Hemodynamically Significant Patent Ductus Arteriosus Research Articles

The Characteristics and Two-Year Neurodevelopmental Outcomes of Home Oxygen Therapy among Preterm Infants with Bronchopulmonary Dysplasia: A Retrospective Study in a Medical Center in Taiwan.

Home oxygen therapy (HOT) is frequently used as a therapeutic strategy for children experiencing chronic oxygen dependency associated with bronchopulmonary dysplasia (BPD). Recent studies have highlighted substantial variations in the characteristics and outcomes of infants requiring oxygen, primarily due to the absence of a consensus on the management of HOT in infants with BPD. We conducted this retrospective study and reviewed the medical records of extremely and very preterm infants who were diagnosed with BPD in a tertiary center in northern Taiwan from January 2020 to September 2021. Their neurodevelopmental outcomes were evaluated at 18 to 24 months of corrected age. A total of 134 patients diagnosed with BPD were divided into a HOT group (n = 39) and a room air group (n = 95). The children in the HOT group had a higher incidence of hemodynamic significant patent ductus arteriosus (PDA) (p = 0.005) and PDA ligation (p = 0.004), high-frequency oscillatory ventilation (p < 0.001), nitrogen oxide inhalation (p < 0.001), pulmonary hypertension (p = 0.01), and longer invasive ventilation (p < 0.001), as well as longer hospitalization (p < 0.001). A multivariate logistic regression model demonstrated that prolonged invasive ventilation (OR = 1.032, 95% CI 0.984-1.020, p = 0.001) was correlated with oxygen dependency in children. Infants with BPD born at advanced gestational age (OR = 0.760, 95%CI 0.582-0.992, p = 0.044) had a decreasing risk of requiring HOT. The children in the HOT group had a higher incidence of emergency room visits (p < 0.001) and re-hospitalization (p = 0.007) within one year of corrected age. The neurodevelopmental outcomes revealed the HOT group had an increasing portion of moderate to severe cognitive delay (18.2% vs. 3.7%, p = 0.009) and moderate to severe language delay (24.2% vs. 6.1%, p = 0.006) at 18 to 24 months of corrected age. In conclusion, infants with BPD necessitating HOT required prolonged invasive ventilation during hospitalization and exhibited a greater prevalence of unfavorable neurodevelopmental outcomes at 18 to 24 months of corrected age as well.

Perfusion Index as a Predictor of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Newborns

Aim: To assess the value of perfusion index (PI) and arrive at the ideal cut-off value of delta PI (DPI) (pre and postductal difference in PI) in identifying hemodynamically significant patent ductus arteriosus (HsPDA). Methods: Prospective observational study was conducted on 156 preterm newborns of &lt;37 weeks in the NICU of tertiary care center, from August 2019 to March 2020 after ethical clearance. 156 preterm babies were classified into noPDA, HsPDA and Non-HsPDA based on echocardiogram findings and compared with DPI value on Day 1 to 3 of life. Receiver operating characteristic (ROC) curve was constructed to establish cut-offs for DPI in diagnosing HsPDA. A P value &lt;.05 is considered for statistical significance. Results: There was a significantly lower PI in both preductal and post ductal limbs with HsPDA compared to other groups. A DPI Cut-off of 0.75 on day 2 of life has a sensitivity of 75%, specificity of 100% and positive predictive value (PPV) of 100% and a negative predictive value of 89%. Conclusion: PI is a simple non-invasive bedside index predict the presence of a HsPDA in preterm newborns and DPI of &gt;0.75 indicates for presence of HsPDA.

