Premature Closure Of Ductus Arteriosus Research Articles

Premature Closure of the Ductus Arteriosus and Veno-Arterial Extracorporeal Membrane Oxygenation in Critically Ill Neonates: A 10-Year Single-Center Retrospective Study.

To describe critically ill neonates with premature closure of the ductus arteriosus (DA) and assess the frequency as well as predictive factors for extracorporeal membrane oxygenation (ECMO) support in the latter. This was a monocentric retrospective observational study conducted in the NICU of a French academic medical center between 01/01/2013 and 01/01/2023. All neonates diagnosed with premature closure of the DA were included. Exclusion criteria were associated congenital heart disease amenable to urgent surgeryor contraindication for ECMO. Eleven neonates with complete premature closure of the DA were included. Births were full-term with a weight of 3.60kg [3.16-3.89]. Only one case (9%) was diagnosed antenatally. Premature closure of the DA was idiopathic in seven neonates (64%) and associatedto maternal exposure to non-steroidal anti-inflammatory drugs (NSAIDs) in three (27%). All newborns had pulmonary hypertension (PH) and right ventricular hypertrophy. Three neonates (27%) were supported on veno-arterial ECMO and appeared to have more pathological adaptation to extra-uterine life, greater need for vasopressor and/or inotropic support, and higher frequency of bi-ventricular failure (100%) or morphological anomaly of the tricuspid valve (67%). No patient died but more than half had non-cardiological sequelae. Veno-arterial ECMO support is not uncommon in critically ill neonates with premature DA closure and appeared to be associated with more pathological adaptation to extra-uterine life, greater need for vasoactive-inotropic support and higher frequency of bi-ventricular failure or morphological anomaly of the tricuspid valve. These parameters can help clinicians to identify neonates likely to require such an assistance.

Echocardiographic findings and pregnancy outcomes for fetuses with complete closure of the ductus arteriosus.

We aimed to analyze the echocardiographic characteristics and pregnancy outcomes for fetuses with premature complete closure of the fetal ductus arteriosus. A retrospective analysis was performed for eight cases of premature ductus arteriosus closure diagnosed by prenatal ultrasonography in the Hunan Maternal and Child Health Hospital from July 2019 to August 2022, and the characteristics of fetal echocardiography and pregnancy outcomes of the eight cases were analyzed and summarized. In all cases, the intima of the ductus arteriosus was thickened and occluded, the ductus arteriosus could be seen with slightly hyperechogenic, and no blood flow signal was found in the ductus arteriosus by Doppler ultrasonography. The right heart was enlarged in seven cases, and the whole heart was enlarged in one case. Tricuspid valve regurgitation was observed to different degrees, of which seven cases were severe and one case was moderate. The pulmonary arteries of eight patients had varying degrees of widening. All eight cases were delivered by cesarean section, and one newborn died after follow-up. The prognosis of the other newborns was good. The parameters of prenatal echocardiography are helpful for the prognosis of fetuses with premature closure of the ductus arteriosus. Early prenatal detection, close observation, and clinical guidance can be used to select the right time of delivery.

Oligohydramnios and Intrauterine Premature Closure of Ductus Arteriosus Associated with the Use of NSAIDs During Pregnancy – An Overview of Clinical Evidence

Background: Pregnant women may experience low back pain and other pain symptoms, fever, and inflammatory conditions that may harm the fetus and mother if left untreated. The most common uses of non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of inflammation, pain and pyrexia. However, after 20-30 weeks of gestation, using NSAIDs during pregnancy may cause oligohydramnios and premature ductus arteriosus closure, which could harm the developing fetus. Objective: The purpose of this review article is to critically examine the clinical evidence that is currently available for oligohydramnios and premature ductus arteriosus closure linked to NSAIDs. Methods: Online databases such as Medline/Pubmed/PMC, EBSCOhost, Scopus, Web of science, Embase, Science Direct, Google Scholar, and reference lists were searched to identify articles which dealt with NSAIDs-associated oligohydramnios and premature closure of ductus arteriosus. Results: Numerous regulatory agencies released warnings about oligohydramnios and premature closure of ductus arteriosus linked to NSAIDs. Furthermore, a number of case reports, case series, and some observational studies have also been published about the possibility of oligohydramnios and premature closure of ductus arteriosus linked to NSAIDs use. Conclusion: Women who are pregnant for 20 weeks or more should refrain from self-medicating with NSAIDs without consulting a pharmacist or a physician. The use of NSAIDs during pregnancy should carefully be considered due to potential risks to the mother and developing fetus, especially after 20-30 weeks of gestation. To guarantee the best possible health for the expectant mother and the unborn child, healthcare professionals should weigh the benefits and risks and look into alternate options. Pregnant women may opt for acetaminophen (paracetamol) to relieve pain and fever during pregnancy. Pregnant women should seek medical attention if there is persisting pain for more than three days.

