Significant Patent Ductus Arteriosus Research Articles

Should Echocardiographic Evaluation Be Performed Routinely in the First 72 Hours in Extremely Low Birth Weight Babies?

Objective: Hemodynamically significant patent ductus arteriosus(hsPDA) is resulting in severe mortality and morbidity in infants with extremely low birth weight(ELBW). In our study, we aimed to evaluate the necessity of performing routine echocardiography(ECHO) in the first 72hours in ELBW infants.Study Design:This study was planned retrospectively and observationally.Between June2016 and December2018,36 patients diagnosed with hemodynamically significant PDA(hsPDA) who were hospitalized in the neonatal intensive care unit(NICU),with ≤28Gw or ≤1000g were included in this study.These babies were routinely performed ECHO for PDA between 24-72hours,although they were asymptomatic in the period from June2016 to December2017(n:23).Between January2018 and December2018, patients without PDA symptoms were expected to complete 72hours for routine PDA screening (n:13).The patients were divided into 2 groups as early ECHO group(EEG)(n=23) and late ECHO group (LEG)(n=13).In the presence of at least one of the clinical signs of systemic hypoperfusion and/or pulmonary hyperperfusion, symptomatic PDA was accepted and closure treatment was applied with ibuprofen(n: 23) or paracetamol(n: 5).While the two groups were compared in terms of demographic features,ECHO findings,and the state of taking closure therapy,patients receiving closure therapy were compared in terms of mortality and premature morbidity.Results:The average birth weight of 36 patients was 855.9(± 241.5)g, and the average week of birth was 26.4(± 2.1)Gw.It was observed that the two groups were similar in terms of demographic characteristics.Although the findings of ECHO and treatment rates were similar between the two groups,it was observed that the EEG had earlier closure treatment(p = 0.03). In patients receiving closure treatment, performing early(n:17)and late(n:11) echocardiography showed no statistical difference in the long-term results.Conclusion:Performing early ECHO without symptoms in infants with ELBW may provoke the clinician to give PDA closure treatment earlier. In infants with ELBW,unnecessary closure treatment can be prevented by closely monitoring the symptoms of PDA and performing ECHO when necessary.

Preterm White Matter Injury: A Prospective Cohort Study

To determine the incidence and risk factors of preterm white matter injury [WMI; periventricular-intraventricular hemorrhage (PIVH) and/or periventricular leukomalacia (PVL)]. Prospective cohort study. Level-3 neonatal intensive care unit. Inborn preterm neonates (n=140) delivered at <32 weeks gestation or birthweight <1500 g. Serial cranial ultrasounds were performed at postnatal ages of 3 days (±12 hour), 7 (±1) days, 21 (±3) days and 40 (±1) weeks postmenstrual age (PMA). PIVH and PVL were graded as per Volpe and De-Vries criteria, respectively. Univariate followed by multivariate analysis was done to evaluate risk factors for PIVH and PVL. The primary outcome was the incidence of preterm WMI. The secondary outcomes were evaluation of risk factors and natural course of WMI. The mean (range) gestation and birth weight of enrolled neonates were 29.7 (24-36) weeks and 1143 (440-1887) g, respectively. PIVH occurred in 25 (17.8%) neonates. PVL occurred in 34 (24.3%) neonates. None of them were grade III or IV PVL. Preterm WMI (any grade PIVH and/or PVL) occurred in 52 (37.1%) neonates. Severe PIVH (grade III) and cystic PVL occurred in 7 (5%) and 5 (3.6%) neonates, respectively. On multivariate analysis, none of the presumed risk factors were associated with PIVH. However, hemodynamically significant patent ductus arteriosus, and apnea of prematurity were significantly associated with increased risk of PVL. Significant WMI occurred only in one-third of the cohort, which is comparable to that described in literature from the developed countries.

The often forgotten systemic effects of ductus arteriosus: impact on decision-making and future trials.

Respiratory symptomatology and echocardiographic features of pulmonary circulation exclusively guide therapy for a hemodynamically significant patent ductus arteriosus in preterm infants. Interrogations of systemic artery Doppler or the exploration of their links with respective end organ symptomatology is not routine practice. This brief report shows the relevance of 'systemic' symptoms and the assessment of 'systemic hypo-perfusion' (and their resolution with physiologically appropriate therapy) in decision-making. Future trials should include this often-ignored aspect in study designs and/or post-hoc analysis.