Ischemia modified albumin as a marker of hypoxia in preterm infants in the first week after birth

BackgroundTissue hypoxia remains a leading cause of morbidity and mortality in preterm infants. Current biomarkers often detect irreversible hypoxic cellular injury (i.e. lactate) and are non-specific. A new biomarker is needed which detects tissue hypoxia before irreversible damage occurs. AimsTo investigate the relation between serum ischemia modified albumin (IMA), a marker of hypoxia; and analytic variables, patient related variables and conditions associated with hypoxia, in preterm infants. Study designRetrospective cohort study. SubjectsInfants with a gestational age < 30 weeks and/or birth weight < 1000 g. Outcome measuresWe collected two remnant blood samples in the first week after birth and measured IMA. IMA/albumin ratio (IMAR) was used to adjust for albumin. We assessed correlations between IMA(R) and analytic variables (albumin, lipemia- and haemolysis index); mean-2 h SpO2; mean-2 h variability of regional splanchnic oxygen saturation (rsSO2), measured using near-infrared spectroscopy; and patent ductus arteriosus (PDA). ResultsSixty-five infants were included. Albumin, the lipemia- and haemolysis index correlated negatively with IMA (r:-0.620, P<0.001; r:-0.458, P<0.001; and r:-0.337, P=0.002). IMAR correlated negatively with SpO2 (rho:-0.614, P<0.001). Lower rsSO2 variability correlated with higher IMAR values (rho:-0.785, n=14, P=0.001 and rho:-0.773, n=11, P=0.005). Infants with a hemodynamic significant PDA (hsPDA) had higher IMAR values than infants without PDA (0.13 [0.11–0.28], n=16 vs. 0.11 [0.08–0.20], n=29, P=0.005 and 0.11 [0.09–0.18], n=13 vs. 0.09 [0.06–0.17], n=37, P=0.026). ConclusionsWhen adjusted for albumin, the lipemia- and haemolysis index, IMAR has potential value as a marker for systemic hypoxia in preterm infants, considering the associations with SpO2, variability of rsSO2, and hsPDA.

Hemodynamic evaluation of extremely low birth weight infants during the first 7 days of life

Background and aimWe aimed to investigate the hemodynamic status of extremely low birth weight (ELBW) infants during the transitional period under intensive management. MethodsThis retrospective cohort study analyzed left ventricular ejection fraction (LVEF), left ventricular end-systolic wall stress (ESWS), left ventricular internal dimension in diastole (LVIDd), and mean arterial pressure (MAP) of ELBW infants during their first week of life. Small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival to discharge infants were compared to their counterparts. ResultsSixty-two infants (25.7 ± 2.1 weeks, 700.7 ± 165.4 g) were analyzed. MAP gradually increased. Median LVEF was 69.8 % on day 1, decreased to 62.7 % on day 2, then increased throughout the week. ESWS was lowest at birth, rose to 28.2 g/cm2 on day 2, and decreased on day 6. There were no significant changes in LVIDd. SGA infants had higher MAP throughout, higher LVEF on day 2 and 3, but lower LVEF on day 5 to 7. LVIDd was lower in hCAM group. Severe IVH group had a more significant drop in LVEF on day 2, higher ESWS, and a higher incidence of hemodynamic significant patent ductus arteriosus (hsPDA). Non-survival had lower LVIDd. ConclusionsMAP increased gradually. Hemodynamic instability was observed in the first two days, with decreased LVEF and increased ESWS before stabilization. We observed an alteration in hemodynamic adaptation in SGA and hCAM infants. Severe IVH group experienced early hemodynamic instability and a higher incidence of hsPDA.

Acetaminophen versus indomethacin for patent ductus arteriosus management in premature infants: systematic review and meta-analysis of randomized controlled trials.

Acetaminophen has gained interest in the neonatal community for its use in the management of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. We conducted a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of acetaminophen with indomethacin for the management of HsPDA in preterm infants. We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS from inception to June 15, 2021. Bibliographies of identified studies were searched for additional references. Data were analyzed with Review Manager (RevMan) Version 5.3. Four RCTs were identified, enrolling a total of 380 subjects. There was no difference between the interventions for the outcome of PDA closure after one course (RR 1.04 [95% CIs: 0.84, 1.29], P-value 0.70) or after two courses of treatment (RR 1.01 [95% CIs: 0.92, 1.12], P-value 0.77); and for the outcome of PDA ligation (RR 1.56 [95% CIs: 0.48, 5.12], P-value 0.46). However, patients who received acetaminophen had lower rates of necrotizing enterocolitis (RR 0.37 [95% CIs: 0.14, 0.95], P-value 0.04). There were no significant differences noted in the other clinical outcomes, that is, intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, and death. Two studies noted significant post-treatment elevation of serum creatinine and blood urea with indomethacin, as compared to none with acetaminophen use. Acetaminophen has comparable efficacy to indomethacin for the outcome of HsPDA closure, with a better safety profile, that is, lesser rates of necrotizing enterocolitis and post-treatment azotemia noted with its use.