Передчасно закрита артеріальна протока: можливі ризики для новонародженого

Premature closure of the fetal ductus arteriosus is a rare phenomenon that results in increased right ventricular pressure, leading to the development of isolated right ventricular hypertrophy, high pulmonary hypertension, and even death. Purpose - to present a rare clinical case of prenatally closed ductus arteriosus in a newborn boy, that clinically manifested by severe respiratory failure immediately after birth. Clinical case. The child was admitted to the neonatal intensive care unit 5 hours after delivery with clinical signs of severe respiratory failure, child was oxygen-dependent. It is known from the anamnesis that the child was delivered by urgent cesarean section on the basis of a prenatally diagnosed prematurely closed arterial duct. A week before the delivery, the mother had an acute respiratory viral infection accompanied by high fever, which was treated with high doses of over-the-counter ibuprofen. The 2D echocardiography showed severe hypertrophy of the right ventricular wall and tricuspid insufficiency, which was caused by premature closure of the ductus arteriosus. The flow through the ductus arteriosus was not determined. Aortic coarctation as a possible cause of right ventricular hypertrophy in the newborn period was excluded. The infant was switched to constant positive pressure artificial ventilation (CPAP) to reduce pulmonary vascular resistance and afterload of the right ventricle. Over the next 3-4 weeks of oxygen therapy, the child's general condition improved significantly. Hypertrophy of the right ventricular wall regressed to normal size, the child grows and develops according to age. Conclusions. Premature prenatal closure of the arterial duct can be idiopathic or caused drugs intake that suppress prostaglandin production late in the pregnancy. Pregnant women should be counseled about the potential side effects on the fetus caused by the use of NSAIDs, especially in the third trimester of pregnancy. Urgent delivery and oxygen therapy contribute to the regression of intracardiac changes and significantly improve general condition of the child. The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent of the child’s parents was obtained for the study. No conflict of interests was declared by the authors.

Premature fetal closure of the ductus arteriosus of unknown cause – could it be influenced by maternal consumption of large quantities of herbal chamomile tea – a case report?

Abstract Objectives The aim of this article was to present a case of premature fetal closure of the ductus arteriosus (DA) of unknown cause. Case presentation A 32-year-old pregnant woman came for the regular prenatal visit at 36 + 1 weeks of gestation (WG) at which oligohydramnios and premature closure of DA were revealed. Use of non-steroidal anti-inflammatory drugs was excluded by the history, although the patient had the symptoms of common cold 2 weeks before the check-up taking more than 1,000 mL of strong chamomile tea daily till the day before the prenatal visit. The patient was hospitalized at 36 + 1 weeks of gestation due to premature closure of DA and oligohydramnios (amniotic fluid index = 4.5/3), which was the indication to deliver the baby by cesarean section at 36 + 6 WG (birth weight was 2,830 g, birth length 49 cm and head circumference 34 cm, Apgar score at 1 and 5 min were 9/9). Postnatal course was uneventful, and postnatal echocardiography at 12 h of life revealed functionally closed DA and mild dysfunction of the right ventricle, which completely resolved after 7 days. The mother and the baby were discharged home healthy, and were doing well 3 months after delivery. Conclusions Although the cause of premature closure of DA in most of the cases will remain undetected, thorough history sometimes with unexpected events should be taken under the consideration as possible causative factor for premature DA closure, as was drinking of high quantities of chamomile tea in our case.

Detection and quantitation of non-steroidal anti-inflammatory drug use close to the time of birth using umbilical cord tissue

