Occurrence Of Patent Ductus Arteriosus Research Articles

Gender and its association with cardiac defects in down syndrome population at Children Hospital & Institute of Child Health, Lahore, Pakistan.

The objective of this study was to determine the frequency of different congenital cardiac defects co-existing in karyotypically proved Down syndrome population. It also highlighted the association between gender and pattern of congenital cardiac defects and gender as a risk factor. A cross sectional comparative study was done in the Department of Genetics, Children Hospital Lahore in the year 2017. A total of 160 patients were subjected to karyotypic analysis through blood test for determining the type of Down Syndrome and Echocardiography of all established cases was performed for determining presence and types of congenital cardiac defects. Results were evaluated in terms of establishing co-existence of various cardiac phenotypes in Down Syndrome cases. In karyotypically proven 160 cases of Down syndrome, 58.1% of Down Syndrome cases and 88.2% of Down Syndrome with Congenital Cardiac Defects presented in infancy. The odds ratio (OR) suggested that females are 1.72 times more likely to experience a cardiac effect compared to males. Female gender was potentially associated (p-value 0.07) with occurrence of Patent Ductus Arteriosus (47.8%), whereas VSD (Ventricular Septal Defects) was most prevalent (41.1%) in males. Patent Ductus Arteriosus + Atrial Septal Defects (44.4%) was the commonest cardiac defect in female cases. The combined data for pattern of cardiac anomalies showed no significant association with gender, as indicated by a p-value of 0.990. The study concluded that most of Down syndrome cases and Down syndrome with congenital cardiac defects present to the hospital in infancy. Female cases are more prone to develop cardiac defects as compared to males. The manifestation of PDA (Patent Ductus Arteriosus) was significantly associated as an isolated anomaly in females and VSD (Ventricular Septal Defects) as isolated anomaly in males. Patent Ductus Arteriosus tend to co-exist most with ASD (Atrial Septal Defects) in female cases. Gender was not established as a risk factor for affecting the pattern of cardiac defects.

Vascular endothelial growth factor polymorphism rs2010963 status does not affect patent ductus arteriosus incidence or cyclooxygenase inhibitor treatment success in preterm infants.

Vascular endothelial growth factor is critically involved in ductus arteriosus closure. Polymorphisms in the vascular endothelial growth factor gene have been associated with several diseases in neonates and adults. Herein, we investigated if vascular endothelial growth factor polymorphism rs2010963 status is associated with patent ductus arteriosus incidence and/or pharmacological treatment success. We assessed rs2010963 status in 814 preterm infants (<1500 g birth weight) by means of restriction fragment length polymorphism analysis. DNA samples were obtained from dry-spot cards used for the German national newborn screening program. Clinical data were obtained by retrospective chart review. We could not find any statistically significant difference in the incidence of patent ductus arteriosus depending on vascular endothelial growth factor rs2010963 polymorphism status. Furthermore, no statistically significant associations between vascular endothelial growth factor polymorphism rs2010963 status and cyclooxygenase inhibitor treatment success were observed. Our results indicate that there is no association between vascular endothelial growth factor polymorphism rs2010963 status and the occurrence of patent ductus arteriosus or the response to cyclooxygenase inhibitor treatment in a large cohort of preterm infants. Additional studies are needed to determine the role of genetic factors on patent ductus arteriosus incidence and treatment response.

Intercenter variability and factors associated with survival without bronchopulmonary dysplasia in extremely preterm newborns

Background: Variability in clinical practice may influence morbidity and mortality in extremely preterm infants. We aimed to know if there are differences in survival and survival without bronchopulmonary dysplasia (BPD) in extremely preterm infants in Spanish tertiary hospitals and the potential associated factors.Methods: Fifteen hospitals from the SEN1500 network were studied. The overall rate of survival without BPD was 61.4%. Hospitals with extreme results were grouped for comparison (Group 1; N = 2480 versus Group 2; N = 2367). A bivariate analysis of the characteristics of patients and perinatal interventions was carried out and the probability of survival without BPD was studied by Cox regression.Results: Survival (79.0 versus 72.9%; p < .001) and survival without BPD (72.5 versus 49.1%; p < .001) were greater in Group 1. Higher gestational age, birth weight, and female sex were associated with better outcomes. Oxygen administration (aHR: 0.868 [95%CI: 0.782, 0.964]; p=.008) and intubation (aHR: 0.767 [95%CI: 0.701, 0.839]; p < .001) in delivery room were associated with lower survival without BPD. The occurrence of patent ductus arteriosus (PDA), sepsis and/or necrotizing enterocolitis (NEC) was independently associated with worse outcomes. After adjusting for confounders, the probabilities of survival without BPD were significantly higher among patients in Group 1: aHR: 1.557 [95% CI: 1.458, 1.662]; p < .001.Conclusions: Among the studied hospitals, we found great variability in clinical practice and in the rates of survival and survival without BPD. A more conservative approach to the use of oxygen and respiratory support seems to be related to an increase in survival without BPD. Complications such as PDA, sepsis, and/or NEC decrease survival without BPD. Other variables not included in the present study could be relevant and deserve further study.

