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Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price? J Pediatr 2023; 254:25-32. [PMID: 36241053 DOI: 10.1016/j.jpeds.2022.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the relation between duration of hemodynamically significant patent ductus arteriosus (PDA), cerebral oxygenation, magnetic resonance imaging-determined brain growth, and 2-year neurodevelopmental outcome in a cohort of infants born preterm whose duct was closed surgically. STUDY DESIGN Infants born preterm at <30 weeks of gestational age who underwent surgical ductal closure between 2008 and 2018 (n = 106) were included in this observational study. Near infrared spectroscopy-monitored cerebral oxygen saturation during and up to 24 hours after ductal closure and a Bayley III developmental test at the corrected age of 2 years is the institutional standard of care for this patient group. Infants also had magnetic resonance imaging at term-equivalent age. RESULTS In total, 90 infants fulfilled the inclusion criteria (median [range]: 25.9 weeks [24.0-28.9]; 856 g [540-1350]. Days of a PDA ranged from 1 to 41. Multivariable linear regression analysis showed that duration of a PDA negatively influenced cerebellar growth and motor and cognitive outcome at 2 years of corrected age. CONCLUSIONS Prolonged duration of a PDA in this surgical cohort is associated with reduced cerebellar growth and suboptimal neurodevelopmental outcome.
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Dou C, Yu YH, Zhuo QC, Qi JH, Huang L, Ding YJ, Yang DJ, Li L, Li D, Wang XK, Wang Y, Qiao X, Zhang X, Zhang BJ, Jiang HY, Li ZL, Reddy S. Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study. World J Pediatr 2023; 19:577-585. [PMID: 36604390 DOI: 10.1007/s12519-022-00671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia (BPD) and focus on discussing its relationship with the duration of initial invasive mechanical ventilation (IMV) in very preterm neonates less than 32 weeks of gestational age (GA). METHODS We performed a prospective cohort study involving infants born at 23-31 weeks of GA who were admitted to 47 different neonatal intensive care unit (NICU) hospitals in China from January 2018 to December 2021. Patient data were obtained from the Sina-northern Neonatal Network (SNN) Database. RESULTS We identified 6538 very preterm infants, of whom 49.5% (3236/6538) received initial IMV support, and 12.6% (823/6538) were diagnosed with moderate-to-severe BPD symptoms. The median duration of initial IMV in the moderate-to-severe BPD group was 26 (17-41) days, while in the no or mild BPD group, it was 6 (3-10) days. The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs. Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV [adjusted odds ratio (AOR): 1.97; 95% confidence interval (CI): 1.10-2.67], late-onset neonatal sepsis (LONS), and patent ductus arteriosus (PDA). CONCLUSION In this multicenter cohort study, the duration of initial IMV was still relatively long in very premature infants, and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.
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Affiliation(s)
- Cong Dou
- Department of Neonatology, Maternal and Child Health Care Hospital of Shandong Province, Shandong University, Jinan, 250014, China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China. .,Department of Neonatology, Shandong Provincial Hospital, Shandong University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China.
| | - Qing-Cui Zhuo
- Department of Neonatology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Jian-Hong Qi
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China
| | - Lei Huang
- Department of Neonatology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, 250014, China
| | - Yan-Jie Ding
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - De-Juan Yang
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, China
| | - Li Li
- Department of Neonatology, Linyi People's Hospital, Linyi, 276000, China
| | - Dan Li
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Xiao-Kang Wang
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, HuaiYin District, No. 324, Jingwu Road, Jinan, 250021, China
| | - Yan Wang
- Department of Neonatology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, China
| | - Xin Qiao
- Department of Neonatology, Jinan Maternity and Child Healthcare Hospital, Jinan, 250001, China
| | - Xiang Zhang
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, China
| | - Bing-Jin Zhang
- Department of Neonatology, Shengli Olifield Central Hospital, Dongying, 257000, China
| | - Hai-Yan Jiang
- Department of Neonatology, The Third Hospital of Baogang Group, Baotou, 014000, China
| | - Zhong-Liang Li
- Department of Neonatology, W.F. Maternal and Child Health Hospital, Weifang, 261011, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, 250000, China
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Elbayiyev S, Canpolat FE, Kadıoğlu Şimşek G, Işık S, Büyüktiryaki M, Kanmaz Kutman HG. Long-term neurodevelopmental outcomes in very low birth weight infants with and without patent ductus arteriosus: A retrospective case control observational study. Child Care Health Dev 2022; 48:862-868. [PMID: 35274341 DOI: 10.1111/cch.12997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/18/2022] [Accepted: 03/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) has been associated with early morbidities and long-term developmental problems in very preterm infants. AIMS The aim of this study is to investigate the effect of patent ductus arteriosus and medical treatment on long-term developmental outcomes in very low birth weight infants. STUDY DESIGN This is a retrospective case control observational study. SUBJECT The study included preterm infants who were born before 30 weeks' gestation and birth weight less than 1,500 g and underwent neurodevelopmental testing at a corrected age of 24 months during follow-up in our centre. The results of neurodevelopmental assessment using the Bayley Scales of Infant Development II at 24 months of corrected age and other morbidities were recorded. RESULTS Of 820 infants screened, the 2-year data of 647 infants (78%) were analysed. The mean gestational age was 27.4 weeks (±1.7 weeks), mean birth weight was 980 g (±250 g) and 283 (44%) of the infants received pharmaceutical treatment for hemodynamically significant PDA. The prevalence of neurodevelopmental impairment was higher in infants with PDA compared to those without PDA (odds ratio [OR], 1.6; 95% CI, 1.13-2.29; chi-square, Fisher's exact test P = .009). However, when birth weight and gestational age were corrected for as covariates and other risk factors were added to the analysis, PDA alone was not an independent risk factor for neurodevelopmental problems (OR, 1.12; 95% CI, 0.824-1.549; P = .450). There was no difference between the groups who received ibuprofen or paracetamol for PDA. CONCLUSION Although we have not found an association between hemodynamically significant PDA and poor neurodevelopment, this potentially needs to be investigated.