BackgroundNonsteroidal anti-inflammatory drugs are contraindicated in the third trimester of pregnancy due to negative effects including alteration of uteroplacental blood flow, premature ductus arteriosus closure, and adverse effects on the fetal kidney. However, many women are unaware of these risks, and commonly report their use in pregnancy. We aimed to determine if umbilical cord was a reliable matrix for detecting NSAID use, determine incidence of use close to labour, and uncover associations with obstetric/neonatal outcomes. MethodsWe developed a UHPLC-MS/MS method to simultaneously detect diclofenac, ibuprofen, indomethacin, naproxen, and salicylic acid in plasma and umbilical cord lysate. Using this method, we screened 380 lysates to determine the prevalence of NSAID use. Results were compared to the clinical outcomes in pregnancy using ICD9/10 chart codes (n = 21). ResultsThe UHPLC-MS/MS method has excellent linearity, accuracy, and precision in solvent and plasma, but lower sensitivity in umbilical cord lysate. We report a 3 % rate of NSAID ingestion within days of labour – the pharmacokinetically-determined window for active ingestion. There were no significant differences observed for maternal, obstetric, or neonatal outcomes between the NSAID positive group (n = 11) and NSAID negative group (n = 369). ConclusionsBecause NSAID use in third trimester is contraindicated, even a 3% usage rate is alarmingly high. Based on UHPLC-MS/MS performance of umbilical cord lysate, 3% is likely a conservative estimate. Recent adoption of NSAIDs under clinical supervision to support in vitro fertilisation and prevent pre-eclampsia indicates future work should focus on determining safe dosages of NSAIDs and the correct therapeutic window in pregnancy.

Maternal Daily Intake of Polyphenol-Rich Dark Chocolate and Premature Closure of Ductus Arteriosus

Premature closure of ductus arteriosus (PCDA), defined as early constriction and closure of fetal ductus arteriosus, is induced by a certain class of anti-inflammatory agents (cyclooxygenase inhibitors), which inhibit prostaglandin synthesis..

Investigating the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement: A STROBE-compliant article.

The prognosis of right heart enlargement varies according to different etiologies. The purpose of this study was to investigate the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement.The foetal echocardiogram was performed on 3987 pregnant women, and then 88 fetuses with right heart enlargement were identified. The data about prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, karyotype analysis and autopsy after induced labor were analyzed in the 88 fetuses.Except the 1111 cases that had loss of follow-up, 2876 cases had complete data. Among the 2876 cases, right heart enlargement was identified in 88 fetuses. Of the 88 fetuses, 15 had total atrioventricular septal defect (unbalanced type: right ventricular dominance), 15 Ebstein's anomaly, 18 fallot tetrad, 14 double outlet right ventricle, 13 total anomalous pulmonary venous drainage, and 13 premature closure of ductus arteriosus. Chromosomal abnormality was found in 12 cases.There are many etiological factors causing right heart enlargement. The prognosis is better in the fetuses with single heart malformation than in the fetuses who have extracardiac malformation or/and chromosomal abnormality besides heart malformation. Fetal echocardiography combined with karyotype analysis can provide important bases for evaluating the prognosis of fetuses with right heart enlargement.

Dysfunction of the foetal arterial duct results in a wide spectrum of cardiovascular pathology

Objective: Foetal ductal problems may have various cardiopulmonary consequences. This study aimed to identify the spectrum of ductus arteriosus (DA) dysfunction (closure, constriction, kinking, aneurysm and thrombosis) and the resultant clinical and echocardiographic presentation in foetuses and neonates.Methods and results: This is a retrospective analysis of serial pre- and post-natal data of 27 cases of foetal ductal dysfunction diagnosed at a median gestational age of 33 weeks (range 20–39). The most common abnormalities observed were premature closure of the DA in 56% (15/27) and constriction in 29% (8/27). Right ventricular hypertrophy was present in 75% (n = 11/15) of foetuses with premature DA closure, while ventricular dilation (4/7, 57%) was a more common feature in foetuses with ductal constriction. After birth, 63% (17/27) of new borns presented with cyanosis and pulmonary hypertension that required active treatment. Three infants died after birth. Abnormalities resolved spontaneously after birth in about 50% of patients. In some children, pulmonary valve stenosis and regurgitation was progressive and required further treatment.Conclusions: An abnormal right heart on foetal four-chamber ultrasound view should alert the sonographer to the possible presence of foetal ductal dysfunction. Ductal occlusion, transient or fixed constriction, kinking and aneurysm formation are associated with foetal cardiopulmonary sequelae. Symptoms and pathology is probably related to the type, foetal age, rapidity of progression and duration of intrauterine ductal dysfunction. Correspondingly, clinical outcomes vary ranging from little or no symptoms to severe respiratory distress and even foetal or neonatal death.