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants.

Intraventricular hemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. IVH is particularly common in preterm infants. Although advances in obstetric management and neonatal care have led to a lower mortality rate for preterm infants with IVH, the IVH-related morbidity rate in this population remains high. Therefore, the present review investigated the pathophysiology of IVH and the evidence related to interventions for prevention. The analysis of the pathophysiology of IVH was conducted with a focus on the factors associated with cerebral hemodynamics, vulnerabilities in the structure of cerebral vessels, and host or genetic predisposing factors. The findings presented in the literature indicate that fluctuations in cerebral blood flow, the presence of hemodynamic significant patent ductus arteriosus, arterial carbon dioxide tension, and impaired cerebral venous drainage; a vulnerable or fragile capillary network; and a genetic variant associated with a mechanism underlying IVH development may lead to preterm infants developing IVH. Therefore, strategies focused on antenatal management, such as routine corticosteroid administration and magnesium sulfate use; perinatal management, such as maternal transfer to a specialized center; and postnatal management, including pharmacological agent administration and circulatory management involving prevention of extreme blood pressure, hemodynamic significant patent ductus arteriosus management, and optimization of cardiac function, can lower the likelihood of IVH development in preterm infants. Incorporating neuroprotective care bundles into routine care for such infants may also reduce the likelihood of IVH development. The findings regarding the pathogenesis of IVH further indicate that cerebrovascular status and systemic hemodynamic changes must be analyzed and monitored in preterm infants and that individualized management strategies must be developed with consideration of the risk factors for and physiological status of each preterm infant.

THE DIAGNOSTIC VALUE OF URINE GELATINASE-ASSOCIATED LIPOCALIN AS A BIOMARKER FOR ACUTE KIDNEY INJURY IN PRETERM INFANTS WITH HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS

THE DIAGNOSTIC VALUE OF URINE GELATINASE-ASSOCIATED LIPOCALIN AS A BIOMARKER FOR ACUTE KIDNEY INJURY IN PRETERM INFANTS WITH HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS

Conservative Management of Patent Ductus Arteriosus Is Feasible in the Peri-Viable Infants at 22-25 Gestational Weeks.

The purpose of this study was to determine the natural course of hemodynamically significant (HS) patent ductus arteriosus (PDA) with conservative management and whether the presence or prolonged duration of HS PDA affected mortality/morbidities in infants at 22-25 weeks estimated gestational age (EGA). We retrospectively reviewed the medical records of 77 infants born at 22-25 weeks EGA, stratified into 22-23 weeks (n = 21) and 24-25 weeks EGA (n = 56). HS PDA was present in 77%, 76%, and 77%, and open ductus at discharge was 12%, 13%, and 12% in the total and at 22-23 and 24-25 weeks EGA infants, respectively. For backup rescue treatment, 7% and 5% of the infants received oral ibuprofen and device closure, respectively. A mortality rate of 9% was found in the HS PDA (+) infants, significantly lower than the 28% in HS PDA (-) infants. There are no significant differences in morbidities. In multivariate analyses, the presence and/or prolonged duration of HS PDA was not associated with increased mortality or morbidity. Spontaneous closure of HS PDA was achieved through conservative management in the peri-viable infants at 22-25 weeks EGA.