The Effect of Inhaled Budesonide on the Prevention of Chronic Lung Disease in Premature Neonates with Respiratory Distress Syndrome.

Background:Considering all the latest achievements in neonatal respiratory care, bronchopulmonary dysplasia (BPD) is still among the most prevalent morbidity causes in premature infants. Involvement in this process results in longer period of hospitalization for the newborn and in the long run makes the living conditions more difficult. Taking the multifactorial pathogenesis into account, approaches to tackle chronic lung disease (CLD) are mainly focused on interventions and prevention procedures. This study tries to investigate the potential capability of inhaled budesonide in the prevention of BPD in newborns with gestational age of <28 weeks with the respiratory distress syndrome (RDS).Methods:This study was a randomized clinical trial done on seventy newborns with gestational ages of 23–28 weeks with RDS in Isfahan Shahid Beheshti Educational Hospital from June 2014 to April 2016. Patients were randomly assigned to two groups of intervention with budesonide and control. There were 35 newborns in each group. Upon recording demographic characteristics, the newborns in two groups were compared based on the length of noninvasive ventilation, the need for invasive mechanical ventilation, the number of surfactant administrations, pneumothorax, intraventricular hemorrhage, patent ductus arteriosus (PDA), CLD, and death.Results:The length of the need for nasal continuous positive airway pressure showed no statistically significant difference between the groups (P = 0.54). The number of newborns who needed invasive mechanical ventilation also revealed no meaningful difference (P = 0.14). Similarly, the number of newborns who were characterized as affected by CLD also showed no significant difference between the groups (P = 0.053). Moreover, the number of newborns who experienced pneumothorax was not significantly different for the groups (P = 0.057). The number of newborns who received three administrations of surfactant had also no statistically meaningful difference between the groups (P = 0.69). However, the number of newborns who received two doses of surfactant was statistically lower in budesonide intervention group than the control (P = 0.041). The prevalence of intraventricular hemorrhage with degrees of I, II, and III also showed no statistically meaningful difference between the groups with P = 0.74, 0.32, and 0.49, respectively. The occurrence of PDA had no meaningful difference between the groups (P = 0.66). Relative death cases also revealed no significant difference between the groups (P = 0.53).Conclusions:The current study revealed a decrease in CLD prevalence for newborns in interventional group; however, this decrease was not statistically meaningful. The newborns, in the intervention group, who had received two doses of surfactant (survanta) showed a significant decrease, which can be the basis for further research in this field.

Randomised Trial of Volume-Targeted Ventilation versus Pressure-Limited Ventilation in Acute Respiratory Failure in Prematurely Born Infants

Background: During volume-targeted ventilation (VTV), a constant volume is delivered with each ventilator inflation. Objectives: To determine whether VTV compared to pressure-limited ventilation (PLV) reduced the time to reach weaning criteria in prematurely born infants with acute respiratory distress, and if any difference was explained by better respiratory muscle strength and/or a lower work of breathing (WOB). Methods: Infants of <34 weeks of gestational age ventilated for <24 h in the first week after birth were randomised to receive either VTV or PLV. The primary outcome was the time to achieve pre-specified weaning criteria. Respiratory muscle strength was assessed by the measurement of the maximum inflation and expiratory pressures, and the WOB assessed by the transdiaphragmatic pressure time product. Other outcomes reported are the duration of ventilation, occurrence of patent ductus arteriosus, pneumothorax, intraventricular haemorrhage, periventricular leukomalacia and episodes of hypocarbia. Results: Forty infants, median gestational age 27 (range 23-33) weeks, were recruited. The time taken to achieve weaning criteria was similar in the two groups [median 14 h (VTV) vs. 23 h (PLV)]. There were no significant differences between the groups with regard to respiratory muscle strength, WOB or other outcomes, except that fewer of the VTV compared to the PLV group had episodes of hypocarbia (8 vs. 19; p < 0.001). Conclusion: In prematurely born infants with acute respiratory failure, use of VTV did not reduce the time to reach weaning criteria, but was associated with a reduction in episodes of hypocarbia.

