonates <30 weeks' gestational age during the first week of life as correlated with ductal patency and severity. Results Sixteen preterm neonates had a closed ductus on initial echocardiogram during the first week of life; 30 had a PDA that was open but hemodynamically insignificant; and 16 were found to have a hemodynamically significant PDA. Pulse pressure showed no correlation (p = 0.266) with the degree of ductal patency, whereas diastolic BP was best correlated with ductal severity (p < 0.001). Conclusion We found that low diastolic pressures are better correlated with ductal patency and severity than is pulse pressure in preterm neonates during the first week of life.

scholarly journals DOES THE TIMING OF MEDICAL TREATMENT OF PATENT DUCTUS ARTERIOSUS (PDA) HAVE AN IMPACT ON THE SUCCESS OF TREATMENT IN PRETERM INFANTS?

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e26-e27
Author(s):  
Sharandeep Kaur ◽  
Amelie Stritzke ◽  
Amuchou Soraisham
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Gestational Age ◽  
Positive Response ◽  
Ductus Arteriosus ◽  
Postmenstrual Age ◽  
Baseline Characteristics ◽  
And Gender ◽  
Positive Response Rate ◽  
Patent Ductus

Abstract BACKGROUND Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common cardiovascular problem of prematurity often treated with nonsteroidal anti-inflammatory drugs (NSAIDs-indomethacin and ibuprofen). There is limited data on the effect of postmenstrual age (PMA) at the time of start of treatment on response rates to NSAIDs in preterm infants with hsPDA. OBJECTIVES The objective of our study was to examine the effect of PMA at the start of treatment on response to NSAIDs in hsPDA. DESIGN/METHODS In this retrospective cohort study, we included infants with gestational age (GA) ≤ 32 weeks admitted to a tertiary NICU between January 2014 and December 2016, who had received one or more doses of NSAIDs for the treatment of hsPDA. Positive response (responders) to NSAIDs was considered if post treatment echocardiogram showed that PDA was either closed or small, and did not require further medical or surgical treatment. We compared baseline characteristics between responders and non-responders using univariate and multivariable logistic regression. RESULTS A total of 183 infants received 257 courses (one, two and three courses in 183, 62 and 12 neonates respectively) of NSAIDs. Positive response rate was overall 60%, and 66%, 48%, and 50% for the first, second, and third course respectively. The baseline characteristics were comparable between responders and non-responders except for higher GA, birth weight (BW), and earlier (<14 days of life) start of NSAIDs in responders. After adjusting for BW, Apgar score and gender, GA at birth but not the PMA, was associated with positive response to NSAIDs (aOR 1.24, 95% CI 1.07, 1.42 for GA; aOR 0.92, 95% CI 0.79, 1.07 for PMA). Early NSAIDs treatment was associated with increased odds of PDA closure (aOR 1.95; 95% CI 1.00–3.8). CONCLUSION Gestational age is the strongest predictor for response to NSAIDs in hs-PDA and PMA at treatment does not affect efficacy of NSAIDs.

Abstract 13501: Patent Ductus Arteriosus Catheterization Closure in Preterm Infants: A Descriptive Study of an Institutional Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heidi Kim ◽  
Sushmita Yallapragada ◽  
Rashmin C Savani ◽  
Vedanta Dariya ◽  
Sana Ullah ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Retrospective Chart Review ◽  
Pulmonary Artery Hypertension ◽  
Adverse Outcomes ◽  
Critical Congenital Heart Disease ◽  
Oxygen Requirements ◽  
Patent Ductus

Introduction: A patent ductus arteriosus (PDA) in a preterm infant can lead to respiratory insufficiency and chronic lung disease as well as necrotizing enterocolitis due to systemic hypoperfusion. Recently, catheter-based PDA closure has emerged as an appealing alternative to invasive surgical ligation in preterm infants; however, evidence to support this procedure in infancy, particularly in the premature population, is still evolving. Methods: A retrospective chart review was conducted to collect information regarding demographics, neonatal and maternal clinical characteristics, and procedural and post-catheterization data. Inclusion criteria included infants born at <32 weeks gestational age whose PDAs were closed via catheterization at our institution between January 2017 and August 2019. Infants with critical congenital heart disease and/or lethal congenital anomalies were excluded from this study. Results: Twenty-seven patients were included in our study. Indications for PDA closure in our patient population included hemodynamically significant PDA on echocardiogram, difficulty weaning respiratory support, poor feeding and weight gain, and development of NEC. Median gestational age and weight were 26 weeks and 820 g (ranging from 23 to 30 weeks and 400 to 1540 g, respectively). Most infants tolerated the procedure well and without serious adverse outcomes. One infant developed an intimal flap post-catheterization that resolved without invasive intervention, and 1 infant developed a PAH crisis after PDA closure with resolution of PAH prior to discharge. Statistically significant associations were found between PDA plug closures and decreased oxygen requirements, decreased pulmonary artery hypertension, decreased diuretic requirements, and decreased vasodilator requirements by time of discharge. Conclusions: Successful device closures of PDAs are feasible and safe, and preliminary findings show promising outcomes without mortality or long-term morbidity following transcatheter PDA closure.

scholarly journals Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

2017 ◽  
Vol 113 ◽  
pp. 10-17 ◽  
Author(s):  
Nansi S. Boghossian ◽  
Barbara T. Do ◽  
Edward F. Bell ◽  
John M. Dagle ◽  
Jane E. Brumbaugh ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Ductus Arteriosus ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Patent Ductus
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