The Ideal Timing of Bedside Surgical Ligation of Patent Ductus Arteriosus in Premature Babies Less Than 30 Gestational Weeks.

Objective:The aim of our study is to determine the relationship between exposure to hemodynamically significant patent ductus arteriosus and morbidities in premature babies, the optimal number of pharmacologic treatment cycles, and ideal ductus ligation timing.Materials and Methods:The study was a retrospective single-center study conducted in a 3-year period between July 2017 and June 2020. Premature babies, born ≤30 weeks of gestation and transferred to our unit for bedside ductus ligation, were included in the study. The subjects were divided into 2 groups; Group A consisted of the patients who received ≥3 pharmacologic treatment cycles, and group B consisted of the patients who received ≤2 cycles. The groups were compared according to preoperative and postoperative features. The main outcome of the study was the presence of severe bronchopulmonary dysplasia. The secondary outcomes were specified as the length of stay in the neonatal intensive care unit and the duration of invasive mechanical ventilation (MV).Results:The study group consisted of 24 patients. There were 10 patients in group A and 14 patients in group B. The mean gestational week and the mean birthweight were found to be 26,7 ± 2.2 weeks and 928 ± 190 g, respectively. The incidence of severe bronchopulmonary dysplasia was significantly higher in group A (70% vs. 14.3%; P = .019). Post-ligation invasive MV, duration, and length of stay in the intensive care unit were found to be significantly longer in group A. None of the patients had hemodynamic disturbances or complications during and after the operation.Conclusions:Bedside surgical ductus ligation is a safe procedure. Prolonging pharmacologic treatment in order to avoid surgery increases the risk of severe bronchopulmonary dysplasia and prolongs hospital stay.

Efficacy and safety of surfactant administration via thin catheter in preterm infants with neonatal respiratory distress syndrome: A systematic review and meta-analysis.

The efficacy and safety of surfactant administration via thin catheter in preterm infants with neonatal respiratory distress syndrome (NRDS) was investigated. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify randomized controlled trials (RCTs) that comparing thin catheter technique with intubation for surfactant delivery in preterm infants with NRDS. Thirteen RCTs (1931 infants) were included in the meta-analysis. The use of thin catheter technique decreased the incidences of bronchopulmonary dysplasia (BPD), pneumothorax, and hemodynamically significant patent ductus arteriosus (hsPDA) (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.46-0.75, p < .0001; RR: 0.60, 95% CI: 0.39-0.93, p = .02 and RR: 0.88, 95% CI: 0.78-1.00, p = .04, respectively). In addition, infants in the intervention group required less mechanical ventilation within 72 h of life or during hospitalization (RR: 0.60, 95% CI: 0.48-0.75, p < .00001 and RR: 0.64, 95% CI: 0.49-0.82, p = .0005, respectively) compared with infants in the control group. However, the rate of surfactant reflux was higher in the intervention group than that in the control group (RR: 2.12, 95% CI: 1.37-3.29, p = .0008). There were no significant differences in mortality and other outcomes between the two groups. The administration of surfactant via thin catheter could lower the requirement for mechanical ventilation, and decrease the incidence of BPD, pneumothorax, and hsPDA.

Anesthesia protocols for "bedside" preterm patent ductus arteriosus ligation: A single-institutional experience.