Relationship between Platelet Count and Volume and Spontaneous and Pharmacological Closure of Ductus Arteriosus in Preterm Infants

It has been reported that low platelet count may increase the risk of patent ductus arteriosus (PDA) in preterm infants. Moreover, high mean platelet volume (MPV) has been found to be associated with the development of prematurity complications due to enhanced platelet reactivity. Our aim was to assess the relationship between platelet count and MPV and the occurrence of PDA and its resistance to ibuprofen closure in a cohort of extremely preterm infants. Platelet count <100 (×10(3)/mm(3); odds ratio 4.50; 95% confidence limits 1.39 to 14.61) at birth is an independent risk factor for PDA but does not affect its response to ibuprofen. MPV values did not influence PDA fate. Low platelet count increases the risk of developing a hemodynamically significant PDA but does not affect the ibuprofen closure rate. MPV is unrelated to the DA outcome.

Patent ductus arteriosus: an overview.

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, accounting for 5%-10% of all congenital heart disease in term infants. The occurrence of PDA is inversely related to gestational age and weight, with an even greater incidence in preterm infants. The maintenance of ductal patency is essential for the normal development of the fetus. In the neonate, however, persistent patency of the ductus arteriosus (DA) is associated with significant morbidity and mortality. Normally, at birth, the DA constricts, resulting in intraluminal ischemic hypoxia, which eventually leads to closure and remodeling of the ductus. PDA in term infants is usually associated with a functional defect, whereas in preterm infants it is associated with immaturity. Normal physiologic mechanisms contributing to closure - oxygen tension and decreased prostaglandins-are altered in prematurity. Clinical signs of ductal patency include murmur, tachycardia, bounding peripheral pulses, and congestive heart failure and associated symptoms. Symptoms are not always present; therefore, diagnostic imaging is critical if a PDA is suspected on clinical grounds. Three management strategies are currently available for PDA: fluid restriction and diuretics (as clinically appropriate), medical intervention, and surgical ligation. Pharmacologic closure can be achieved via administration of intravenous indomethacin or ibuprofen lysine. While both agents have shown similar efficacy, ibuprofen lysine has demonstrated an improved safety profile, particularly in terms of renal effects, compared to indomethacin.

Prophylactic Ibuprofen for the Prevention of Intraventricular Hemorrhage Among Preterm Infants: A Multicenter, Randomized Study

Ibuprofen enhances cerebral blood flow autoregulation and was shown to protect neurologic functions after oxidative stresses in an animal model. For these reasons, we hypothesized that the prophylactic use of ibuprofen would reduce the occurrence of intraventricular hemorrhage (IVH) and its worsening toward grades 2 to 4 among preterm infants. To confirm this hypothesis, we planned the present prospective study. This was a double-blind, randomized, controlled trial in which preterm infants with gestational ages of <28 weeks received ibuprofen or placebo within the first 6 hours of life. The infants were assigned randomly, at 7 neonatal care units, to receive ibuprofen (10 mg/kg, followed by 5 mg/kg after 24 and 48 hours) or placebo. Serial echoencephalography was performed 24 and 48 hours after the initial cerebral ultrasound study, on postnatal days 7, 15, and 30, and at 40 weeks' postconceptional age. Grade 1 IVH or no IVH was considered a successful outcome, whereas grade 2 to 4 IVH represented failure. The rates of ductal closure, side effects, and complications were recorded. We studied 155 infants. Grade 2 to 4 IVH developed for 16% of the ibuprofen-treated infants and 13% of the infants in the placebo group. The occurrence of patent ductus arteriosus was less frequent only on day 3 of life in the ibuprofen group. There were no significant differences with respect to other complications or adverse effects. Our study demonstrated that prophylactic ibuprofen is ineffective in preventing grade 2 to 4 IVH and that its use for this indication cannot be recommended.

Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial

Ibuprofen is used for treatment and prevention of patent ductus arteriosus in low-birthweight infants. Its effects on regional circulations differ from those of indometacin. Because prophylactic indometacin reduces the frequency of severe intraventricular haemorrhage and patent ductus arteriosus, we aimed to study the efficacy of early ibuprofen in reducing these outcomes in a double-blind, multicentre trial. Within 6 h after birth, 415 low-birthweight infants (gestational age <31 weeks) were randomly allocated ibuprofen-lysine (10 mg/kg then two doses of 5 mg/kg after 24 h and 48 h) or placebo intravenously. The primary outcome was occurrence of severe intraventricular haemorrhage; secondary outcomes were occurrence of patent ductus arteriosus and possible adverse effects of ibuprofen. Analysis was by intention to treat. 17 (8%) of 205 infants assigned ibuprofen and 18 (9%) of 210 assigned placebo developed severe intraventricular haemorrhage (relative risk 0.97 [95% CI 0.51-1.82]). In 172 (84%) infants of the ibuprofen group, the ductus was closed on day 3 compared with 126 (60%) of the placebo group (relative risk 1.40 [1.23-1.59]). No important differences in other outcomes or side-effects were noted; however, urine production was significantly lower on day 1 and concentration of creatinine in serum was significantly higher on day 3 after ibuprofen. Ibuprofen prophylaxis in preterm infants does not reduce the frequency of intraventricular haemorrhage, but does decrease occurrence of patent ductus arteriosus.