OP04.04: Isolated RV dysfunction: a sign of premature closure of ductus arteriosus

<scp>OP04</scp>.04: Isolated <scp>RV</scp> dysfunction: a sign of premature closure of ductus arteriosus

Transient Isolated Right Ventricular Hypertrophy in a Neonate

Transient hypertrophic cardiomyopathy is rarely seen in neonates. We have reported a term neonate with transient right ventricular hypertrophy, diagnosed with echocardiographic investigation on the third day of life and interestingly disappeared within 10 weeks without any specific treatment. Transient right ventricular hypertrophy has not attracted enough attention in the pediatric cardiologic literature. It is well known that during pregnancy, maternal consumption of polyphenol-rich substances may cause fetal ductal constriction. In our case, this anomaly might be due to premature closure of ductus arteriosus. We have reported such a case because of the rarity of this anomaly and we wanted to attract attention about the nutrition of pregnant women.

Fetal hydrops associated with spontaneous premature closure of ductus arteriosus

A 36-year-old woman presenting with fetal growth restriction in the 25th week of gestation was referred to Kobe University Hospital where hydrops fetalis was detected. A stillborn fetus, 2012 g in weight and 40 cm in height, was delivered in the 33rd week of gestation. The mother had no past history of non-steroidal anti-inflammatory drug (NSAID) use during the pregnancy. The male fetus showed maceration without macroscopic anomalies, but it was markedly edematous with bilateral pleural effusion and massive ascites. The autopsy revealed an enlarged heart and aortic coarctation in the region of the ductus arteriosus. A mild form of aortic coarctation and premature closure of the ductus arteriosus with fibrous thickening of the wall were observed. The lungs were atelectatic with vascular dilatation and congestion. This is the first documented case of hydrops fetalis caused by spontaneous premature closure of the ductus arteriosus concomitant with aortic coarctation. The findings suggest that some form of idiopathic, or spontaneous, closure of the ductus arteriosus can be one of the causes of chronic fetal heart failure, coarctation of the aorta, and fetal hydrops.

Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome

Purpose To understand the natural history and define indications for fetal intervention in sacrococcygeal teratoma (SCT), the authors reviewed all cases of fetal SCT presenting for evaluation. Methods Prenatal diagnostic studies including ultrasound scan, magnetic resonance imaging (MRI), echocardiography and pre- and postnatal outcomes were reviewed in 30 cases of SCT that presented between September 1995 and January 2003. Results The mean gestational age (GA) at presentation was 23.9 weeks (range, 19 to 38.5) with 3 sets of twins (10%). Overall outcomes included 4 terminations, 5 fetal demises, 7 neonatal deaths, and 14 survivors. Significant obstetric complications occurred in 81% of the 26 continuing pregnancies: polyhydramnios (n = 7), oligohydramnios (n = 4), preterm labor (n = 13), preeclampsia (n = 4), gestational diabetes (n = 1), HELLP syndrome (n = 1), and hyperemesis (n = 1). Fetal intervention included cyst aspiration (n = 6), amnioreduction (n = 3), amnioinfusion (n = 1), and open fetal surgical resection (n = 4). Indications for cyst aspiration and amnioreduction were maternal discomfort, preterm labor, and prevention of tumor rupture at delivery. Although 15 SCTs were solid causing risk for cardiac failure, only 4 fetuses met criteria for fetal debulking based on ultrasonographic and echocardiographic evidence of impending high output failure and favorable anatomy at 21, 23.6, 25, and 26 weeks’ gestation. Intraoperative events included maternal blood transfusion (n = 1), fetal blood transfusion (n = 2), chorioamniotic membrane separation (n = 2), and fetal arrest requiring successful cardiopulmonary resuscitation (CPR) (n = 1). In the fetal resection group, 3 of 4 survived with mean GA at delivery of 29 weeks (range, 27.6 to 31.7 weeks), mean birth weight of 1.3 kg, hospital stay ranging from 16 to 34 weeks, and follow-up ranging from 20 months to 6 years. Postnatal complications in the fetal surgery group included neonatal death (n = 1, secondary to premature closure of ductus arteriosus with cardiac failure), embolic event (n = 1, resulting in unilateral renal agenesis, jejunal atresia), chronic lung disease (n = 1), and tumor recurrence (n = 1). Conclusions For fetal SCT, the rapidity at which cardiac compromise can develop and the high incidence of obstetric complications warrant close prenatal surveillance. Amnioreduction, cyst aspiration, and surgical debulking are potentially life-saving interventions.

The potential benefits of using fish oil in relation to preterm labor: the case for a randomized controlled trial?

The potential benefits of using fish oil in relation to preterm labor: the case for a randomized controlled trial?