Background :Hemodynamically significant patent ductus arteriosus (PDA) is frequently encountered in preterm infants sometimes requiring surgical attention. Although PDA ligation is regularly performed in the operating room, conducting it at the bedside in a neonatal intensive care unit (NICU) and its anesthetic management remains challenging.Aim :We aim to discuss the anesthetic considerations in patients undergoing bedside PDA ligation and describe our experience highlighting the feasibility and safety of this procedure.Setting and Design :The study was conducted in the NICU in a tertiary care hospital; This was a retrospective, observational study.Methods :Preterm infants scheduled for bedside PDA ligation using a predefined anesthesia protocol between August 2005 and October 2020 were included.Statistical Analysis Used:Quantitative data were presented as median with interquartile range and categorical data were presented as numbers and percentage thereof.Results :Sixty-six premature infants underwent bedside PDA ligation. Thirty-day mortality was 4.5% (3 infants), but there were no procedural deaths. One (1.5%) patient had intraoperative endotracheal tube dislodgement. Three (4.5%) infants had postoperative pneumothorax requiring an additional chest tube insertion. Twenty-one (32%) patients required initiation of postoperative inotrope/vasodilator therapy within 6 h. Three postligation cardiac syndromes (≥ Grade-III mitral regurgitation with left ventricular dysfunction and hypotension) occurred.Conclusions :Although anesthesia for preterm neonates undergoing bedside PDA ligation poses unique challenges, it can be safely conducted by following a predetermined standardized anesthesia protocol. Its successful conduct requires utmost vigilance and pristine understanding of the principles of neonatal and cardiac care.

Is intravenous paracetamol as effective as ibuprofen in closing haemodynamically significant patent ductus arteriosus after the first treatment course in preterm babies?

Is intravenous paracetamol as effective as ibuprofen in closing haemodynamically significant patent ductus arteriosus after the first treatment course in preterm babies?

Patent ductus arteriosus, systemic NT-proBNP concentrations and development of bronchopulmonary dysplasia in very preterm infants: retrospective data analysis from a randomized controlled trial

BackgroundPatent ductus arteriosus (PDA) is a common complication in very preterm infants. It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. The study aimed to evaluate the relationship between PDA, serum NT-proBNP levels at 2–3 and 8–9 days of life, and BPD/death in very preterm infants.MethodsData of 52 preterm infants with a gestational age < 32 weeks, chronological age < 72 h, and PDA diameter > 1.5 mm, enrolled in a randomized controlled trial, were used for the retrospective analysis. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. Two groups of infants were formed retrospectively at PMA of 36 weeks depending on the outcome, BPD (n = 18)/death (n = 7) or survival without BPD (n = 27). Receiver operator characteristic (ROC) curve was used to evaluate the predictive performance of serum NT-proBNP levels for BPD/death occurrence.ResultsThe percentage of infants who received pharmacological treatment for PDA did not differ between the groups. Based on the area under the ROC curve, serum NT-proBNP levels on the 2–3 day of life (AUC = 0.71; 95% confidence interval (CI): 0.56–0.9; p = 0.014)) and on the 8–9 day of life (AUC = 0.76; 95% CI: 0.6–0.9; p = 0.002) could reliably predict BPD/death in very preterm infants who had PDA diameter > 1.5 mm in the first 72 h of life. Hemodynamically significant PDA (hsPDA) was significantly more often detected in newborns with BPD/death, however, treatment of infants with hsPDA did not reduce the incidence of BPD/death.ConclusionsIn very preterm infants with PDA > 1.5 mm at the age of 24–48 h, serum NT-proBNP concentration could reliably predict the development of BPD or death, regardless of the persistence of PDA, with the highest diagnostic value at 8–9 days.Trial registrationThis study is registered in ClinicalTrials.gov - NCT03860428 on March 4, 2019.

Determining hemodynamic significance of patent ductus arteriosus using echocardiographic data prognostic tables

The paper presents an analysis of echocardiographic data of patients with PDA having different hemodynamic significance. Presently, the concept of “degree of hemodynamic significance” remains controversial. Criteria for determining the hemodynamic significance of PDA in term infants are not described. In our work, we used a classification of three degrees of hemodynamic significance: non-hemodynamically significant PDA – insignificant, moderately hemodynamically significant – moderately significant and large PDA – hemodynamically significant PDA. Aim – to work out an algorithm for determining the degree of PDA hemodynamic significance for prediction of its further development. The study involved children under 18 years old (80% of them ‒ children under 3 years old) who were examined in the cardiac surgery department of the SI “IGUS n.a.V.T. Zaytsev NAMS of Ukraine” during 2013-2017 yy. Gestational age (from 37 weeks), the presence of left to right PDA shunt, absence of a ASD shunt and other congenital heart defects served as enrollment criteria for the trial. Two prognostic tables were formed with the main criteria for determining hemodynamic significance of PDA by the sum of the signs according to gradations (insignificant, moderately significant and hemodynamically significant) as an outcome of the trial. Based on the determination of the main and additional criteria of hemodynamic significance and the strength of their influence, a diagnostic algorithm is formed for a patient with PDA with the possibility of predicting a further clinical scenario. For determination of hemodynamic significance, an increase in pulmonary gradient with an information index of 1.135 and a prognostic factor of +5.90/-1.75 were dominant, while the left ventricular dilatation located from the A4C with an informational index of 1.020 and a prognostic coefficient of +3.69/-2.50 dominated in determining the degree of hemodynamic significance in the presence of secondary changes. The proposed mechanism for determining the level of hemodynamic significance of PDA for children with borderline changes will predict more precisely the development of the disease, determine the patient’s observation tactics and regulate the decision-making process of surgical intervention.

