Treatment Of Persistent Ductus Arteriosus Research Articles

Comparison of acetaminophen with ibuprofen in the treatment of patent ductus arteriosus in neonates admitted to training hospitals in Khorramabad from 2018 to 2022: A retrospective study

Background: Due to the possible complications of a persistent ductus arteriosus (PDA), the treatment of the PDA will be necessary, depending on the opinion of the treating physician. Medical or surgical treatment can be used in this regard. In recent years, acetaminophen has been considered a medication with fewer potential side effects. The present study aimed to compare acetaminophen with ibuprofen in the patent ductus arteriosus in neonates admitted to training hospitals in Khorramabad. Materials and Methods: A total of 28 neonates were included in this retrospective cohort study. The required data were collected by studying the patients' files. The PDA in newborns was diagnosed by primary echocardiography by the attending physician. Thereafter, 12 and 16 cases were treated with ibuprofen and acetaminophen, respectively. After completing the treatment period on days 3 and 5, the attending physician performed echocardiography to check PDA closure. Data were analyzed in SPSS software (version 24) using descriptive indices of mean, standard deviation, frequency, percentage, Fisher's exact test, and Mann-Whitney U test. Results: In this study, the frequency of affected male neonates was the same as that of affected female newborns (n=14; 50%). The mean weight scores of neonates in acetaminophen and ibuprofen groups were obtained at 2831/25±918/49 and 2241/5 ±868/9 gr, respectively. All newborns in both groups were treated; thereafter, 23 cases recovered with 3-day treatment and 5 neonates with 5-day treatment. No significant complications were observed in patients. Conclusion: The effect of acetaminophen on PDA closure was similar to that of ibuprofen. The need for 5-day treatment was higher in the acetaminophen group; nonetheless, no significant side effects were reported in any newborn. According to this study, acetaminophen can be a good alternative to ibuprofen in the treatment of PDA.

PATENT DUCTUS ARTERIOSUS CLOSURE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER.

ABSTRACTObjective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital.Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored.Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001).Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.

Paracetamol vs. Ibuprofen in Preterm Infants With Hemodynamically Significant Patent Ductus Arteriosus: A Non-inferiority Randomized Clinical Trial Protocol.

Background: Currently, the first line treatment of persistent ductus arteriosus (PDA) is either indomethacin or ibuprofen. However, the potentially life-threatening side effects associated to their use have prompted physicians to look for alternative options. The incorporation of paracetamol as an alternative to ibuprofen in the management of PDA is still based on insufficient clinical evidence. Hence, more clinical trials are needed to establish a therapeutic role for paracetamol in the management of PDA that take into consideration short- and long-term safety and efficacy outcomes.Study Design: This is a non-inferiority, randomized, multicenter, double-blinded study to evaluate the efficacy, and safety of intravenous (IV) paracetamol vs. IV ibuprofen (standard treatment) for PDA in preterm patients with a gestational age ≤ 30 weeks. At baseline, patients will be randomized (1:1) to treatment with paracetamol or ibuprofen. The primary endpoint is closure of the ductus after the first treatment course. Secondary endpoints are related to effectiveness (need for a second treatment course, rescue treatment, reopening rate, time to definitive closure, need for surgical ligation), safety (early and long-term complications), pharmacokinetics, and pharmacodynamics, pharmacogenetics, pharmacoeconomics, and genotoxicity. Long-term follow-up to 24 months of corrected postnatal age will be performed using Bayley III neurodevelopmental scale.Trial Registration: ClinicalTrials.gov Identifier: NCT04037514. EudraCT: 2015-003177-14.

Persistência do ducto arterioso em um bovino

The ductus arteriosus is a structure that connects the pulmonary arch to the aorta during the fetal life of mammals. This ductus allows arterial blood to bypass the unexpanded lung. The absence of closure of this channel characterizes the persistence of the ductus arteriosus. The aim of this study was to describe a case of persistent ductus arteriosus (PDA) in a four-day-old crossbred heifer. The animal had apathy, decubitus and anorexia. The clinical signs evolved to severe dyspnea and death of the animal. Necropsy was performed in which PDA was observed. It has been mentioned that PDA is uncommon in ruminants when compared to dogs. However, some authors suggest that the lack of diagnosis in large animals, especially in ruminants, makes this disease a rare condition. In humans and small animals, the treatment of PDA is surgical. However, there are no reports of this treatment for cattle. PDA in calves should be included in the differential diagnosis of animals with severe dyspnea shortly after birth.

A conservative treatment of patent ductus arteriosus in very low birth weight infants

BackgroundTreatment of the patent ductus arteriosus (PDA) in the preterm infant remains contentious. There are numerous options of the PDA management from early targeted treatment, late (symptomatic) treatment to no treatment at all. AimsTo evaluate a three different PDA management approaches in very low birth weight (VLBW) infants. Study designA retrospective observational time series study of three cohorts of VLBW infants born between 2004 and 2011. SubjectsInfants in Symptomatic Treatment Group (STG) were echocardiographically evaluated when clinical signs suggestive of a PDA were present and treated if a haemodynamically significant PDA was confirmed. Early Targeted Group (ETG) underwent echocardiography within the first 48h and infants received ibuprofen if a large PDA was present. Conservative Treatment Group (CTG) was screened by echocardiography on day seven of life; patients with PDA were managed with increased positive end expiratory pressure and fluid restriction as a first line intervention. OutcomesThe primary outcome was medical and surgical treatment in the three time periods. Secondary outcomes included mortality, severe periventricular and intraventricular haemorrhage, respiratory distress syndrome and chronic lung disease. ResultsThere were 138 infants diagnosed with PDA; 52 infants in STG, 52 infants in ETG and 34 infants in CTG. Ibuprofen therapy and ligation were less frequent in CTG. There was significantly decreased incidence of chronic lung disease in CTG compared to STG (18% vs. 51%; p=0.003) and to ETG (18% vs. 46%; p=0.02). There was no difference in the other short term outcomes. ConclusionConservative treatment of persistent ductus arteriosus in VLBW infants is a feasible option and future randomized trials of conservative management are warranted.