25 Paracetamol versus Indomethacin for management of Patent Ductus Arteriosus in Premature Infants- A Systematic Review and Meta-Analysis

Abstract Background Premature infants with hemodynamically significant patent ductus arteriosus (HsPDA) have high rates of morbidity and mortality in neonatal units. Indomethacin has been the most common agent used for pharmacological closure of the PDA. Recently, paracetamol has gained interest in the neonatal community for its use for management of HsPDA. Objectives To conduct a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of paracetamol with indomethacin for HsPDA management in preterm infants. Design/Methods We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS using controlled vocabulary and key words representing the concepts "preterm neonates" and "acetaminophen" and "indomethacin". Databases were searched from inception to June 15, 2021. Bibliographies of identified studies were searched for additional references. Studies were included if they enrolled preterm infants with HsPDA (diagnosed on echocardiogram), and randomised them for treatment with paracetamol or indomethacin for the primary outcome of HsPDA closure. Discrepancies among reviewers for study selection, RoB assessments, and data extraction were resolved by consensus. Data were analyzed with the help of Review Manager (RevMan) Version 5.3. Results Four RCTs were identified, enrolling a total of 380 subjects. There was no difference between the two interventions for the rates of PDA closure either after one course (4 studies; RR 1.04 [95% CIs: 0.84, 1.29], p-value 0.70) or after two courses of treatment (2 studies; RR 1.01 [95% CIs: 0.92, 1.12], p-value 0.77), and for PDA ligation (3 studies; RR 1.56 [95% CIs: 0.48, 5.12], p-value 0.46). However, the patients who received paracetamol had lower rates of necrotizing enterocolitis (NEC) (3 studies; RR 0.37 [95% CIs: 0.14, 0.95], p-value 0.04). There were no significant differences noted in the other important secondary outcomes, i.e., Intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, and death. Two studies reported baseline and post-treatment serum markers for renal and hepatic injury; there was significant post-treatment elevation of serum creatinine and blood urea noted with the indomethacin use in each of these studies, as compared to no change noted with paracetamol use. Conclusion The efficacy of paracetamol is comparable to indomethacin for the outcome of PDA closure, with lesser rate of NEC and post-treatment azotemia noted with the paracetamol use. Paracetamol should be preferred over indomethacin for HsPDA management in premature infants.

Patent ductus arteriosus and spontaneous intestinal perforation in a cohort of preterm infants.

To assess whether either duration and magnitude of ductal shunt or medical treatment for patent ductus arteriosus (PDA) are related to spontaneous intestinal perforation (SIP). Clinical charts of infants <29 weeks' gestation born from 2006 to 2018 were reviewed. Echocardiographic examinations were evaluated according to McNamara and Sehgal's staging system. A higher percentage of patients with SIP had a hemodynamically significant PDA (HSPDA) and was treated with either NSAIDs or paracetamol (79% vs 53% and 81% vs 54%, respectively). Among non-treated patients, we found a 1.32 increase in the odds of SIP per day of persistence of HSPDA. In the cohort of patients treated despite the absence of HSPDA, we found a 2.35 increase in the odds of SIP per dose of drug administered. Both treating a non-HSPDA and leaving a HSPDA to its natural history seem to be associated with SIP.

B-type Natriuretic Peptide: A Diagnostic Biomarker for a Hemodynamically Significant PDA

Background: B-type natriuretic peptide (BNP) it has been reported to be a useful biomarker for the severity of hemodynamically significant patent ductus arteriosus (HsPDA) in premature infants. Objective: To assess serum levels of BNP in premature neonates with echocardiographically-confirmed hemodynamically significant and non-significant PDA (HnsPDA) and to explore the effect of PDA on left ventricular function. We also aimed to detect the level of BNP that differentiates between HsPDA and HnsPDA. Patients and methods: This was a cross-sectional observational study conducted on 73 randomly selected preterm neonates with HsPDA or hemodynamically nonsignificant PDA (HnsPDA), between May 2017 and May 2018. Echocardiography was done. BNP was measured using enzyme linked immunosorbent assay Results: There was no affection of left ventricular function in either group (LA/Ao ratio, FS, LVESD and LVEDD). PDA size, PFO size and PAP were significantly larger in HsPDA (p&lt;0.001, p=0.001, p&lt;0.001 respectively). Levels of BNP were significantly higher in HsPDA and correlated with the size of the PDA. At a cut-off value of 160.5 pg/ml, BNP had 80.49% sensitivity and 90.62% specificity with a positive predictive value of 91.7% and a negative predictive value of 78.04%, (AUC: 0.923, 95% C.I. 0.837 to 0.973). Conclusion: Levels of BNP in preterm babies with hemodynamically significant PDA rise early in neonatal life and correlate well with the size of the PDA. BNP can be used to screen for this condition. Ventricular dysfunction may not appear in the first 3 days of life.

