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Zuo JY, Chen HX, Yang Q, He GW. Variants of the promoter of MYH6 gene in congenital isolated and sporadic patent ductus arteriosus: case-control study and cellular functional analyses. Hum Mol Genet 2024; 33:884-893. [PMID: 38340456 DOI: 10.1093/hmg/ddae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Patent ductus arteriosus (PDA) is a common form of congenital heart disease. The MYH6 gene has important effects on cardiovascular growth and development, but the effect of variants in the MYH6 gene promoter on ductus arteriosus is unknown. DNA was extracted from blood samples of 721 subjects (428 patients with isolated and sporadic PDA and 293 healthy controls) and analyzed by sequencing for MYH6 gene promoter region variants. Cellular function experiments with three cell lines (HEK-293, HL-1, and H9C2 cells) and bioinformatics analyses were performed to verify their effects on gene expression. In the MYH6 gene promoter, 11 variants were identified. Four variants were found only in patients with PDA and 2 of them (g.3434G>C and g.4524C>T) were novel. Electrophoretic mobility shift assay showed that the transcription factors bound by the promoter variants were significantly altered in comparison to the wild-type in all three cell lines. Dual luciferase reporter showed that all the 4 variants reduced the transcriptional activity of the MYH6 gene promoter (P < 0.05). Prediction of transcription factors bound by the variants indicated that these variants alter the transcription factor binding sites. These pathological alterations most likely affect the contraction of the smooth muscle of ductus arteriosus, leading to PDA. This study is the first to focus on variants at the promoter region of the MYH6 gene in PDA patients with cellular function tests. Therefore, this study provides new insights to understand the genetic basis and facilitates further studies on the mechanism of PDA formation.
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Affiliation(s)
- Ji-Yang Zuo
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Huan-Xin Chen
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Qin Yang
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Guo-Wei He
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
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Ozdemir M, Tepe T, Ozlu F, Yapicioglu H, Atmıs A, Demir F, Unal I, Narli N. Lung ultrasound score in the decision of patent ductus arteriosus closure in neonates. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:415-425. [PMID: 38385619 DOI: 10.1002/jcu.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings of the patients before and after closure. METHODS The study groups (107 preterm neonates under 34 gestational weeks) were classified as hemodynamically significant PDA (group 1), hemodynamically insignificant PDA with closure therapy (group 2), hemodynamically insignificant PDA without closure therapy (group 3), and no PDA group (group 4) based on the echocardiography. 6- and 10-region LUS scores were compared for each group. RESULTS There was a significant difference between groups 1 and 3 on first, third, and seventh days. In contrast, groups 1 and 2 had similar LUS scores on the first, third, and seventh days. There was a negative correlation between LUS scores on the first and third days and gestational age, birth weight, the first- and fifth-minute APGAR scores, and there was a positive correlation between aortic root to left atrium ratio, and PDA diameter/weight ratio. CONCLUSION We observed that LUS scores in patients with hemodynamically insignificant PDA treated with closure therapy were similar to in patients with hemodynamically significant PDA. Thus, LUS score can have role in PDA closure in preterm neonates. However, more comprehensive studies are needed.
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Affiliation(s)
- Mustafa Ozdemir
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Tugay Tepe
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Ferda Ozlu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Hacer Yapicioglu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Anıl Atmıs
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Fadli Demir
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Ilker Unal
- Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey
| | - Nejat Narli
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
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Duboue PM, Padovani P, Bouteiller XP, Martin-Kabore F, Benbrik N, Gronier CG, Bouissou A, Garnier E, Mitanchez D, Flamant C, Rozé JC, Baruteau AE, Lefort B. Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study. Eur J Pediatr 2024; 183:2193-2201. [PMID: 38381375 DOI: 10.1007/s00431-024-05481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
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MESH Headings
- Humans
- Ductus Arteriosus, Patent/surgery
- Retrospective Studies
- Infant, Newborn
- Female
- Ligation/methods
- Ligation/adverse effects
- Male
- Cardiac Catheterization/methods
- Cardiac Catheterization/adverse effects
- Infant, Premature
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Infant, Low Birth Weight
- Incidence
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Syndrome
- Propensity Score
- Septal Occluder Device
- Risk Factors
- Infant, Premature, Diseases/surgery
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infant, Premature, Diseases/epidemiology
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Affiliation(s)
| | - Paul Padovani
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Xavier Paul Bouteiller
- Department of Cardiology, Electrophysiology and Heart Modelling Institute, CHU Bordeaux, IHU Liryc, Bordeaux University Foundation, Pessac, France
| | | | - Nadir Benbrik
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Céline Grunenwald Gronier
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Antoine Bouissou
- Department of Neonatology, CHU Tours, Tours University, Tours, France
| | - Elodie Garnier
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France
| | - Delphine Mitanchez
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, Paris, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes University, Nantes, France
| | | | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
- CNRS, INSERM, L'institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Bruno Lefort
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France.
- UMR 1069, INSERM, Tours University, Tours, France.
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Clocheville Hospital, CHRU Tours, 49, Boulevard Béranger, 37000, Tours, France.
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Ford A, Beauchene M, Stanford AH, Klein JM, Dagle JM, Rios DR, Larson SA, McNamara PJ, Giesinger RE. Exposure to persistent hemodynamically significant patent ductus arteriosus is associated with retinopathy of prematurity. J AAPOS 2024:103923. [PMID: 38692561 DOI: 10.1016/j.jaapos.2024.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Hemodynamically significant patent ductus arteriosus (hsPDA) shunt may predispose infants to retinopathy of prematurity (ROP) because of its higher preductal cardiac output and blood oxygen content, which may augment ocular oxygen delivery. METHODS A retrospective cohort study of preterm infants, born at <27 weeks' gestation and admitted at <24h postnatal age to a large quaternary referral was conducted. The primary composite outcome was death at <32 weeks or moderate-to-severe ROP (≥stage 2 or requiring treatment) in either eye. Secondary outcomes included ROP requiring treatment, and any ROP. Univariate analysis of patient characteristics and outcomes was performed as well as logistic regression. A receiver operating characteristics curve was generated for the outcome of ROP ≥stage 2 or requiring treatment. RESULTS A total of 91 patients were screened, of whom 86 (54 hsPDA, 32 controls) were eligible for inclusion. hsPDA patients were younger and lighter at birth and had a higher burden of hyperglycemia and respiratory illness. The rates of the composite outcome (death <32 weeks or moderate-to-severe ROP) and of any ROP were more frequent in the hsPDA group. hsPDA shunt exposure was independently associated with development of any ROP among survivors to assessment (P = 0.006). PDA cumulative exposure score of 78 (clinical equivalent = 7 days high-volume shunt exposure) predicts moderate-to-severe ROP with 80% sensitivity and 78% specificity. CONCLUSIONS Among infants <27 weeks, hsPDA shunt is associated with increased risks of a composite outcome of death or moderate-to-severe ROP, as well as ROP of any stage. Shunt modulation as a strategy to reduce ROP represents a biologically plausible avenue for investigation.