Early paracetamol treatment associated with lowered risk of persistent ductus arteriosus in very preterm infants

Objectives: Persistent ductus arteriosus (PDA) delays the recovery of very preterm infants (VLGA, gestation <32 weeks). Indomethacin/ibuprofen treatment and ligation of PDA have complications. As a prostaglandin synthase inhibitor paracetamol may also promote the closure of ductus arteriosus. We studied retrospectively whether early paracetamol therapy was associated with decreased incidence of PDA without adverse events.Methods: On June 2009, we introduced intravenous paracetamol during early respiratory therapy. We included 105 VLGA infants who received paracetamol before the age of 72 h. The loading dose was 20 mg/kg followed by 7.5 mg/kg every 6 hours. The 96 VLGA infants admitted from January 2008 to May 2009 without lethal congenital disease were controls. Infants dying very early were excluded, leaving 102 paracetamol-exposed and 88 controls for analysis.Results: After the introduction of paracetamol, the incidence of PDA decreased from 30.7% to 14.7% (p = 0.008). Ibuprofen treatment was given to 15 paracetamol-treated and to 26 control infants (p = 0.013). Three paracetamol-exposed and seven control infants required surgery. There was no detectable increase in adverse events.Conclusions: Annual incidence of PDA decreased after introduction of paracetamol. Efficacy and safety in promoting the early closure of ductus arteriosus remains to be established.

Division or Occlusion of Patent Ductus Arteriosus?

The traditional and most effective form of treatment of persistent ductus arteriosus is surgical ductal division. New therapeutic techniques such as intraluminal ductal occlusion are currently recommended to replace the traditional treatment procedure. The purpose of this paper is to analyze the state of the art of these new therapeutic modalities. From reports in the medical literature, the authors analyzed the indications, results, and complications of the intraluminal ductal occlusion procedures. They applied the Student's t test for independent samples to evaluate the results of intraluminal patent ductus arteriosus occlusion by means of umbrellas, buttons, coils, and Gianturco-Grifka and Amplatzer occluders, respectively, in 2,691 patients collected from the medical literature. According to their analysis the results of intraluminal ductal occlusion with coils were as follows: success 83.7 +/- 12.2%, failure 3.9 +/- 2.8%, incomplete ductal occlusion 17.5 +/- 15.3%, need for surgery 2.8 +/- 3.8%, need for a second intraluminal procedure 5.8 +/- 9.9%, and device embolization 6.2 +/- 7.2%. The use of the Gianturco-Grifka device showed the following results: success 96.0 +/- 5.6%, failure 4.0 +/- 5.6%, incomplete ductal occlusion 4.0 +/- 5.6%, need for surgery 0%, need for a second intraluminal procedure 4.0 +/- 5.6%, and device embolization 4.0 +/- 5.6%. The Amplatzer occluder showed the following results: success 92.8 +/- 6.1%, failure 7.2 +/- 6.1%, incomplete ductal occlusion 2.0 +/- 4.3%, need for surgery 0%, need for a second intraluminal procedure 0.8 +/- 1.7%, and device embolization 0.5 +/- 1.3%. According to the state of the art, intraluminal ductal occlusion with Gianturco-Grifka device and Amplatzer occluder reduces the proportion of incomplete obstructions and need for surgery. Additionally, the use of the Amplatzer occluder reduces need for a second procedure and the embolization rate. Although the results obtained with the new procedures are better than those obtained previously, they are still not totally satisfactory.

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience.

In order to define the safety and efficacy of Cook detachable coils for interventional closure of patent ductus arteriosus, we performed a retrospective analysis of all patients who underwent cardiac catheterization in seven centres for intended interventional occlusion of patent arterial duct. From January 1995 until March 1998, cardiac catheterization for intended interventional occlusion of patent arterial duct was performed in 317 consecutive children. Successful placement of at least one coil was achieved in 282 children (89%). The mean diameter of the ductus in children treated with Cook detachable coils was 1.65 mm, mean fluoroscopy time was 10.7 min. Occlusion rates were 62% 10 min after the procedure, 82% at the time of discharge, 91% at 4 months and 95% at late follow-up (2 years). In children with a ductus diameter of < or = 2.5 mm the rate of successful coil deployment was 94% with a 98% occlusion rate at late follow-up. Complications occurred in 11 procedures (3.5%) including haemolysis (3 patients), embolization of a coil to the pulmonary artery (7 patients, 2.3%) and inability to release a coil (1 patient). In our opinion, Cook detachable coils are safe and effective especially in the treatment of persistent ductus arteriosus with a diameter < or = 2.5 mm. Due to the low costs these coils appear to be superior to other devices in this subgroup of patients.

The surgical treatment of persistent ductus arteriosus: Brain, R. H. F.: Guy's Hosp.Rep. 108:163, 1959

The surgical treatment of persistent ductus arteriosus: Brain, R. H. F.: Guy's Hosp.Rep. 108:163, 1959