Relationship between placental autophagy and inflammasome activities with morbidity of extremely preterm infants.

The placenta is the major regulatory element of the in-utero environment, and alterations in placental cellular functions in infection, inflammation, and hypoxemia lead to adverse preterm birth outcomes. The importance of regulation of autophagy and inflammasome activities has been shown in the pathogenesis of morbidities in immature animal models. This study aimed to determine the relationship between placental autophagy and inflammasome activities with morbidity in extremely preterm infants. Premature infants born between 24th to 29th gestational weeks were evaluated prospectively. Placental LC3B and NLRP3 immunostainings were performed to assess autophagy and inflammasome activities. Preterm morbidities including respiratory distress syndrome (RDS), patent ductus ateriosus: (PDA), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), periventricular leukomalacia (PVL), sepsis, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and mortality were evaluated. Fifty-nine infants with a mean gestational age of 26.9 ± 1.5 weeks were included. Anti-LC3B staining scores were moderate or intense positive in 75% of the placentas. Anti-LC3B activity was not associated with the existance of evaluated neonatal morbidities or mortality. Autophagy and inflammasome coexistence were demonstrated in 35 placentas (59.3%). Anti-NLRP3 staining score was moderate or intensely positive in 75% of the placentas. Infants with BPD had a lower rate of positive anti -NLRP3 staining than infants without BPD (42.9 vs 57.1%, p=0.048). Infants who had hemodynamic significant patent ductus arteriosus (hsPDA) and surgical- NEC showed significantly intense anti-NLRP3 staining compared to infants who did not (18.8% vs 0%, p= 0.027 and 33% vs 7.5%, p=0.048 respectively). The results showed that autophagy and inflammatory activities were present in varying amounts in the placenta of preterm infants. Association of decreased or increased rates of inflammasome activities with certain diseases such as BPD, hsPDA and surgical-NEC indicates the role of the intrauterin inflammatory process and the importance of critical balance in inflammation. Because of the complex pathophysiology of preterm morbidities, placental autophagy and inflammasome activities seem worthy of further investigation.

Early diagnostic value of C-reactive protein as an inflammatory marker for moderate-to-severe bronchopulmonary dysplasia in premature infants with birth weight less than 1500 g

BackgroundBronchopulmonary dysplasia (BPD) is a serious respiratory complication in premature infants and moderate-to-severe BPD may affect the long-term quality of life and lack of specific treatment once it happened. Therefore, it is necessary to identify early diagnostic biomarkers for moderate-to-severe BPD. MethodsThis retrospective cohort study included all premature infants with birth weight <1500 g from March 1, 2015 to June 30, 2017. Patients were categorized into mild BPD, moderate-to-severe BPD and non BPD groups. Data collected included patient characteristics, C-reactive protein (CRP) tested at six time points, including 1d (2 h after birth and before the first feeding), 3d, 7d, 2w, 3w, and 4w after birth, and maternal factors. Ordinal regression analysis was used to identify independent predictors of moderate-to-severe BPD and receiver operating characteristic (ROC) curve was used to evaluate the value of CRP as an early diagnostic marker for moderate-to-severe BPD. ResultsA total of 831 patients were recruited. BPD occurred in 156/831 premature infants with birth weight less than 1500 g. Lower birth weight (OR = 0.998, 95% CI 0.997–0.999, P = 0.004), higher CRP level 3 days after birth (OR = 1.287, 95% CI 1.195–1.384, P = 0.000), and hemodynamically significant patent ductus arteriosus (HsPDA) (OR = 12.256, 95% CI 3.766–39.845, P = 0.000) were independent risk factors for moderate-to-severe BPD. The area under curve of the CRP level 3 days after birth for diagnosing moderate-to-severe BPD was 0.867 (95% CI, 0.823–0.912, P = 0.000). The sensitivity was 83.0% and the specificity was 78.3% when the cut-off value was set at 4.105 mg/L. ConclusionThe CRP level 3 days after birth may be used as an early diagnostic marker for moderate-to-severe BPD in preterm infants who have the risk factors for BPD with birth weight less than 1500 g.

