Patent Ductus Arteriosus In Premature Neonates Research Articles

Prediction of Therapeutic Response to Cyclooxygenase Inhibitors in Preterm Infants with Patent Ductus Arteriosus.

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. This paper reviews the factors that can predict successful closure of the PDA in preterm infants using indomethacin or ibuprofen and presents new opinions and recent findings on this topic, including the predictive roles of intrauterine growth restriction, timing of the treatment, and the importance of platelet count and arterial pH. We also discuss the prospects for future studies to improve the individualized therapy of PDA in premature neonates.

Oral pharmacological treatment for patent ductus arteriosus in premature neonates with hemodynamic repercussions.

To evaluate the efficacy of oral indomethacin, ibuprofen, and paracetamol in oral dosage form on patent ductus arteriosus (PDA) in premature neonates with significant clinical and hemodynamic repercussions (CHRs) and to determine the effect of these respective treatments on renal function. A retrospective study of cases of PDA in premature neonates in the Neonatal Intensive Care Unit was conducted. The treatments consisted of indomethacin [0.2mg/(kg·d), 3-day cycle], ibuprofen [10mg/(kg·d) followed by 5mg/(kg·d), 3-day cycle], and paracetamol (15mg/kg every 6h, 5-day cycle). The drugs were administered as an oral solution. The following variables were considered: gestational age, newborn weight at birth, Apgar score, diuresis, serum creatinine and urea levels, and serum electrolyte levels (sodium and potassium). Treatment with indomethacin presented efficacy of 87.5% in closure of the ductus with a mean outcome period of 3.5d. In premature neonates with CHRs and contraindications for indomethacin, the initial treatment with either ibuprofen or paracetamol failed to close the ductus. However, when this treatment was followed by indomethacin, closure occurred in 66.7% of the neonates, with an outcome period of 9.66d. The initial treatment with one cycle of ibuprofen followed by one or two cycles of paracetamol failed to close the ductus. Oral indomethacin was effective for closure of the PDA in premature neonates with severe CHRs. Oral paracetamol or ibuprofen for PDA closure in premature neonates with severe CHRs and contraindications for indomethacin was ineffective. However, results in clinical improvements of neonates allowed the subsequent use of indomethacin and successful closure of the ductus. A significant reduction of diuresis occurred in neonates who were treated with indomethacin, either as a first-line treatment or after the failure of ibuprofen or paracetamol.

Transcatheter occlusion of the patent ductus arteriosus in premature infants weighing less than 1200 g

ObjectivesOver the last few decades different strategies have been proposed to treat persistent ductal patency in premature infants. The advent of the Amplatzer Duct Occluder II Additional Size (ADOIIAS) provided...

Abstract 13990: Early Clinical Experience of Trans-Catheter Closure of Patent Ductus Arteriosus in Extremely Premature Neonates

Introduction: Children born prematurely often have a patent ductus arteriosus (PDA). Surgical ligation of the PDA is standard when pharmacologic therapy fails. Trans-catheter closure of PDA (TCCPDA) in premature neonates is a relatively new technique. Hypothesis: To describe our early clinical experience of TCCPDA in premature neonates who require positive pressure ventilation (PPV) and to identify risk factors for poor respiratory outcomes. Methods: A retrospective review was performed. A respiratory severity score (RSS) was calculated for all patients. The change in the RSS post-procedure and the time taken for return to pre-procedure RSS were used as outcome variables. Patients with pulmonary artery systolic pressure >50% of the systolic blood pressure were considered to have pulmonary hypertension (PHT). Results: Thirty premature neonates (25.7±2.8 weeks’ gestation, birth weight=756±284 g) that were PPV dependent with or without PHT were referred for TCCPDA at 55.5±32.2 days of age, weighing 1.67±0.54 Kg. Procedures were performed using only femoral venous access under echo and fluoroscopic guidance. The device used for closure included the 4mm Amplatzer Vascular Plug-II (AVP-II) in 10, 6 mm AVP-II in 10, 8mm AVP-II in 3, 4mm AVP-4 in 1 and MVP-5Q device in 6 patients. The procedure and fluoroscopic times were 83.7±56.8 and 12.8±11.6 minutes respectively. The radiation and contrast doses were 52.8±34.2 mGy and 2.8±1.5 mL/Kg respectively. The baseline RSS and QP:QS ratio were 3.9±3.3 and 2.2±0.8 respectively. The presence of PHT was the only predictor for a longer time to return to pre-procedure RSS (18 vs. 87 hours; OR=5.4, 95% CI:2.2-9.4, P<0.001) with a 68.8±32.6% increase in RSS (P<0.01). There was one procedure-related mortality. One patient, weighing1.06 Kg, developed left pulmonary artery stenosis following device closure. The device embolized in another patient 6 hours post-procedure. Both these devices were snared and retrieved. No other complications were noted during the procedure or on follow-up (mean 1.8 ± 0.8 years). No patients had residual PDA on follow-up echocardiogram. Conclusions: It is feasible to perform trans-catheter closure of PDAs in premature neonates. Presence of PHT prolongs the need for PPV after PDA closure.

The strategy of paracetamol (acetaminophen) use in closing patent ductus arteriosus in premature neonates.