Does the risk of infective endarteritis justify routine patent ductus arteriosus closure?

The risk of infective endarteritis in patients with patent ductus arteriosus seems to have declined during the last 30-40 years, and cases of patent ductus arteriosus complicated by infective endarteritis are now very rare. Moreover, with the introduction of antibiotics, there has been a dramatic reduction in mortality from infective endocarditis. Despite these changes, however, the prevention of infective endarteritis has remained the principal indication, apart from haemodynamic reasons, for surgical patent ductus arteriosus closure. The aim of this study was to ascertain whether prevention of infective endarteritis is still a justifiable indication for routine closure in all cases of patient ductus arterious. The records of 270 paediatric and adult cases of patent ductus arteriosus was reviewed with respect to infective endarteritis. All Swedish death certificates issued during the period 1960-93 were checked for the occurrence of patent ductus arteriosus in combination with infective endarteritis. There had been no cases of infective endarteritis over an aggregate of 1196 years at risk. Of nearly three million deaths in Sweden during the period 1960-93 two cases were due to infective endarteritis as a complication of patent ductus arteriosus. The present findings suggest routine closure of a patent ductus arteriosus, for the sole purpose of eliminating the risk of infective endarteritis, is unnecessary.

Effect of birth order on incidence of periventricular-intraventricular hemorrhage in very low birth weight twins.

The purpose of the study was to determine whether the incidence of periventricular-intraventricular hemorrhage (PV-IVH) is significantly different between the firstborn and secondborn of very low birth weight twins. The firstborn and secondborn of 102 sets of twins were compared by incidence of PV-IVH, mode of delivery, birth weight, 5-minute Apgar score, pH, duration of oxygen therapy, duration of ventilator support, and occurrence of patent ductus arteriosus, air leak, bronchopulmonary dysplasia, or hyaline membrane disease. PV-IVH was graded by the Papile classification. Statistical data were analyzed by either the paired t test or McNemar's test. Major PV-IVH (grades III and IV) occurred in 11 firstborn and 14 secondborn infants. Minor PV-IVH (grades I and II) occurred in 11 firstborn and 8 secondborn twins. Neither these findings nor those from other measured variables showed a statistically significant difference.

Patent ductus arteriosus in a cohort of 1338 preterm infants: a collaborative study.

As part of a prospective national survey on morbidity and mortality of all infants born at less than 32 weeks and/or weighing less than 1500 g in the Netherlands we studied the incidence of symptomatic patent ductus arteriosus (PDA) in infants surviving at least 24 hours. In 1252 of the 1338 infants the presence or absence of PDA could be established. The incidence of PDA was 10.7%. Logistic regression analyses revealed that idiopathic respiratory distress syndrome (IRDS) was the most predictive factor, followed in order of importance by septicaemia, birthweight, prolonged rupture of membranes and gestational age. None of the other maternal and perinatal factors showed any association with the occurrence of PDA. Furthermore, bronchopulmonary dysplasia (BPD) and necrotising enterocolitis (NEC) were found to be sequelae of PDA. The combination of IRDS, very pre-term birth and septicaemia should be considered as high risk for the development of PDA.

Phototherapy Effect on the Incidence of Patent Ductus Arteriosus in Premature Infants: Prevention With Chest Shielding

Patent ductus arteriosus is common among premature neonates, especially those with birth weights less than 1,500 g. In vitro, room light inhibits the contraction of immature piglet's ductal rings. Because phototherapy is used frequently from the first days of life to treat jaundice in preterm neonates, we compared the occurrence of patent ductus arteriosus among premature infants exposed to this intense light source with those whose chests were shielded. Seventy-four babies with respiratory distress syndrome were randomly assigned to either a treatment group (chest shielded with aluminum foil while on phototherapy, 36 babies) or control group (no shield, 38 babies). All were on radiant warmers, received mechanical ventilation for respiratory distress syndrome, and phototherapy (Air Shields model PTU 78-1) from day 1 of life. Irradiance was maintained at greater than 4.0 microW/cm2/nm in all cases. Although both groups had similar birth weights, gestational ages, severity of respiratory distress syndrome, intravenous fluid intake, and duration of phototherapy, the incidence of patent ductus arteriosus was significantly less in the shield group (shield 11/36 v No shield 23/38; P = .009). Patent ductus arteriosus murmurs developed in shielded patients at a later date, they required less vigorous treatment (ie, indomethacin), and they had shorter hospitalizations (74 v 85 days; P less than .05). The significant reduction of patent ductus arteriosus with shielding suggests that phototherapy may play a role in the occurrence of patent ductus arteriosus in premature infants. Shielding may be a practical method to decrease this common complication should this initial observation be confirmed.