SCENARIOS OF THE COURSE OF BRONCHOPULMONARY DYSPLASIA IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS IN FOLLOW-UP TO 3 YEARS

Summary. Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications associated with preterm birth. The severity of BPD is associated with immaturity of a child's body, perinatal infections, and patent ductus arteriosus (PDA).The aim of the study was to identify the features of BPD in the 1st year of life of a child and in the follow- up to 3 years, depending on the condition of the ductus arteriosus.Material and methods. The observations of 146 premature infants with BPD, who were divided into groups depending on the state of the ductus arteriosus, were analyzed: Group I consisted of 58 children with BPD whose ductus arteriosus closed spontaneously in the early neonatal period; II group – 60 children with hemodynamically insignificant PDA, which remained open for 6-12 months; III group – 28 children with hemodynamically significant (HS) PDA, which required surgical closure during the stay of a child in the perinatal center. Results. There were significantly more cases of severe BPD among children of group II compared to group I: 23.3 vs. 8.6 % (p &lt;0.01) and, accordingly, fewer cases of moderate course: 41.7 vs. 58.6 % (p &lt;0.05) at the stage of children treatment in the perinatal center. At the age of 3 years, there were significantly more healthy children who underwent BPD in group I compared to group III: 62.5 vs. 25.9 % (p &lt;0.01), and severe course was significantly more common in both groups II and III compared to group I: 6.8 and 7.4 % vs. 0 % (p &lt;0.01). No significant differences in the severity of BPD at the age of 2-3 months and in the follow-up to 1 year from the date of surgical closure of HS PDA were detected. Conclusions. Sexual dimorphism was found, namely the prevalence of males among preterm infants with delayed closure of the ductus arteriosus. The presence of hemodynamic disorders connected with PDA is associated with a more severe course of BPD at the age of 3 years compared to children whose ductus arteriosus closed on its own in the early neonatal period. At the average term of surgical closure of PDA 21.5 ± 1.6 days of life, significant differences in the severity of BPD from the term of surgical closure of PDA weren`t detected.

Echocardiographic Study in Preterm Infant with Hemodynamic Significant Patent Ductus Arteriosus

Background: Potential complications of hemodynamic significant patent ductus arteriosus (hsPDA) after birth include heart failure, need for respiratory support, renal disfunction, intraventricular hemorrhage, as well as long term altered growth and development. Nevertheless, clinical signs of patent ductus arteriosus (PDA) are not sensitive and specific enough. Therefore, echocardiography still remains the preferred method to evaluate the ductal patency in preterm infant. The present study aimed to evaluate the echocardiography characteristic in preterm infant with hsPDA.Methods: A cross-sectional study was conducted on preterm infants aged 3-7 days with 24-336/7 weeks of gestation. Data taken were demographic, clinical and echocardiography. Diagnosis of hsPDA was carried out by echocardiography; defined as &gt;1.5mm diameter of ductus and &gt;1.4 left pulmonal artery and aorta (La/Ao) ratio. The statistical analysis was undertaken using SPSS 21.0.Results: There were 11 out of 52 preterm infants diagnosed hsPDA. Mean birth weight was 1213±293 gram; Mean gestational age was 30.72±2.01 weeks. In hsPDA group, mean ductus diameter was 2.84±0.93 mm, mean La/Ao ratio was 1.56±0.26, and mean ejection fraction (EF) was 71.55±5.72%.Conclusion: Echocardiographic evaluation is important for addressing hsPDA in preterm infants.