Background: Patent ductus arteriosus (PDA) is a common problem in premature neonates which can be closed pharmacologically using nonsteroidal anti-inflammatory drugs (NSAIDs) with many side effects. Recently paracetamol is used in this field when these drugs can not be used like in cases of gastrointestinal (G.I.T) bleeding or perforation, or if the patient doesn’t show response to the NSAIDs and it seems to be of good safety. To the best knowledge this is the first paper that describes in details the strategy of using paracetamol in closing PDA in premature neonates and gives recommendations about this therapy.Objective: To give a guide and recommendations about using paracetamol in closing PDA in premature neonates regarding dosage regimen, route of administration, and about how to select and evaluate the patients before and during this therapy.Patients and Methods: A web search was done in MEDLINE, SCOPUS, Cochrane library and ISI Web of Knowledge databases as well as electronic and manual screening of conference abstracts from international meetings of relevant organizations using the words acetaminophen, paracetamol, patent ductus arteriosus, preterm and premature for all English written publications (case reports, case series and studies with no date restrictions) related to the topic.Results and data synthesis: Twenty article of different types have been evaluated. Best candidates were those premature babies with hemodynamically significant (hds) PDA and had no contraindication for paracetamol therapy. Generally success rate was ranging between 70-100 % using oral or intravenous (IV) paracetamol in a dose of 30-60 mg/kg/24 hours (h) divided every 6-8 h .Therapy commonly started after 48 h of postnatal age, patients were maximally given 2 courses during 7 days period. Pretreatment evaluation included clinical, echocardiography, cranial ultrasonography, liver function tests (LFT), renal function tests (RFT) and platelet count; and the same parameters were used during daily follow up of the patients.Conclusion: Paracetamol found to be the best choice for pharmacological closure of PDA in premature neonates if they are not responding to the other NSAIDs or when they are contraindicated. Patients should not have contraindications for this therapy and paracetamol was used in a dose that is higher than the analgesic dose with special concentration on intraventricular hemorrhage, liver function, renal function and blood platelets during treatment but generally the drug is safe one with no serious complications being reported.

Late Morbidity During Childhood and Adolescence in Previously Premature Neonates After Patent Ductus Arteriosus Closure

The health status of previously premature neonates after closure of a patent ductus arteriosus (PDA) was analyzed in childhood and adolescence. Physician questionnaires were used to study 180 hospital survivors among 210 consecutive premature neonates who underwent PDA closure between 1985 and 2005. Complete follow-up data were obtained for 129 patients (72%). During a median follow-up period of 7 years (range, 2-22 years), three late deaths (2.3%) had occurred. Only 45% of the patients were considered healthy. Morbidity included developmental delay (41.1%), pulmonary illness (12.4%), neurologic impairment (14.7%), hearing impairment (3.9%), gastrointestinal disease (3.1%), and thoracic deformity (1.2%). None of the adverse variables during the neonatal period (intraventricular hemorrhage, bradycardia apnea syndrome, bronchopulmonary dysplasia, pulmonary bleeding, hyaline membrane disease, artificial respiration time [continuous positive airway pressure + intubation], or necrotizing enterocolitis) statistically predicted respective system morbidity at the follow-up evaluation. Hyaline membrane disease (odds ratio, 2.5; p = 0.026) and longer hospitalization time (odds ratio, 1.2 days per 10 hospitalization days; p = 0.032) in the newborn period were significant predictors of an unhealthy outcome at the last follow-up evaluation. Survival until childhood after closure of a hemodynamically significant PDA in premature neonates is satisfactory. However, physical and neurodevelopmental co-morbidity persist for half of the patients, perhaps as a sequela of prematurity unrelated to ductus closure.

Therapeutic management of patent ductus arteriosus

Management of patent ductus arteriosus (PDA) in premature neonates has always been a challenge to the neonatologist and continues to be a controversial topic. Indications for treatment are not clear. Approximately 40% of ductus arteriosus close spontaneously even in extremely-low-birth-weight neonates. Prophylactic or early pre-symptomatic treatment may unnecessarily expose these babies, in whom the ductus might close spontaneously, to pharmacologic agents and their adverse effects. On the other hand, with advancing postnatal age, delaying treatment could potentially decrease successful medical closure thereby increasing the rate of surgical ligation and the complications associated with surgery. We tried to develop some clinical guidelines for management of PDA in premature neonates based on evidence, or lack thereof, and experience.

Ibuprofen Lysine (Neoprofen) for the Treatment of Patent Ductus Arteriosus

Patent ductus arteriosus (PDA) affects approximately 31% of infants whose birth weight is between 501 and 1500 g. The ductus arteriosus is a blood vessel that allows blood to bypass the pulmonary vasculature in utero. Oxygen delivery and elimination of prostaglandins are essential for the closure of the ductus after birth. For years, indomethacin has been the drug of choice for the treatment of PDA in the USA. Undesirable adverse effects prompted researchers to seek alternative agents. In April 2006, the US Food and Drug Administration approved the use of ibuprofen lysine (NeoProfen) for closure of clinically significant PDA in premature neonates. Ibuprofen's mechanism of action for closure of PDA is believed to be through the inhibition of prostaglandins. Clinical studies have shown ibuprofen to be as effective as indomethacin with fewer adverse effects.

Patent Ductus Arteriosus: A Commentary

In 1938, Dr. Robert E. Gross first successfully ligated a patent ductus arteriosus (PDA) in a 7-year-old child. This operation played a major role in the development of cardiac surgery, and has benefited an inestimable number of children. Recently, there has been renewed interest in PDA ligation in the treatment of premature infants with respiratory distress syndrome (RDS). Whether early operative intervention, prior to the onset of congestive heart failure, decreases the early mortality and morbidity of RDS, whether it aids in preventing the late crippling sequelae of this syndrome, i.e., bronchopulmonary dysplasia, or whether both results are true remains to be demonstrated. The risk of surgical closure of the PDA in premature neonates with RDS is small, and surgical closure of the PDA reduces the need for prolonged tracheal intubation considerably and the time of hospital stay.