Surgical management of patent ductus arteriosus in pre-term infants - a british paediatric surveillance study

BackgroundThis study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 – 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome.ResultsOver the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge.ConclusionThis study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.

Effect of first-month head-size growth trajectory on cognitive outcomes in preterm infants

To examine whether the patterns of head-size growth trajectory in the first month after birth are associated with different susceptibility to cognitive impairment outcomes at age 24 months. This retrospective cohort study included 590 infants of very-preterm survivors born between 2001 and 2016 receiving neurodevelopmental assessment at age 24 months. 403 children were enrolled for analysis after excluding infants with small-for-gestational age and severe brain injury. The head circumference (HC) growth evaluated weekly in the first month after birth compared to the at-birth HC was analyzed using group-based trajectory modeling. Neurocognition outcomes were determined as normal, borderline delay, or impaired using the Bayley Scales of Infant Development. The HC growth dynamics in the first month after birth showed three trajectory patterns: delayed catch-up (31.5%), slow catch-up (54.0%), and fast catch-up (14.5%), which significantly corresponded to different rates of impaired cognition at 19.5%, 6.0%, and 8.5%, respectively (p<0.001). While 60% of the fast catch-up group had normal cognition, only one-third of the delayed catch-up group showed normal cognition. Three neonatal risk factors, gestational age (p=0.006), respiratory distress syndrome requiring surfactant therapy (p=0.012), and hemodynamically significant patent ductus arteriosus requiring intervention (p=0.047) significantly affected HC growth trajectory patterning that led to cognitive impairment outcomes at follow-up. Preterm infants with delayed catch-up of head-size growth in the first month of age is susceptible to cognitive impairment outcome.

B-type brain natriuretic peptide as marker of hemodynamicoverload of the patent ductus arteriosus in the preterm infant.

The echocardiogram is the gold standard, in the diagnosis of the hemodynamically significant patent ductus arteriosus (hs-PDA) of the premature newborn (PNB). Type B brain natriuretic peptide (BNP) may be useful in the diagnosis and management of CAP-hs. The objective of the study was to assess the utility of BNP as a marker of hemodynamic overload of the patent ductus arteriosus in newborns with gestational age < 32 weeks or weight < 1500 g, and to identify the best cutoff point for BNP levels that would best predict a PDA with hemodynamic impact requiring pharmacological and/or surgical treatment. Retrospective, observational, and descriptive study of PNB < 32 weeks gestation or weight < 1500 g, in which echocardiogram and BNP determination was performed. Analysis of the global sample and by subgroups, depending on the hs-PDA status was performed. A total of 29 patients were analyzed. A significant correlation was found between the PDA/weight ratio and BNP levels (Spearman: 0.71; 95% confidence interval: 0.45-0.87; p < 0.001). The best BNP cutoff point to predict CAP-hs was 486.5 pg/ml with a sensitivity of 81% and specificity of 92% (p < 0.001). The BNP cutoff point identified in the present study was correlated with the presence of CAP-hs.