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Affiliation(s)
- Alison Ford
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Amy H Stanford
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | | | - John M Dagle
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Danielle R Rios
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Scott A Larson
- Department of Ophthalmology, University of Iowa, Iowa City, Iowa
| | - Patrick J McNamara
- Department of Pediatrics, University of Iowa, Iowa City, Iowa; Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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Hu XL, Zhu TT, Wang H, Hou C, Ni JC, Zhang ZF, Li XC, Peng H, Li H, Sun L, Xu QQ. A predictive model for patent ductus arteriosus seven days postpartum in preterm infants: an ultrasound-based assessment of ductus arteriosus intimal thickness within 24 h after birth. Front Pediatr 2024; 12:1388921. [PMID: 38725987 PMCID: PMC11079171 DOI: 10.3389/fped.2024.1388921] [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: 02/20/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives To develop a predictive model for patent ductus arteriosus (PDA) in preterm infants at seven days postpartum. The model employs ultrasound measurements of the ductus arteriosus (DA) intimal thickness (IT) obtained within 24 h after birth. Methods One hundred and five preterm infants with gestational ages ranging from 27.0 to 36.7 weeks admitted within 24 h following birth were prospectively enrolled. Echocardiographic assessments were performed to measure DA IT within 24 h after birth, and DA status was evaluated through echocardiography on the seventh day postpartum. Potential predictors were considered, including traditional clinical risk factors, M-mode ultrasound parameters, lumen diameter of the DA (LD), and DA flow metrics. A final prediction model was formulated through bidirectional stepwise regression analysis and subsequently subjected to internal validation. The model's discriminative ability, calibration, and clinical applicability were also assessed. Results The final predictive model included birth weight, application of mechanical ventilation, left ventricular end-diastolic diameter (LVEDd), LD, and the logarithm of IT (logIT). The receiver operating characteristic (ROC) curve for the model, predicated on logIT, exhibited excellent discriminative power with an area under the curve (AUC) of 0.985 (95% CI: 0.966-1.000), sensitivity of 1.000, and specificity of 0.909. Moreover, the model demonstrated robust calibration and goodness-of-fit (χ2 value = 0.560, p > 0.05), as well as strong reproducibility (accuracy: 0.935, Kappa: 0.773), as evidenced by 10-fold cross-validation. A decision curve analysis confirmed the model's broad clinical utility. Conclusions Our study successfully establishes a predictive model for PDA in preterm infants at seven days postpartum, leveraging the measurement of DA IT. This model enables identifying, within the first 24 h of life, infants who are likely to benefit from timely DA closure, thereby informing treatment decisions.
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Affiliation(s)
- Xin-Lu Hu
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ting-Ting Zhu
- Department of Neonatology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Wang
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cui Hou
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun-Cheng Ni
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhuo-Fan Zhang
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Chen Li
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hao Peng
- Department of Epidemiology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Hong Li
- Department of Neonatology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ling Sun
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiu-Qin Xu
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
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Oruz O, Dervişoğulları MS, Öktem ME, İncekaş C. Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06493-y. [PMID: 38656423 DOI: 10.1007/s00417-024-06493-y] [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: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment. METHODS This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both). CONCLUSIONS Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.
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Affiliation(s)
- Oğuzhan Oruz
- Department of Ophthalmology, Başkent University School of Medicine, Adana, Turkey.
| | | | | | - Caner İncekaş
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
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7
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Mitra S, Whitehead L, Smith K, Maclean B, Nixon R, Veysey A, Campbell-Yeo M, Kuhle S, Gale C, Soll R, Dorling J, Johnston BC. Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences. Arch Dis Child Fetal Neonatal Ed 2024; 109:232-238. [PMID: 37419686 DOI: 10.1136/archdischild-2023-325445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
ImportanceProphylactic cyclo-oxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks' gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Our objective was to develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. The Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including 5 experienced neonatal care providers, 2 methods experts, 1 pharmacist, 2 parents of former extremely preterm infants and 2 adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants (conditional recommendation, moderate certainty in estimate of effects). Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group (conditional recommendation, low certainty in the estimate of effects). The panel strongly recommended against use of prophylactic acetaminophen (strong recommendation, very low certainty in estimate of effects) until further research evidence is available.
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Affiliation(s)
- Souvik Mitra
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Whitehead
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Katie Smith
- School of Access, Education and Language, Nova Scotia Community College, Halifax, Nova Scotia, Canada
| | - Breagh Maclean
- Department of Service Nova Scotia, Government of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Rebekah Nixon
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Veysey
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Kuhle
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Chris Gale
- School of Public Health, Imperial College London, London, UK
| | - Roger Soll
- Department of Pediatrics, University of Vermont, Burlington, New Jersey, USA
| | - Jon Dorling
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
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8
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吴 梓, 张 漪, 周 茜, 刘 沁, 程 实, 夏 世. [Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:343-349. [PMID: 38660897 PMCID: PMC11057302 DOI: 10.7499/j.issn.1008-8830.2310145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). METHODS A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis. RESULTS The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05). CONCLUSIONS A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.
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Affiliation(s)
| | | | | | - 沁 刘
- 华中科技大学同济医学院附属湖北妇幼保健院超声科,湖北武汉430070
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9
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Jenni F, Konzett K, Gang S, Sparr V, Simma B. Psychomotor and Cognitive Outcome in Very Preterm Infants in Vorarlberg, Austria, 2007-2019. Neuropediatrics 2024; 55:90-96. [PMID: 38158208 DOI: 10.1055/a-2236-4003] [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] [Indexed: 01/03/2024]
Abstract
AIM The aim of this study was to analyze neurodevelopmental outcome of very and extremely preterm infants in Vorarlberg, Austria, accessed with neurodevelopmental testing, at the corrected age of 24 months. This article also compared these results with (inter)national data and analyzed the impact of perinatal parameters. METHODS Population-based, retrospective multicenter study with data on very and extremely preterm infants born in Vorarlberg from 2007 to 2019 assessed with Bayley Scales of Infant Development (BSID-II/Bayley-III). RESULTS Included were 264 infants with a mean age of 29.0 (± 2.1) weeks of gestational age and a mean birth weight of 1177 (± 328.26) g; 172 infants underwent a BSID-II, 92 a Bayley-III assessment. The psychomotor developmental index (PDI) and mental developmental index (MDI) showed mean scores of 99.6 (± 14.4) and 91 (± 20.4), respectively. Adverse outcomes (scores <70) were assessed in 4.2% for PDI and 15.5% for MDI. In the extremely preterm group (n = 79), results for mean PDI were 100.1 (± 16.8) and for mean MDI 88.4 (± 22.4). Accordingly, adverse outcomes were assessed in 5.1% for PDI and in 20.3% for MDI. In addition to bronchopulmonary dysplasia and intraventricular hemorrhage Grade 3-4, head circumference at birth and patent ductus arteriosus were also identified as risk factors for poor outcome. CONCLUSION This study showed a remarkably good neurodevelopmental outcome in preterm infants with low rates of adverse outcome, similar to (inter)national reports, especially in the group of extremely preterm infants. Research is needed to explore the role of social factors and infants' environment, especially cognitive outcome and language skills.