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Affiliation(s)
- Sarkhan Elbayiyev
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Ankara, Turkey
| | - Fuat Emre Canpolat
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Ankara, Turkey
| | - Gülsüm Kadıoğlu Şimşek
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Ankara, Turkey
| | - Sehribanu Işık
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Ankara, Turkey
| | - Mehmet Büyüktiryaki
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Ankara, Turkey
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Wu W, Chen H, Chen T. Evaluation of Cardiac Function Characteristics after Patent Ductus Arteriosus Closure in Children and Adults by Echocardiographic Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1310841. [PMID: 35126616 PMCID: PMC8816572 DOI: 10.1155/2022/1310841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
This study was to investigate the value of echocardiographic data in assessing changes in cardiac function before and after transcatheter closure in children and adult patients with patent ductus arteriosus (PDA). In this study, 150 patients with isolated PDA treated by cardiac catheterization and transcatheter closure were selected as the study sample. Real-time color Doppler echocardiography was used both after and after operation. The results showed that the left ventricle returned to normal in 75 patients one day after operation, with an average age of 10.95 ± 3.27 years; the left ventricle did not return to normal in 10 patients 360 days after operation, with an average age of 64.31 ± 7.05 years. Left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) of patients decreased significantly one day after operation and remained at 51.95 ± 9.55 mL/m2 and 20.36 ± 8.11 mL/m-2, respectively. In summary, echocardiographic data have a high reference value in assessing cardiac function characteristics in children and adult patients with PDA and are worthy of further promotion.
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Affiliation(s)
- Wenhai Wu
- Cardiac Color Doppler Ultrasound Room, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Hongwei Chen
- Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Tianbao Chen
- Department of Internal Medicine-Cardiovascular, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
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Godin R, Rodriguez JC, Kahn DJ. Oral Versus Intravenous Medications for Treatment of Patent Ductus Arteriosus in Preterm Neonates: A Cost-Saving Initiative. J Pediatr Pharmacol Ther 2021; 26:291-299. [PMID: 33833632 DOI: 10.5863/1551-6776-26.3.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/18/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of the study was to quantify cost savings after promoting oral pharmacotherapy for the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). METHODS This was a retrospective before-and-after time series quality improvement study. Oral ibuprofen and acetaminophen use criteria were developed and recommended, rather than the more costly intravenous equivalents. There were 24-month medication use reports generated for both the pre-criteria (Era-1) and the post-criteria (Era-2) implementation phases to identify neonates prescribed hsPDA medications in order to assess cost differences. RESULTS Era-1 had 190 treatment courses in 110 neonates for a total medication cost of $171,260.70. Era-2 had 210 courses in 109 patients for a total medication cost of $47,461.49, yielding savings of $123,799.21 ($61,899.61 annually) after criteria implementation. The reduction in intravenous ibuprofen use in Era-2 accounted for all the savings. CONCLUSION Preferentially prescribing lower-cost oral medications to treat hsPDA led to significant cost savings.
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Hamrick SEG, Sallmon H, Rose AT, Porras D, Shelton EL, Reese J, Hansmann G. Patent Ductus Arteriosus of the Preterm Infant. Pediatrics 2020; 146:e20201209. [PMID: 33093140 PMCID: PMC7605084 DOI: 10.1542/peds.2020-1209] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 02/07/2023] Open
Abstract
Postnatal ductal closure is stimulated by rising oxygen tension and withdrawal of vasodilatory mediators (prostaglandins, nitric oxide, adenosine) and by vasoconstrictors (endothelin-1, catecholamines, contractile prostanoids), ion channels, calcium flux, platelets, morphologic maturity, and a favorable genetic predisposition. A persistently patent ductus arteriosus (PDA) in preterm infants can have clinical consequences. Decreasing pulmonary vascular resistance, especially in extremely low gestational age newborns, increases left-to-right shunting through the ductus and increases pulmonary blood flow further, leading to interstitial pulmonary edema and volume load to the left heart. Potential consequences of left-to-right shunting via a hemodynamically significant patent ductus arteriosus (hsPDA) include increased risk for prolonged ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis or focal intestinal perforation, intraventricular hemorrhage, and death. In the last decade, there has been a trend toward less aggressive treatment of PDA in preterm infants. However, there is a subgroup of infants who will likely benefit from intervention, be it pharmacologic, interventional, or surgical: (1) prophylactic intravenous indomethacin in highly selected extremely low gestational age newborns with PDA (<26 + 0/7 weeks' gestation, <750 g birth weight), (2) early targeted therapy of PDA in selected preterm infants at particular high risk for PDA-associated complications, and (3) PDA ligation, catheter intervention, or oral paracetamol may be considered as rescue options for hsPDA closure. The impact of catheter-based closure of hsPDA on clinical outcomes should be determined in future prospective studies. Finally, we provide a novel treatment algorithm for PDA in preterm infants that integrates the several treatment modalities in a staged approach.
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Affiliation(s)
- Shannon E G Hamrick
- Divisions of Neonatology and
- Cardiology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hannes Sallmon
- Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | | | - Diego Porras
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Elaine L Shelton
- Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Jeff Reese
- Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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