An Observational Study on Use of Intravenous Paracetamol for Closure of Patent Ductus Arteriosus in Newborns

Introduction: Failure or delay in spontaneous closure of ductus arteriosus is commonly seen among very low birth weight and very preterm neonates (&lt;32 weeks), results in patent ductus arteriosus (PDA). Hemodynamically significant PDA (hs-PDA) is associated with significant morbidity and mortality if not timely intervened. At present, treatment modalities for hs- PDA remain pharmacological with nonspecific cyclo-oxygenase inhibitors such as ibuprofen/indomethacin or surgical ligation whenever pharmacological management is contraindicated. Recently, trials with prostaglandin synthase inhibitor, paracetamol are emerging as an effective treatment modality for PDA closure. In this retrospective observational cohort study, we evaluated the effectiveness of intravenous paracetamol as a first line therapy in very low birth weight infants with hemodynamically significant PDA.&#x0D; Methods: Twenty four preterm infants with hemodynamically significant PDA (hs-PDA) were treated with intravenous paracetamol 15mg/kg every 6 hourly and subsequent closure was evaluated clinically and by follow-up 2D-Echocardiography. The dosage of 15 mg/kg for IV paracetamol was chosen based on previously reported data for paracetamol in the treatment of PDA in preterm newborns.&#x0D; Results: PDA closure following intravenous paracetamol was evident in 22 preterm neonates (91.67%). There were no significant side effects noted with paracetamol therapy.&#x0D; Conclusions: This study concludes that intravenous paracetamol is an effective alternative for the pharmacological closure of hemodynamically significant patent ductus arteriosus in preterm infants.

Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants.

Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.

Early targeted patent ductus arteriosus treatment in premature neonates using a risk based severity score: study protocol for a randomised controlled trial (PDA RCT)

A patent ductus arteriosus (PDA) in preterm infants is associated with increased ventilator dependence and chronic lung disease, necrotizing enterocolitis, intraventricular haemorrhage, and poor neurodevelopmental outcome. Randomised controlled trials of early PDA treatment have not established a drop in the aforementioned morbidities. Those trials did not physiologically categorise PDA severity. Incorporating the specific physiological features of a haemodynamic significant PDA may evolve our understanding of this phenomenon, allowing accurate triaging using echocardiography and targeted treatment. Our group has recently demonstrated that a PDA severity score (PDAsc) derived at 36-48 hours of age can accurately predict the later occurrence of chronic lung disease or death (CLD/Death). Using echocardiography, we assessed PDA characteristics, as well as left ventricular diastolic function and markers of pulmonary overcirculation, and from this formulated a PDAsc. Gestation was also incorporated into the score. We hypothesise that in preterm infants at high risk of developing CLD/Death based on a PDAsc, early treatment with Ibuprofen compared with placebo will result in a reduction in CLD/Death. This is a single centre double-blind two arm randomised controlled trial conducted in the neonatal intensive care unit in the Rotunda Hospital, Dublin. Echocardiogram is carried out in the first 36-48 hours of life to identify preterm infants with a PDAsc ≥ 5.0 and these infants are randomised to Ibuprofen or placebo. Primary outcomes are assessed at 36 weeks post menstrual age. This pilot study’s purpose is to assess the feasibility of performing the trial and to obtain preliminary data to calculate a sample size for a definitive multi-centre trial of early PDA treatment using a PDAsc. We aim to recruit a total of 60 infants with a high risk PDA over three years.Trial Registration: ISRCTN ISRCTN13281214 (26/07/2016) and the European Union Drug Regulating Authorities Clinical Trials Database 2015-004526-33 (03/12/2015).

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.

Acetaminophen Therapy for Persistent Patent Ductus Arteriosus.

Persistence of a left-to-right shunt caused by a patent ductus arteriosus (PDA) leads to significant sequelae in extremely premature infants as a result of pulmonary overcirculation and systemic steal. Although timing and duration of treatment for a persistent clinically significant PDA differ among institutions, standard pharmacologic interventions are the nonsteroidal anti-inflammatory drugs indomethacin and ibuprofen. Acetaminophen has emerged as an alternative to indomethacin and ibuprofen with less significant adverse effects, but there is no consensus regarding its use. This review summarizes the most recent evidence for the use of acetaminophen in PDA treatment.