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Affiliation(s)
- Fabio Jenni
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Karin Konzett
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefanie Gang
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Verena Sparr
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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10
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Arriaga-Redondo M, Rodríguez-Sánchez de la Blanca A, Zunzunegui JL, Ballesteros-Tejerizo F, Rodríguez-Ogando A, González-Navarro P, Blanco-Bravo D, Sánchez-Luna M. Impact of catheterized ductal closure on renal and cerebral oximetry in premature neonates. Eur J Pediatr 2024:10.1007/s00431-024-05541-3. [PMID: 38558310 DOI: 10.1007/s00431-024-05541-3] [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: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of interventional closure in surgical ligation, its application in percutaneous transcatheter closure remains unexplored. This study aims to assess cerebral and renal hemodynamic changes using NIRS during percutaneous closure compared to surgical closure in preterm infants. A prospective observational study enrolled preterm infants born at 32 weeks of gestation or less and diagnosed with hsPDA between January 2020 and December 2022. These infants received either surgical or catheter-based closure of the PDA. Cerebral and renal oxygen saturation was monitored using the INVOS 5100 device from 12 h before the intervention until 24 h after. Linear mixed-effects models were used to analyze time-dependent variables. Twenty-two patients were enrolled, with catheter-based closure performed in 16 cases and conventional surgery in 6 cases. Following ductal closure, a significant increase in renal and cerebral oximetry was observed alongside a decrease in renal and cerebral tissue oxygen extraction. These changes were particularly pronounced in the renal territory. No differences were detected between catheterization and surgical closure. Conclusion: An improvement in cerebral and renal oximetry following hsPDA closure was observed. However, we did not identify differences in this pattern based on the type of interventional procedure for PDA, whether surgery or catheterization. What is Known: • The presence of a significant ductus is common in premature patients. Studies have shown that it affects cerebral and renal hemodynamics negatively, leading to decreased oximetry values in these areas. It has been reported that closure of the ductus, either pharmacologically or surgically, results in improved oximetry values. What is New: • This study assess the impact of percutaneous closure of ductus, revealing increased oximetry values in cerebral and renal territories without significant differences compared to surgical ligation. Notably, renal oximetry values showed a greater increase, underscoring the importance of multi-location monitoring.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain.
| | | | - José Luis Zunzunegui
- Pediatric Cardiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | - Pablo González-Navarro
- Unidad de Investigación Materno Infantil-Fundación Familia Alonso (UDIMIFFA)-Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Dorita Blanco-Bravo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
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11
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Dalby ST, Shibbani K, Mercadante A, Veeram Reddy SR, Aldoss O, Gordon BM, El-Said H, Mohammad Nijres B. Transcatheter Patent Ductus Arteriosus Closure in Premature Infants: A Multicenter Retrospective Study Comparing Available Devices. Circ Cardiovasc Interv 2024; 17:e013723. [PMID: 38502722 DOI: 10.1161/circinterventions.123.013723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Stephen T Dalby
- Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock (S.T.D.)
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla (S.T.D., K.S., B.M.G., H.E.-S.)
| | - Kamel Shibbani
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla (S.T.D., K.S., B.M.G., H.E.-S.)
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City (K.S., O.A., B.M.N.)
| | - Austin Mercadante
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas (A.M., S.R.V.R.)
| | - Surendranath R Veeram Reddy
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City (K.S., O.A., B.M.N.)
| | - Osamah Aldoss
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City (K.S., O.A., B.M.N.)
| | - Brent M Gordon
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla (S.T.D., K.S., B.M.G., H.E.-S.)
| | - Howaida El-Said
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla (S.T.D., K.S., B.M.G., H.E.-S.)
| | - Bassel Mohammad Nijres
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City (K.S., O.A., B.M.N.)
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12
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Boyd SM, Kluckow M, McNamara PJ. Targeted Neonatal Echocardiography in the Management of Neonatal Pulmonary Hypertension. Clin Perinatol 2024; 51:45-76. [PMID: 38325947 DOI: 10.1016/j.clp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pulmonary hypertension (PH) in neonates, originating from a range of disease states with heterogeneous underlying pathophysiology, is associated with significant morbidity and mortality. Although the final common pathway is a state of high right ventricular afterload leading to compromised cardiac output, multiple hemodynamic phenotypes exist in acute and chronic PH, for which cardiorespiratory treatment strategies differ. Comprehensive appraisal of pulmonary pressure, pulmonary vascular resistance, cardiac function, pulmonary and systemic blood flow, and extrapulmonary shunts facilitates delivery of individualized cardiovascular therapies in affected newborns.
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Affiliation(s)
- Stephanie M Boyd
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Corner Hawkesbury Road, Hainsworth Street, Westmead, Sydney 2145, Australia; The University of Sydney, Sydney, Australia
| | - Martin Kluckow
- The University of Sydney, Sydney, Australia; Department of Neonatology, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Sydney, Australia
| | - Patrick J McNamara
- Division of Neonatology, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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13
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Feng W, Zhang H, Yan H, Yang ZB, Zhao JL, Zhang LB. Gastrointestinal perforation in extremely low birth weight infants: A single center retrospective study in China. Pediatr Neonatol 2024; 65:111-116. [PMID: 38114414 DOI: 10.1016/j.pedneo.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Gastrointestinal perforation in extremely low birth weight infants, characterized by its rapid onset, multiple complications, and critical condition, poses a significant risk of infant mortality. The aim of this study was to investigate the clinical characteristics of pneumoperitoneum in extremely low birth weight infants (ELBWI) and explore the risk factors associated with gastrointestinal perforation in very low birth weight preterm infants. Additionally, we shared our surgical experiences in managing gastrointestinal perforation among extremely low birth weight infants. METHODS The Department of Neonatology at Chengdu Women and Children's Central Hospital conducted a retrospective study on gastrointestinal perforation in extremely low birth weight infants (birth weight <1000 g) who were admitted between 2014 and 2021. After baseline analysis and comparing it with the control group, we identified the risk factors associated with gastrointestinal perforation in ELBWI by multiple logistic regression analysis. The Kaplan-Meier analysis was performed to assess the adverse effect of gastrointestinal perforation for survival in ELBW infants. Cox multivariate regression analysis was used to evaluate hazard level of different variables for ELBW infants survival. RESULTS Hemodynamically significant patent ductus arteriosus (hsPDA)(p = 0.043, OR = 2.779) and sepsis (p = 0.014, OR = 2.265) were significant risk factors for gastrointestinal perforation in extremely low birth weight infants. The Cox proportional hazard model revealed that intraventricular hemorrhage (HR = 2.854, p<0.001) Sepsis (HR = 1.645, p = 0.015) and gastrointestinal perforation (HR = 1.876, p = 0.008) had detrimental effects on the survival of extremely low birth weight infants; conversely, ibuprofen (HR = 0.304, p<0.001) and blood transfusion (HR = 0.372, p<0.001) are beneficial factors for their survival. The preoperative indicators of infection in infants with spontaneous intestinal perforation (SIP) were significantly better than those in the necrotizing enterocolitis (NEC) group (p < 0.05). CONCLUSIONS Gastrointestinal perforation poses a significant threat the survival of extremely low birth weight (ELBW) infants, with hsPDA and sepsis serving as predisposing factors for gastrointestinal perforation. The gastrointestinal perforation caused by various diseases exhibits distinct clinical characteristics, necessitating tailored surgical approaches based on operative conditions.
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Affiliation(s)
- Wei Feng
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hong Zhang
- Department of Pediatric Endocrinology, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Huan Yan
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zheng-Bing Yang
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jin-Liang Zhao
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Li-Bing Zhang
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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14
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Kaluarachchi DC, Rysavy MA, Carper BA, Chock VY, Laughon MM, Backes CH, Colaizy TT, Bell EF, McNamara PJ. Secular Trends in Patent Ductus Arteriosus Management in Infants Born Preterm in the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 2024; 266:113877. [PMID: 38135028 PMCID: PMC10922632 DOI: 10.1016/j.jpeds.2023.113877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
We evaluated changes in patent ductus arteriosus (PDA) diagnosis and treatment from 2012 through 2021 in a network of US academic hospitals. PDA treatment decreased among infants born at 26-28 weeks but not among infants born at 22-25 weeks. Rates of indomethacin use and PDA ligation decreased while acetaminophen use and transcatheter PDA closure increased.