Особливості ренального кровотоку при гострому пошкодженні нирок у недоношених новонароджених дітей з гемодинамічно значущою відкритою артеріальною протокою

Hemodynamically significant patent ductus arteriosus (HSPDA) in premature infants leads to renal hypoperfusion due to the phenomenon of «stealing» of the systemic circulation, which can contribute to the development of acute kidney injury (AKI). The use of ultrasound Doppler sonography of the renal vessels can be effective in assessing renal blood flow and in the early diagnosis of acute renal failure. Purpose — to assess the prognostic significance of the state of renal blood flow in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 40 preterm infants (gestational age 29–36 weeks) with HSPDA. Distribution of the examined patients: the group with AKI — 23 children, the group without AKI — 17 children. The observation period was 10 days. The patients underwent echocardiography with Doppler analysis using a broadband microconvex probe with a frequency of 5–8 MHz (TOSHIBA Nemso XG) at 5–11 hours of life. Color Doppler ultrasound scanning of renal vessels was performed on the first, third and tenth days of life. The parameters of blood flow in the main renal and interlobar renal arteries were studied: peak systolic velocity (PSV) and end diastolic velocity (EDV) of blood flow, resistance index (RI). Diagnosis and stratification of AKI severity met the KDIGO neonatal modification criteria. Results. On the third to fifth day of life, AKI was diagnosed in 23 (57.5%) children, but already in the first day of life, compared with patients without AKI, a significant decrease in PSV parameters of blood flow in the main renal artery was noted (20.6±5.87 cm/sec versus 25.4±6.17 cm/sec in children without AKI, p&lt;0.02). In addition, the main changes in the first day of life in patients with AKI were revealed at the level of the interlobar renal artery, namely: a decrease in PSV blood flow (11.10±3.329 cm/sec versus 18.48±3.014 cm/sec in children without AKI, p&lt;0.001) and EDV of blood flow (2.83±2.063 cm/sec versus 6.16±2.447 cm/sec in children without AKI, p&lt;0.001), increased RI (0.758±0.137 versus 0.666±0.1216 in children without AKI, p&lt;0.02). On the third day of life at AKI, there was a disorder in the parameters of blood flow in the interlobaric renal artery, the value of which on the tenth day of life did not differ from the parameters of children without AKI. Conclusions. In premature infants with HSPDA, who were diagnosed with AKI on the third to fifth day of life, in the first day of life, there is a decrease in PSV blood flow parameters in the main renal artery, changes in blood flow in the interlobar renal artery, namely: a decrease in PSV and EDV blood flow, an increase in RI. Thus, the assessment of the state of blood flow in the interlobar renal artery on the first day of life in premature infants with HSPDA is of diagnostic value for the timely determination of the risk group for AKI. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature infants, patent ductus arteriosus, renal blood flow, acute kidney injury.

Outcomes among preterm infants with patent ductus arteriosus: Relationship with treatment, gestational age, hemodynamic status and timing of treatment.

There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. This retrospective case-control study including infants < 1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios. The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7-4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0-3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6-6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated. Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP.

Effects of antenatal magnesium sulfate use for neuroprotection on cardiorespiratory complications during the early neonatal period in preterm infants