Identification of the hemodynamic significant patent ductus arteriosus in preterm infants

Objective To review the research on the discernible markers of hemodynamic significant patent ductus arteriosus (hsPDA). Date sources We consulted literatures from PubMed in English up to 2020. Study selection Data about sensitivity, specificity and cut-off value and experimental conclusion are from clinical trials and accurate analysis. Result Hemodynamic significant PDA is associated with severe complications and mortality in premature infant. So far, there are still controversies over the treatment of patent ductus arteriosus in preterm infants, mainly relating to identification of hemodynamic significant patent ductus arteriosus (hsPDA) is ununiform. Numbers of scholars used to employ color Doppler markers to evaluate hsPDA in last 4 decades. This review aims to identify hsPDA in preterm infants from three aspects by analysis the literatures, including non-invasive detection index, biological index and clinical index, which providing evidence-based guidance to reduce the occurrence of excessive medical treatment. Conclusion Echocardiographic markers combining with biological and clinical indicators can improve the identification of hsPDA clinically. Despite the definition of hsPDA has been investigated, the diagnosis and treatment remain ambiguous. More comprehensive and meaningful assessment for hsPDA is required.

Protective factors against preterm infants to develop significant patent ductus arteriosus

Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA status during the first week of life for very low birthweight (VLBW, <1500g) preterm infants and to develop a scoring system to predict spontaneous PDA closure. We enrolled VLBW infants admitted between January 2016 and January 2017 and performed daily echocardiographic screening for PDA existence. Oxygen index (OI, mean airway pressure×fraction of inspired oxygen/partial pressure of arterial oxygen) was applied to represent the respiratory condition. A total of 215 VLBW infants were enrolled, and the accumulative incidence of spontaneous PDA closure by age 1 week was 80%, 70%, and 34% for infants born of gestational age (GA) ≥30, 28-29, and ≤27 weeks, respectively. Of these 215 infants, 184 infants entered the second phase to establish the scoring system. Infants with spontaneous PDA closure were more mature (GA 29.2±2.3 vs. 26.9±2.3 weeks, p<0.001), had lower OI (2.8±2.2 vs. 5.6±5.3, p<0.001) and were less likely to need endotracheal intubation (23% vs. 68%, p<0.001). Using the receiver operating characteristics curve, OI <2.5 was determined favoring higher PDA closure incidence. The score was calculated based on the odds ratio generated in multiple regression: 4, 3 and 1 points for GA ≥30, 28-29 and≤27 weeks, 2 and 1 points for OI <2.5 and≥2.5, and 3 and 1 points for without and with endotracheal intubation. Using score ≥6 to predict PDA closure, the sensitivity and specificity were 0.77 and 0.72. A score made up of GA, OI and need for intubation was proposed to predict spontaneous PDA closure by age 1 week, which could be helpful to clinicians in the management of PDA in preterm infants.

Association of fluid overload with patent ductus arteriosus during the first postnatal day.

Evidence examining the association of over-hydration during early life with hemodynamically significant patent ductus arteriosus (hsPDA) and other morbidities is limited. Our aim was to evaluate the association of fluid overload during the first postnatal day with hsPDA and common neonatal morbidities such as bronchopulmonary dysplasia in preterm infants. A retrospective cohort study was conducted enrolling infants ≤30 weeks' gestation and ≤1500 grams' birth weight, admitted to a tertiary Neonatal Unit. We calculated the fluid balance, and we estimated the incidence of infants with fluid overload ≥5% during the first postnatal day, evaluating any possible correlation with hsPDA. One hundred three infants of 27.3±1.6 weeks' gestation and 1009±225 grams' birth weight were enrolled, of whom 32 (31%) were diagnosed with HsPDA. Fluid overload during the first postnatal day was recorded in 42 infants (41%). Infants with fluid overload were diagnosed with hsPDA in 48%, compared to 20% of infants without fluid overload (P=0.004). No differences were recorded in the development of bronchopulmonary dysplasia or survival. Fluid overload of ≥5% was significantly correlated with hsPDA (r=0.37, P=0.003) and had an independent contribution to the risk of hsPDA (OR=1.17, 95% CI: 1.05-1.58), irrespective of other perinatal factors. In preterm infants, fluid overload ≥5% is significantly associated with hsPDA; therefore, fluid management during the first postnatal day should be closely regulated.