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Affiliation(s)
| | - Matthew A Rysavy
- Department of Pediatrics, McGovern Medical School, UTHealth Houston, Houston, TX
| | - Benjamin A Carper
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC
| | - Valerie Y Chock
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Carl H Backes
- Department of Pediatrics, Ohio State University and Nationwide Children's Hospital, Columbus, OH
| | | | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
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15
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Koo J, Torres N, Katheria A. Early Echocardiographic Predictors of Eventual Need for Patent Ductus Arteriosus Treatment: A Retrospective Study. Am J Perinatol 2024. [PMID: 38237629 DOI: 10.1055/a-2249-1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA. STUDY DESIGN Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. t-tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values. RESULTS Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (p-values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively). CONCLUSION Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities. KEY POINTS · Early diagnosis of hsPDA may prevent severe morbidity and death.. · There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis.. · Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA..
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Affiliation(s)
- Jenny Koo
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
| | - Nohemi Torres
- Department of Pediatric Cardiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
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16
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Luo H, He J, Xu X, Chen H, Shi J. The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis. PeerJ 2024; 12:e16591. [PMID: 38304184 PMCID: PMC10832619 DOI: 10.7717/peerj.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
Background This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse events when administering medications to premature infants with patent ductus arteriosus (PDA). Method The protocol for this review has been registered with PROSPERO (CRD 42022324598). We searched relevant studies in PubMed, Embase, Cochrane, and the Web of Science databases from March 26, 1996, to January 31, 2022. Results A total of six randomized controlled trials (RCTs) and five observational studies were included for analysis, involving 630 premature neonates in total. Among these infants, 480 were in the ibuprofen group (oral vs. intravenous routes), 78 in the paracetamol group (oral vs. intravenous routes), and 72 in the ibuprofen group (rectal vs. oral routes). Our meta-analysis revealed a significant difference in the rate of PDA closure between the the initial course of oral ibuprofen and intravenous ibuprofen groups (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.13-1.44]; P < 0.0001, I2 = 0%). In contrast, the meta-analysis of paracetamol administration via oral versus intravenous routes showed no significant difference in PDA closure rates (RR = 0.86, 95% CI [0.38-1.91]; P = 0.71, I2 = 76%). However, there was no statistically significant difference in the risk of adverse events or the need for surgical intervention among various drug administration methods after the complete course of drug therapy. Conclusion This meta-analysis evaluated the safety and effectiveness of different medication routes for treating PDA in premature infants. Our analysis results revealed that compared with intravenous administration, oral ibuprofen may offer certain advantages in closing PDA without increasing the risk of adverse events. Conversely, the use of paracetamol demonstrated no significant difference in PDA closure and the risk of adverse events between oral and intravenous administration.
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Affiliation(s)
- Hanwen Luo
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jianghua He
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoming Xu
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Hongju Chen
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital/ Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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17
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Loeffler KA, Behere SP, Williams PK, Nakamura Y, Burkhart HM, Campbell MD. Reduced morbidity with early surgical ligation of patent ductus arteriosus in extremely low birth weight infants: a retrospective single-centre study. Cardiol Young 2024:1-6. [PMID: 38196381 DOI: 10.1017/s1047951123004432] [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] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Failure of the patent ductus arteriosus to close is common among extremely low birth weight neonates and has been associated with increased morbidities. The objective of this study was to compare outcomes between early and late surgical ligation in extremely low birth weight patients. METHODS This was a single-centre retrospective cohort study of infants who required surgical closure of patent ductus arteriosus between January 2017 and August 2022. RESULTS A total of 43 neonates were identified with birth weight less than 1 kg that underwent surgical patent ductus arteriosus ligation. Compared to the late ligation group, the early ligation group experienced fewer total days of mechanical ventilation (43.9 days vs. 97.2 days, p < 0.05) and a shorter length of hospital stay (114.2 days vs. 169.0 days, p < 0.05). CONCLUSION Early surgical ligation of haemodynamically significant patent ductus arteriosus in extremely low birth weight neonates may improve hospital morbidity, including improved ventilatory outcomes and a shorter length of stay.
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Affiliation(s)
| | - Shashank P Behere
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | | | - Yuki Nakamura
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Harold M Burkhart
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
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18
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Bouazza N, Cambonie G, Flamant C, Rideau A, Tauzin M, Patkai J, Gascoin G, Lumia M, Aikio O, Lui G, Bournaud LF, Walsh-Papageorgiou A, Tortigue M, Baruteau AE, Kallio J, Hallman M, Diallo A, Levoyer L, Treluyer JM, Roze JC. Prophylactic Intravenous Acetaminophen in Extremely Premature Infants: Minimum Effective Dose Research by Bayesian Approach. Paediatr Drugs 2024; 26:83-93. [PMID: 37978159 PMCID: PMC10770203 DOI: 10.1007/s40272-023-00602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) in preterm infants is associated with increased morbidities and mortality. Prophylactic treatment with cyclooxygenase inhibitors, as indomethacin or ibuprofen, failed to demonstrate significant clinical benefits. Acetaminophen may represent an alternative treatment option. OBJECTIVE This study evaluated the minimum effective dose of prophylactic acetaminophen to close the ductus and assessed the safety and tolerability profile in extremely preterm infants at 23-26 weeks of gestation. METHODS A dose finding trial with Bayesian continual reassessment method was performed in a multicenter study with premature infants hospitalized in neonatal intensive care unit. Infants of 23-26 weeks of gestation and post-natal age ≤ 12 h were enrolled. Four intravenous acetaminophen dose levels were predefined. The primary outcome was the ductus arteriosus closing at two consecutive echocardiographies or at day 7. The main secondary objectives included the safety of acetaminophen on hemodynamics and biological hepatic function. RESULTS A total of 29 patients were analyzed sequentially for the primary analysis with 20 infants assigned to the first dose level followed by 9 infants to the second dose level. No further dose level increase was necessary. The posterior probabilities of success, estimated from the Bayesian logistic model, were 46.1% [95% probability interval (PI), 24.9-63.9] and 67.6% (95% PI, 51.5-77.9) for dose level 1 and 2, respectively. A closing or closed pattern was observed among 19 patients at the end of treatment [65.5% (95% confidence interval (CI), 45.7-82.0)]. No change in alanine aminotransferase values was observed during treatment. A significant decrease in aspartate aminotransferase values was observed with postnatal age. No change in systolic and diastolic blood pressures was observed during treatment. CONCLUSIONS Minimum effective dose to close the ductus was 25 mg/kg loading dose then 10 mg/kg/6 h for 5 days in extremely preterm infants. Acetaminophen was well tolerated in this study following these doses. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04459117.
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Affiliation(s)
- Naïm Bouazza
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.
- Unité de Recherche Clinique, Université Paris Cité Necker/Cochin, Hôpital Tarnier, Paris, France.
- CIC-1419 Inserm, Cochin-Necker, Paris, France.