Background/Aim: Antenatal magnesium sulfate (MgSO4) treatment is widely used for fetal neuroprotection in women at risk of preterm delivery. Possible adverse effects of MgSO4 include respiratory depression and delay in closure of ductus arteriosus by antagonism of calcium channels. The aim of this study was to investigate the effects of antenatal MgSO4 exposure on cardiorespiratory complications during the early neonatal period in premature infants. Methods: A retrospective cohort study was performed on 340 preterm infants born between 23 and 32 weeks of gestational age. Patients were divided into two groups according to antenatal MgSO4 exposure: The MgSO4 group (n=186) and the no-MgSO4 group (n=154). Outcomes were acute cardiorespiratory events (intubation at birth, respiratory support, and hypotension in first day of life), and hemodynamically significant patent ductus arteriosus (HsPDA). Results: Mothers in the MgSO4 group were more likely to have preeclampsia and antenatal steroid treatment, while their infants were younger in gestation and weighed less (P<0.05). Multivariate regression analysis showed that antenatal MgSO4 exposure was significantly associated with decreased mechanical ventilation (odds ratio [OR] 0.45 95% confidence interval [CI] 0.25-0.81, P=0.008), hypotension (OR 0.47, 95% CI 0.24-0.90, P=0.023) and HsPDA (OR 0.52, 95% CI 0.28-0.97, P=0.039). There was no significant association between antenatal MgSO4 exposure and intubation at birth (OR 1.06 95% CI 0.62-1.82, P=0.828). Conclusion: Among the preterm infants ≤ 32 weeks, antenatal MgSO4 was not associated with increased risk for acute cardiorespiratory events during the early neonatal period. It might have a protective role in helping with ductal closure.

Echocardiographic Parameters of Severity in Isolated Neonatal Patent Ductus Arteriosus

Background: A hemodynamically-significant patent ductus arteriosus (hsPDA) compromises the early neonatal transition. There is no general agreement on echocardiographic indicators of hsPDA that can predict clinical decompensation. Aim of the Work: We aimed to assess echocardiographic parameters that are associated with the isolated PDA effects on hemodynamics, which could help in subsequent management decision making. Materials and Methods: We conducted a prospective observational analytical study on 50 neonates with isolated PDA and 20 controls. They underwent clinical and echocardiographic assessment at 48 hours of age, after another 48-72 hours and prior to discharge. Results: No correlation was found between PDA diameter and weight (p=0.72), length (p=0.11), Body surface area (BSA) (p=0.33), gestational age (p=0.13). A strong association of PDA-related hemodynamic instability was found with pulmonary hypertension (p= Conclusion: Pulmonary hypertension, larger LA Z-score and LPA Z-scores are important early (at 48 hours) associations of a hsPDA and hemodynamic instability.

Association between intrauterine growth restriction and patent ductus arteriosus: Use of a dichorionic twin pregnancy model

ObjectiveTo evaluate the association between intrauterine growth restriction (IUGR) and the incidence of fetuses with patent ductus arteriosus (PDA) and Hemodynamically significant PDA (Hs-PDA) in dichorionic twins (DC) with selective IUGR. Materials and methodsThis is an observational cohort study and retrospective case assessment, involved twins born at Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan between 2013 and 2018. DC twins with selective IUGR (sIUGR) were defined as the presence of a birth weight discordance of >25% and a smaller twin with a birth weight below the tenth percentile. PDA was diagnosed using echocardiography between postnatal day 3 and 7. Hs-PDA was defined as PDA plus increased pulmonary circulation, poor systemic perfusion, cardiomegaly, pulmonary edema, or hypotension requiring pharmacotherapeutic intervention. ResultA total of 1187 twins were delivered during the study period, and 53 DC twins with selective IUGR were included in this study. DC twins with PDA have higher rate of preterm birth, lower gestational age of delivery, and lower mean birth weight of both twins compared with DC twins without PDA. In a comparison of the sIUGR twin with the appropriate for gestational age co-twin, both the incidences of PDA (28.30% vs. 7.55%, respectively; P = 0.003) and Hs-PDA (24.53% vs. 5.66%, respectively; P = 0.002) were higher in sIUGR fetuses than in the appropriate for gestational age co-twins. Small gestational age of delivery was the only variable to predict PDA and Hs-PDA [p = 0.002, Odds ratio = 0.57 (0.39–0.82), p = 0.009, Odds ratio = 0.71 (0.55–0.92), respectively]. ConclusionAn analysis of dichorionic twins with sIUGR indicated that IUGR increased the risk of PDA and hemodynamically significant PDA.