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Kuo CM, Su PC, Yang ST, Chung HW, Chen HL. Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:610. [PMID: 38790605 PMCID: PMC11119670 DOI: 10.3390/children11050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Ductus arteriosus closure may be delayed in preterm infants, and prostaglandin, a vasodilator, can affect ductal patency. Furosemide can increase renal prostaglandin synthesis, so its net effect on patent ductus arteriosus (PDA) is uncertain. Our goal is to explore the relationship between furosemide and spontaneous ductal closure in very-low-birth-weight preterm infants. Our treatment for PDA involves fluid restriction initially and furosemide administration for hemodynamically significant PDA until closure is confirmed by the echocardiogram. We enrolled 105 infants from 1 January 2019 to 30 June 2022 and evaluated the impact of furosemide on ductal closure, including exposure duration and cumulative dose. There is no correlation between furosemide exposure and spontaneous ductal closure (p = 0.384). Furosemide exposure does not delay the postmenstrual age at which spontaneous ductal closure occurs (p = 0.558). The time for spontaneous ductal closure is positively associated with furosemide prescription days (coefficient value = 0.547, p = 0.026) and negatively with gestational age (coefficient value = -0.384, p = 0.062). The prescription of furosemide does not impact the probability or time duration of ductus arteriosus spontaneous closure. The cumulative dose of furosemide has minimal impact on ductal closure. The correlation between furosemide exposure duration and ductal patency duration is likely due to our treatment protocol, with gestational age being a significant factor.
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Affiliation(s)
- Chi-Mei Kuo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Pin-Chun Su
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Shu-Ting Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 80756, Taiwan; (C.-M.K.); (P.-C.S.); (S.-T.Y.); (H.-W.C.)
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
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Moronta SC, Bischoff AR, Ryckman KK, Dagle JM, Giesinger RE, McNamara PJ. Clinical and echocardiography predictors of response to first-line acetaminophen treatment in preterm infants with hemodynamically significant patent ductus arteriosus. J Perinatol 2024; 44:379-387. [PMID: 38297179 DOI: 10.1038/s41372-024-01883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To assess clinical and echocardiography predictors of acetaminophen response for the treatment of patent ductus arteriosus (PDA) in preterm neonates. STUDY DESIGN Retrospective cohort study of preterm infants born <30 weeks, with a diagnosis of hemodynamically significant PDA, who received 1st line treatment with intravenous acetaminophen during the first 2 postnatal weeks. Response was defined by PDA closure or improvement in PDA score of >50%. RESULTS A total of 100 infants were included whose median weight and gestational age at birth were 663 grams and 24.6 weeks respectively. In total, 66 infants were classified as responders and were more likely to have intrauterine growth restriction, exposure to maternal hypertension and chorioamnionitis. Non-response was more common among infants with thrombocytopenia and anemia. CONCLUSION Responders were more likely to be IUGR with echocardiography indices of lower preload. Response to 1st line intravenous acetaminophen therapy is comparable to non-steroidal drugs in preterm infants. Relationship of response to acetaminophen to perinatal characteristics requires further characterization.
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Affiliation(s)
| | | | - Kelli K Ryckman
- Indiana University, Department of Epidemiology and Biostatistics, Bloomington, IN, USA
| | - John M Dagle
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA
| | | | - Patrick J McNamara
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA.
- University of Iowa, Department of Internal Medicine, Iowa City, IA, USA.
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Hsieh YC, Jeng MJ, Lin MC, Lin YJ, Rohsiswatmo R, Dewi R, Chee SC, Neoh SH, Velasco BAE, Imperial MLS, Nuntnarumit P, Ngerncham S, Chang YS, Kim SY, Quek BH, Amin Z, Kusuda S, Miyake F, Isayama T. Contemporary fluid management, humidity, and patent ductus arteriosus management strategy for premature infants among 336 hospitals in Asia. Front Pediatr 2024; 12:1336299. [PMID: 38487471 PMCID: PMC10937448 DOI: 10.3389/fped.2024.1336299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives The management of patent ductus arteriosus (PDA) is a critical concern in premature infants, and different hospitals may have varying treatment policies, fluid management strategies, and incubator humidity. The Asian Neonatal Network Collaboration (AsianNeo) collected data on prematurity care details from hospitals across Asian countries. The aim of this study was to provide a survey of the current practices in the management of PDA in premature infants in Asian countries. Methods AsianNeo performed a cross-sectional international questionnaire survey in 2022 to assess the human and physical resources of hospitals and clinical management of very preterm infants. The survey covered various aspects of hospitals resources and clinical management, and data were collected from 337 hospitals across Asia. The data collected were used to compare hospitals resources and clinical management of preterm infants between areas and economic status. Results The policy of PDA management for preterm infants varied across Asian countries in AsianNeo. Hospitals in Northeast Asia were more likely to perform PDA ligation (p < 0.001) than hospitals in Southeast Asia. Hospitals in Northeast Asia had stricter fluid restrictions in the first 24 h after birth for infants born at <29 weeks gestation (p < 0.001) and on day 14 after birth for infants born at <29 weeks gestation (p < 0.001) compared to hospitals in Southeast Asia. Hospitals in Northeast Asia also had a more humidified environment for infants born between 24 weeks gestation and 25 weeks gestation in the first 72 h after birth (p < 0.001). A logistic regression model predicted that hospitals were more likely to perform PDA ligation for PDA when the hospitals had a stricter fluid planning on day 14 after birth [Odds ratio (OR) of 1.70, p = 0.048], more incubator humidity settings (<80% vs. 80%-89%, OR of 3.35, p = 0.012 and <80% vs. 90%-100%, OR of 5.31, p < 0.001). Conclusions In advanced economies and Northeast Asia, neonatologists tend to adopt a more conservative approach towards fluid management, maintain higher incubator humidity settings and inclined to perform surgical ligation for PDA.
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Affiliation(s)
- Yao-Chi Hsieh
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Lin
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rizalya Dewi
- Budhi Mulia Women and Children Hospital, Pekanbaru, Indonesia
| | - Seok Chiong Chee
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Siew Hong Neoh
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | | | | | - Pracha Nuntnarumit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sopapan Ngerncham
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Huey Quek
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Zubair Amin
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Satoshi Kusuda
- Neonatal Research Network of Japan, Tokyo, Japan
- Department of Pediatrics, Kyorin University, Mitaka, Tokyo, Japan
| | - Fuyu Miyake
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
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Chan B, Singh Y. Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants. J Cardiovasc Dev Dis 2023; 11:7. [PMID: 38248877 PMCID: PMC10816643 DOI: 10.3390/jcdd11010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation of PDA, echocardiographic diagnosis, and hemodynamic impact of ductal shunt on the pulmonary and systemic circulation. In this article, updated evidence on the efficacy and adverse effects of pharmacological treatment options and expectant management are presented, while highlighting the long-term benefits of PDA treatment remains equivocal and controversial. The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes.
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Affiliation(s)
- Belinda Chan
- Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, UT 84113, USA;
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, UT 84113, USA
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Department of Pediatrics, Division of Neonatology, University of Southern California (USC), Los Angeles, CA 90007, USA
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