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pathogenesis and Control of Chronic Infection, INSERM, UMR 1058, University of Montpellier, Montpellier, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France
| | - Aline Rideau
- Department of Pediatrics, Robert Debré Hospital, APHP, Paris, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Juliana Patkai
- Neonatology Department, Port-Royal Hospital, 75014, Paris, France
| | - Géraldine Gascoin
- Department of Neonatology, Angers University Hospital, Angers, France
| | - Mirka Lumia
- Department of Children and Adolescents, New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Aikio
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine and MRC Oulu, University of Oulu, Oulu, Finland
| | - Gabrielle Lui
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Léo Froelicher Bournaud
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | | | - Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
- Nantes Université, INRAE, UMR 1280, PhAN, Nantes, France
| | - Jaana Kallio
- Department of Children and Adolescents, New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Hallman
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine and MRC Oulu, University of Oulu, Oulu, Finland
| | - Alpha Diallo
- Clinical Trial Safety and Public Health, ANRS|Emerging Infectious Diseases, Paris, France
- Clinical Research Safety Department, INSERM, Paris, France
| | - Léa Levoyer
- Clinical Trial Safety and Public Health, ANRS|Emerging Infectious Diseases, Paris, France
- Clinical Research Safety Department, INSERM, Paris, France
| | - Jean-Marc Treluyer
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France
- Unité de Recherche Clinique, Université Paris Cité Necker/Cochin, Hôpital Tarnier, Paris, France
- CIC-1419 Inserm, Cochin-Necker, Paris, France
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Jean-Christophe Roze
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
- Nantes Université, INRAE, UMR 1280, PhAN, Nantes, France
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19
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Qian A, Jiang S, Gu X, Li S, Lei X, Shi W, Zhou J, Hu L, Xiao T, Zhu Y, Cao Y, Du L, Zhou W, Lee SK, Cheng R, Yin R. Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study. EClinicalMedicine 2024; 67:102356. [PMID: 38125962 PMCID: PMC10730999 DOI: 10.1016/j.eclinm.2023.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background The optimal treatment strategy for patent ductus arteriosus (PDA) in extremely preterm infants is currently highly controversial. This study aimed to evaluate the association between PDA treatment and short-term outcomes among extremely preterm infants. Methods This cohort study included all extremely preterm infants (≤27 and 6/7 weeks) who were admitted to hospitals participating in the Chinese Neonatal Network from January 2019 to December 2021, and were diagnosed to have PDA by echocardiogram. PDA treatment was defined as medical treatment and/or surgical ligation of PDA during hospitalization. Short-term outcomes included death, bronchopulmonary dysplasia (BPD), death/BPD, retinopathy of prematurity, necrotizing enterocolitis, and severe brain injury. Multivariate logistic regression was used to evaluate the association between PDA treatment and outcomes. Subgroup analysis were performed among infants with different respiratory support on 3 and 7 days of life. Findings A total of 2494 extremely preterm infants with the diagnosis of PDA were enrolled, of which 1299 (52.1%) received PDA treatment. PDA treatment was significantly associated with lower risk of death (adjusted odds ratio, 0.48; 95% confidence interval, 0.38-0.60). The decreased risk of death was accompanied by increased risk of BPD and death/BPD. In subgroup analysis according to respiratory support, PDA treatment was associated with lower risk of death among infants who required invasive ventilation. However, the beneficial effect on death was not significant among infants who did not require invasive ventilation. Interpretation PDA treatment was associated with reduced mortality in extremely preterm infants, but this beneficial effect was mainly present among infants who required invasive ventilation. Funding This study was funded by the Shanghai Science and Technology Commission's Scientific and Technological Innovation Action Plan (21Y21900800) and the Canadian Institutes of Health Research (CTP87518).
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Affiliation(s)
- Aimin Qian
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Shujuan Li
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoping Lei
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Shi
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianguo Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Liyuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Tiantian Xiao
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanping Zhu
- Department of Neonatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Lizhong Du
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K. Lee
- Maternal-Infant Care Research Center and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Rong Yin
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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20
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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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21
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Honnorat M, Perouse-De-Montclos T, Bakloul M, Walton C, Butin M, Vo Van P. Transcatheter closure of patent ductus arteriosus in preterm infants: results from a single-center cohort. Front Pediatr 2023; 11:1292623. [PMID: 38178913 PMCID: PMC10765538 DOI: 10.3389/fped.2023.1292623] [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: 09/11/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To assess the success rate of patent ductus arteriosus (PDA) transcatheter closure in preterm infants and to describe the nature of procedural adverse events and short-term clinical status. Study design All the preterm infants with PDA transcatheter closure were evaluated retrospectively between July 2019 and March 2023 in a single level III neonatal intensive care unit in France. The procedure was performed in the catheterization laboratory using venous canulation. We retrospectively collected data about the patients' characteristics, procedural outcomes and complications. Results Twenty-five infants born between 23.4 and 32.0 weeks of gestational age (mean ± SD 26.3 ± 1.9 weeks) underwent transcatheter PDA closure. Their mean age and weight at the time of the procedure were 52 days (range 22-146 days) and 1,620 g (range 890-3,700 g), respectively. Successful closure was achieved in all but one patient. Procedure related complications were reported in 10 infants (40%), including 6 left pulmonary artery stenosis one of which required a balloon dilatation, two cardiac tamponades and two inferior vena cava thrombosis. Only two post-ligature syndromes occurred after the procedure. Two infants died one of which was related to the procedure. Conclusion Transcatheter closure of a PDA is a valid alternative to surgical ligation due to its high success rate and low incidence of post-ligature syndrome. Nevertheless, we also report rare, although serious complications.
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Affiliation(s)
- Marion Honnorat
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
| | | | - Mohamed Bakloul
- Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Camille Walton
- Cardiologie pédiatrique, Hôpital Privé Natécia, Lyon, France
| | - Marine Butin
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
- INSERM U1111, CNRS UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Equipe “Pathogénie des Infections à Staphylocoques”, Lyon, France
| | - Philippe Vo Van
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
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22
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Baek SH, Shin JE, Han J, Song IG, Park J, Lee SM, Shim S, Eun HS, Lee SM, Lim J, Yoon SJ, Chang W, Park MS. Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study. BMJ Paediatr Open 2023; 7:e002302. [PMID: 38114242 DOI: 10.1136/bmjpo-2023-002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Dexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and analyse the factors associated with the response to dexamethasone in very low birthweight infants using a nationwide database. METHODS We included very low birthweight infants born between January 2013 and December 2020 with a gestational age of 23-31 weeks using data from the Korean Neonatal Network registry. Patients were grouped based on their dexamethasone use into 'Dex' or 'No Dex' groups. Clinical variables and data were collected, and the annual trends of dexamethasone use and the proportion of patients who received dexamethasone according to gestational age were analysed. Respiratory outcomes were compared between the groups. Univariate and multivariate analyses were performed to analyse factors associated with the response to dexamethasone in BPD. RESULTS Of 11 261 eligible infants, 2313 (20.5%) received dexamethasone, and 1714 (74.1%) of them were diagnosed with moderate-to-severe BPD. The 8-year annual prevalence of dexamethasone use was 17.7-22.3%. The 'Dex' group had more moderate-to-severe BPD, more frequent invasive ventilation use at a postmenstrual age of 36 weeks and longer ventilator duration. Birth weight, 5-minute APGAR score, pulmonary hypertension within the first 28 days, surgical treatment of patent ductus arteriosus, medical treatment of patent ductus arteriosus, pathological chorioamnionitis, hydrocortisone or budesonide use, surgical management of necrotising enterocolitis and fungal sepsis were associated with BPD after dexamethasone use. CONCLUSIONS Approximately 20.5% of preterm infants received dexamethasone, and the frequency increased as gestational age decreased. Poor response to dexamethasone was associated with antenatal and postnatal inflammation, low birth weight and early pulmonary hypertension.
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Affiliation(s)
- Seung Hwan Baek
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Jeong Eun Shin
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Jungho Han
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - In Gyu Song
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Joonsik Park
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Su Min Lee
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Sungbo Shim
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Ho Seon Eun
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
| | - Soon Min Lee
- Pediatrics, Gangnam Severance Hospital, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Joohee Lim
- Pediatrics, Gangnam Severance Hospital, Gangnam-gu, Seoul, Korea (the Republic of)
| | - So Jin Yoon
- Pediatrics, Gangnam Severance Hospital, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Wook Chang
- Pediatrics, Yongin Severance Hospital, Yongin, Gyeonggi-do, Korea (the Republic of)
| | - Min Soo Park
- Pediatrics, Severance Hospital, Seodaemun-gu, Seoul, Korea (the Republic of)
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23
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Chen Y, Wu Y, Feng W, Luo X, Xiao B, Ding X, Gu Y, Lu Y, Yu Y. Vav2 promotes ductus arteriosus anatomic closure via the remodeling of smooth muscle cells by Rac1 activation. J Mol Med (Berl) 2023; 101:1567-1585. [PMID: 37804474 DOI: 10.1007/s00109-023-02377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
The ductus arteriosus (DA), bridging the aorta and pulmonary artery, immediately starts closing after birth. Remodeling of DA leads to anatomic obstruction to prevent repatency. Several histological changes, especially extracellular matrices (ECMs) deposition and smooth muscle cells (SMCs) migration bring to anatomic closure. The genetic etiology and mechanism of DA closure remain elusive. We have previously reported a novel copy number variant containing Vav2 in patent ductus arteriosus (PDA) patients, but its specific role in DA closure remains unknown. The present study revealed that the expression of Vav2 was reduced in human patent DA, and it was less enrichment in the adjacent aorta. Matrigel experiments demonstrated that Vav2 could promote SMC migration from PDA patient explants. Smooth muscle cells with Vav2 overexpression also presented an increased capacity in migration and downregulated contractile-related proteins. Meanwhile, SMCs with Vav2 overexpression exhibited higher expression of collagen III and lessened protein abundance of lysyl oxidase, and both changes are beneficial to DA remodeling. Overexpression of Vav2 resulted in increased activity of Rac1, Cdc42, and RhoA in SMCs. Further investigation noteworthily found that the above alterations caused by Vav2 overexpression were particularly reversed by Rac1 inhibitor. A heterozygous, rare Vav2 variant was identified in PDA patients. Compared with the wild type, this variant attenuated Vav2 protein expression and weakened the activation of downstream Rac1, further impairing its functions in SMCs. In conclusion, Vav2 functions as an activator for Rac1 in SMCs to promote SMCs migration, dedifferentiation, and ECMs production. Deleterious variant potentially induces Vav2 loss of function, further providing possible molecular mechanisms about Vav2 in PDA pathogenesis. These findings enriched the current genetic etiology of PDA, which may provide a novel target for prenatal diagnosis and treatment. KEY MESSAGES: Although we have proposed the potential association between Vav2 and PDA incidence through whole exome sequencing, the molecular mechanisms underlying Vav2 in PDA have never been reported. This work, for the first time, demonstrated that Vav2 was exclusively expressed in closed DAs. Moreover, we found that Vav2 participated in the process of anatomic closure by mediating SMCs migration, dedifferentiation, and ECMs deposition through Rac1 activation. Our findings first identified a deleterious Vav2 c.701C>T variant that affected its function in SMCs by impairing Rac1 activation, which may lead to PDA defect. Vav2 may become an early diagnosis and an effective intervention target for PDA clinical therapy.
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Affiliation(s)
- Yinghui Chen
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yizhuo Wu
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Weiqi Feng
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xueyang Luo
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Bing Xiao
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xiaowei Ding
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yongjia Gu
- Department of Stomatology, Shidong Hospital of Yangpu District, Shanghai, 200438, China.
| | - Yanan Lu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
| | - Yu Yu
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
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24
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Huang Z, Cheng X, Lin B, Zhao J, Huang Z, Xiong X, Yang C, Chen X. Diameter of ductus arteriosus on postnatal Day 7 is associated with late pulmonary hypertension in extremely preterm infants. Pediatr Pulmonol 2023; 58:3523-3529. [PMID: 37712599 DOI: 10.1002/ppul.26686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES A clinically feasible biomarker for pulmonary hypertension (PH) prediction is still lacking. Thus, we aim to assess the association between ductus arteriosus (DA) diameter and PH in extremely preterm infants. STUDY DESIGN A retrospective case-control study was performed to compare the diameter of DA in infants with and without late PH. Propensity scores were calculated to match the gestational age in two groups with a match ratio of 1:2. The diameter of DA was measured by echocardiography on postnatal Days 3 and 7. RESULTS A total of 91 infants were included in the study. The diagnosis of late PH was made in 32 infants between postnatal life of 28-159 days. Univariable analysis showed that late PH was associated with birth weight, invasive mechanical ventilation, hemodynamically significant PDA (hsPDA), duration of PDA exposure, the rate of surgical ligation, and diameter of DA on postnatal Days 3 and 7. After adjusting for these selected factors, the diameter of DA measured on postnatal Day 7 was independently associated with the risk of late PH (odds ratios: 5.511, 95% confidence interval: 1.552-19.562, p = .008). Receiver operator curve analysis indicated that 1.95 mm in DA diameter on postnatal Day 7 was the cutoff value for late PH with an area under the curve of 0.697. CONCLUSIONS Our findings suggest that DA diameter (larger than or equal to 1.95 mm) on postnatal Day 7 might serve as a predictor for late PH in extremely preterm infants.
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Affiliation(s)
- Zilu Huang
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xiaoqin Cheng
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Jie Zhao
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Zhifeng Huang
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xiaoyun Xiong
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xueyu Chen
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
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25
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Lai KC, Richardson T, Berman D, DeMauro SB, King BC, Lagatta J, Lee HC, Lewis T, Noori S, O'Byrne ML, Patel RM, Slaughter JL, Lakshmanan A. Current Trends in Invasive Closure of Patent Ductus Arteriosus in Very Low Birth Weight Infants in United States Children's Hospitals, 2016-2021. J Pediatr 2023; 263:113712. [PMID: 37659587 DOI: 10.1016/j.jpeds.2023.113712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To describe the current practices in invasive patent ductus arteriosus (PDA) closure (surgical ligation or transcatheter occlusion) in very low birth weight (VLBW) infants and changes in patient characteristics and outcomes from 2016 to 2021 among US children's hospitals. STUDY DESIGN We evaluated a retrospective cohort of VLBW infants (birth weight 400-1499 g and gestational age 22-31 weeks) who had invasive PDA closure within 6 months of age from 2016 to 2021 in children's hospitals in the Pediatric Health Information System. Changes in patient characteristics and outcomes over time were evaluated using generalized linear models and generalized linear mixed models. RESULTS 2418 VLBW infants (1182 surgical ligation; 1236 transcatheter occlusion) from 42 hospitals were included. The proportion of infants receiving transcatheter occlusion increased from 17.2% in 2016 to 84.4% in 2021 (P < .001). In 2021, 28/42 (67%) hospitals had performed transcatheter occlusion in > 80% of their VLBW infants needing invasive PDA closure, compared with only 2/42 (5%) in 2016. Although median postmenstrual age (PMA) at PDA closure did not change for the overall cohort, PMA at transcatheter occlusion decreased from 38 weeks in 2016 to 31 weeks by 2020, P < .001. Among those infants not intubated prior to PDA closure, extubation within 3 days postprocedure increased over time (yearly adjusted odds ratios of 1.26 [1.08-1.48]). Length of stay and mortality did not change over time. CONCLUSION We report rapid adoption of transcatheter occlusion for PDA among VLBW infants in US children's hospitals over time. Transcatheter occlusions were performed at younger PMA over time.
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Affiliation(s)
- Kuan-Chi Lai
- Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA.
| | | | - Darren Berman
- Division of Cardiology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA
| | - Sara B DeMauro
- Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Brian C King
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, PA
| | - Joanne Lagatta
- Division of Neonatology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI
| | - Henry C Lee
- Division of Neonatology, Rady Children's Hospital and University of California San Diego, San Diego, CA
| | - Tamorah Lewis
- Division of Neonatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shahab Noori
- Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA
| | - Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Ravi M Patel
- Division of Neonatology, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Jonathan L Slaughter
- Division of Neonatology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Ashwini Lakshmanan
- Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA; Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA
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26
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Cheema HA, Majeed Z, Hayat T, Ahmed A, Tariq MH, Shahid A, Titus A, Minhas AMK, Ijaz SH, Ghelani SJ, Kulkarni A, Dani SS. Expectant management of patent ductus arteriosus for preterm infants: A meta-analysis of randomized controlled trials. Am Heart J 2023; 266:179-183. [PMID: 37567354 DOI: 10.1016/j.ahj.2023.07.007] [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: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
We conducted this meta-analysis to compare expectant management of patent ductus arteriosus (PDA) with active treatment for PDA closure in preterm infants. Data from 7 randomized controlled trials (RCTs) showed that all-cause mortality and other clinical adverse outcomes did not differ between expectant management of PDA and active treatment. Future large-scale and double-blinded RCTs with a consistent definition for hemodynamically significant PDA, and focusing on clearly delineated high-risk subgroups or later selective treatment are needed to further evaluate the role of expectant management.
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Affiliation(s)
- Huzaifa Ahmad Cheema
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan; Department of Medicine, King Edward Medical University, Lahore, Pakistan.
| | - Zuhair Majeed
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Tajamal Hayat
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Arslan Ahmed
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Sardar Hassan Ijaz
- Division of Cardiovascular Medicine, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Aparna Kulkarni
- Children's Heart Center at Cohen Children's Medical Center/ Northwell Health, Donald and Barbara Zucker School of Medicine, New York, NY
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA
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27
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Chen YX, Xiao TT, Chen HY, Chen X, Wang YQ, Ni Q, Wu BB, Wang HJ, Lu YL, Hu LY, Cao Y, Cheng GQ, Wang LS, Xiao FF, Yang L, Dong XR, Zhou WH. Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors. World J Pediatr 2023; 19:1192-1202. [PMID: 37318723 DOI: 10.1007/s12519-023-00733-7] [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: 01/04/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hemodynamically significant patent ductus arteriosus (hsPDA) is associated with increased comorbidities in neonates. Early evaluation of hsPDA risk is critical to implement individualized intervention. The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions. METHODS We enrolled infants who were diagnosed with PDA and performed exome sequencing. The collapsing analyses were used to find the risk gene set (RGS) of hsPDA for model construction. The credibility of RGS was proven by RNA sequencing. Multivariate logistic regression was performed to establish models combining clinical and genetic features. The models were evaluated by area under the receiver operating curve (AUC) and decision curve analysis (DCA). RESULTS In this retrospective cohort study of 2199 PDA patients, 549 (25.0%) infants were diagnosed with hsPDA. The model [all clinical characteristics selected by least absolute shrinkage and selection operator regression (all CCs)] based on six clinical variables was acquired within three days of life, including gestational age (GA), respiratory distress syndrome (RDS), the lowest platelet count, invasive mechanical ventilation, and positive inotropic and vasoactive drugs. It has an AUC of 0.790 [95% confidence interval (CI) = 0.749-0.832], while the simplified model (basic clinical characteristic model) including GA and RDS has an AUC of 0.753 (95% CI = 0.706-0.799). There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice. The AUC of the models was improved by RGS, and the improvement was significant (all CCs vs. all CCs + RGS: 0.790 vs. 0.817, P < 0.001). DCA demonstrated that all models were clinically useful. CONCLUSIONS Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life. Genetic features might further improve the model performance. Video Abstract (MP4 86834 kb).
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Affiliation(s)
- Yu-Xi Chen
- Center for Molecular Medicine of Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai, China
| | - Tian-Tian Xiao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hui-Yao Chen
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xiang Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ya-Qiong Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Bing-Bing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Hui-Jun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yu-Lan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Li-Yuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guo-Qiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lai-Shuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Fei-Fan Xiao
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Lin Yang
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xin-Ran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Wen-Hao Zhou
- Center for Molecular Medicine of Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai, China.
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Baruteau AE, Fraisse A, Butera G, Bautista-Rodriguez C. The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results. J Cardiovasc Dev Dis 2023; 10:476. [PMID: 38132644 PMCID: PMC10744056 DOI: 10.3390/jcdd10120476] [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: 09/25/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients' selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, CHU Nantes, Nantes Université, FHU PRECICARE, F-44000 Nantes, France
- CIC FEA 1413, INSERM, CHU Nantes, Nantes Université, F-44000 Nantes, France
- L’institut du thorax, INSERM, CNRS, CHU Nantes, Nantes Université, F-44000 Nantes, France
- UMR 1280, PhAN, INRAE, Nantes Université, F-44000 Nantes, France
| | - Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
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Villamor E, van Westering-Kroon E, Gonzalez-Luis GE, Bartoš F, Abman SH, Huizing MJ. Patent Ductus Arteriosus and Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Bayesian Meta-Analysis. JAMA Netw Open 2023; 6:e2345299. [PMID: 38015504 PMCID: PMC10685885 DOI: 10.1001/jamanetworkopen.2023.45299] [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: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Bronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies. Objective To explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies. Data Sources PubMed and Embase were searched up to April 2023. Key search terms included BPD and PH. Study Selection Studies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA. Main Outcomes and Measures The primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0). Results A total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable. Conclusions and Relevance In this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.
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Affiliation(s)
- Eduardo Villamor
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Gema E. Gonzalez-Luis
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - František Bartoš
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven H. Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children’s Hospital Colorado, Aurora
| | - Maurice J. Huizing
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
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Lee Y, Jung H. Unnecessity of routine chest tube drainage after patent ductus arteriosus ligation in preterm neonates. Ital J Pediatr 2023; 49:142. [PMID: 37858197 PMCID: PMC10588261 DOI: 10.1186/s13052-023-01548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Conventionally, a chest tube drainage is placed following patent ductus arteriosus (PDA) ligation to monitor possible bleeding and drain air or effusion postoperatively. However, the necessity of chest tube drainage after thoracotomy in PDA ligation is controversial. We evaluated the feasibility and safety of omitting chest tube drainage in preterm neonates who underwent PDA ligation via thoracotomy. METHODS We retrospectively reviewed the medical records of 56 preterm neonates who underwent surgical ligation of PDA via thoracotomy in the neonatal intensive care unit between January 2014 and March 2022. RESULTS The median gestational age was 26.9 (interquartile range [IQR]: 25.9-28.8) weeks and the median body weight at birth was 895 (IQR: 795-1190) g. The median age on the day of surgery was 17.0 (IQR: 10.0-22.0) days and the median body weight on the day of surgery was 1100 (IQR: 958-1410) g. The median operative time was 44.5 (IQR: 35.5-54.0) minutes. There were no intraoperative events or procedure-related deaths. On postoperative chest radiographs, no patients had major complications, such as pneumothorax or hemothorax. Nineteen patients (34%) had minor complications of subcutaneous emphysema around the thoracotomy site. No patients required additional chest tube drainage for postoperative bleeding, pleural effusion, or progressive subcutaneous emphysema. No patients had surgical wound infections. There were seven in-hospital mortalities, which were unrelated to the surgery. CONCLUSIONS Omitting chest tube drainage is feasible and safe for the postoperative management of preterm neonates undergoing PDA ligation via thoracotomy.
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Affiliation(s)
- Youngok Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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Yusuf K, Francescato G. Nutrition with a patent ductus arteriosus: feast, feed, or famine? Pediatr Res 2023:10.1038/s41390-023-02861-2. [PMID: 37857849 DOI: 10.1038/s41390-023-02861-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, Univeristy of Calgary, Rm 273, Heritage Medical Research Building, Calgary, AB, T2N 4N1, Canada.
| | - Gaia Francescato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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刘 太, 施 丽. [Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1001-1007. [PMID: 37905755 PMCID: PMC10621055 DOI: 10.7499/j.issn.1008-8830.2304027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/02/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants. METHODS A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants. RESULTS The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (P<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (P<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%CI: 0.802-0.944, P<0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%. CONCLUSIONS Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.
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Mini N, Schneider MBE, Schneider K. Transcatheter closure of tubular PDA with amplatzer plug 4 in preterm infants weighing between 900 and 3,400 g: the pros and cons. Front Cardiovasc Med 2023; 10:1283992. [PMID: 37900563 PMCID: PMC10611490 DOI: 10.3389/fcvm.2023.1283992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To our knowledge, no prior study has focused on the outcome of PDA occlusion using an Amplatzer™ Vascular Plug 4 (AP4) in ill preterm infants. This study aims to highlight the pros and cons of AP4 in this cohort. Methods Between 2020 and 2022, 26 ill preterm infants underwent PDA closure in our centre. The median age, weight, and gestational age were 60 days (11-180 days), 1,900g (900-3,400 g), and 25 weeks (22-33 weeks), respectively. The indication of the intervention was hemodynamically significant PDA. A medical trial with non-steroid medication failed to close the ducts in all patients. Follow-up using echocardiography was done 24, 48, and 72 h after the intervention. Results Of 26 ducts, 21 were successfully closed with AP4. Five ducts shorter than 7 mm were unsuitable for AP4 and were closed with the Amplatzer Piccolo device. The median radiation time was 4 min (3-9 min). No early plug-related complications or deaths were documented. Plug-related jailing of the left pulmonary artery as a late complication was 9.5%, and LPA reintervention was required. All ducts were closed after 48 h. Conclusion Implantation of the AP4 using a 4 F 0.38 guide wire-compatible catheter without inserting a long sheath makes the closure of tubular ducts with this device feasible and uncomplicated with a short intervention time. However, the limited sizes with fixed lengths of the AP4 make it unsuitable for ducts wider than 4.5 mm and shorter than the chosen device length, which can increase the risk of significant left pulmonary stenosis. A wide range of plug diameters and lengths is required to accommodate the large and short ducts.
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Affiliation(s)
- Nathalie Mini
- Department of Cardiology, German Paediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
| | - Martin B. E. Schneider
- Department of Cardiology, German Paediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
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Morray BH, Sathanandam SK, Forbes T, Gillespie M, Berman D, Armstrong AK, Shahanavaz S, Jones T, Rockefeller T, Justino H, Nykanen D, Weiler C, Gutfinger D, Zahn EM. 3-year follow-up of a prospective, multicenter study of the Amplatzer Piccolo™ Occluder for transcatheter patent ductus arteriosus closure in children ≥ 700 grams. J Perinatol 2023; 43:1238-1244. [PMID: 37587183 PMCID: PMC10541325 DOI: 10.1038/s41372-023-01741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study describes 3-year follow-up of 200 infants weighing ≥ 700 grams who underwent transcatheter patent ductus arteriosus (PDA) closure with the Amplatzer Piccolo™ Occluder. STUDY DESIGN Between June 2017 and February 2019, 200 children were enrolled in this U.S. study (NCT03055858). PDA closure, survival, and device- or procedure-related events were evaluated. A total of 156 of the available 182 patients (86%) completed the study. RESULTS The implant success rate was 95.5% (191/200). At 3 years, PDA closure was observed in 100% (33/33) of patients. Survival was >95% with 9 reported deaths. No deaths were adjudicated as device- or procedure-related. Notable events included aortic obstruction (2) requiring stent placement and tricuspid regurgitation (5), for which no interventions were required. CONCLUSIONS This follow-up study demonstrates high rates of PDA closure, low serious complication rates, and survival > 95% at 3 years. The Amplatzer Piccolo™ Occluder is a safe and effective therapy for PDA treatment in premature infants. CLINICALTRIALS gov identifier: NCT0305585.
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Affiliation(s)
- Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.
| | | | - Thomas Forbes
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Darren Berman
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | - Thomas Jones
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | | | | | | | | | | | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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KAYA B, AKDUMAN H, DILLI D, CETINKAYA S, OKTEM A, ORUN UA, TASAR M, ZENCIROGLU A. The Effects of Thyroid Hormone Levels on Patent Ductus Arteriosus Closure in Newborns. Medeni Med J 2023; 38:187-192. [PMID: 37766600 PMCID: PMC10542982 DOI: 10.4274/mmj.galenos.2023.25853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Although the role of thyroid hormones in functional and anatomical closure of patent ductus arteriosus (PDA) is well known, their effects on the medical or surgical closure of PDA in newborns remain unclear. This study aimed to assess the correlation between thyroid function tests and PDA closure through medical or surgical interventions in newborns. Methods This retrospective study was conducted on 65 newborns diagnosed with hemodynamically significant PDA (hs-PDA), with a premature rate of 81.5% (n=53). The subjects were divided into two groups according to the nature of the ductal closure as medically responsive "MR-PDA" or surgically treated "ST-PDA". The groups were compared in terms of thyroid hormone levels and other clinical parameters. Results Thirty-three (51%) of all 65 patients had PDA and responded to medical treatment. Gestational week, birth weight, and mode of delivery were similar between the medical and surgical treatment groups (p>0.05). Free thyroxine levels were significantly lower in the MR-PDA group than in the ST-PDA group (p=0.01). Conclusions Because hs-PDA is associated with increased morbidity and mortality in the neonatal period, especially in premature infants, we hypothesize that thyroid hormone levels may play a role in the closure of hs-PDA.
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Affiliation(s)
- Basak KAYA
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Neonatology, Ankara, Turkey
| | - Hasan AKDUMAN
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Neonatology, Ankara, Turkey
| | - Dilek DILLI
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Neonatology, Ankara, Turkey
| | - Semra CETINKAYA
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Ahmet OKTEM
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Neonatology, Ankara, Turkey
| | - Utku Arman ORUN
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet TASAR
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Cardiovascular Surgery, Ankara, Turkey
| | - Aysegul ZENCIROGLU
- University of Health Sciences of Turkey, Ankara Dr. Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Clinic of Neonatology, Ankara, Turkey
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Kitaoka H, Konishi T, Shitara Y, Ito A, Kashima K, Fujita A, Matsui H, Kato M, Takahashi N, Yasunaga H. Effects of Milrinone on Neonates after Patent Ductus Arteriosus Ligation: A Retrospective Nationwide Database Study. Neonatology 2023; 120:751-759. [PMID: 37757762 DOI: 10.1159/000533958] [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: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Milrinone is administered after patent ductus arteriosus (PDA) ligation to prevent and treat postoperative hemodynamic instability (i.e., postligation cardiac syndrome). We aimed to explore the effectiveness of milrinone on in-hospital outcomes in infants who underwent PDA ligation using a nationwide inpatient database in Japan. METHODS Using the Japanese Diagnosis Procedure Combination database, we identified patients who received milrinone after PDA ligation (n = 428) in neonatal intensive care units between July 2010 and March 2021 and those who did not (n = 3,392). We conducted a 1:4 propensity score-matched analysis with adjustment for background characteristics (e.g., gestational age, birth weight, comorbidities, preoperative treatments, and hospital background) to compare morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity), mortality, total hospitalization costs, and other outcomes. For sensitivity analysis, we performed an overlap propensity score-weighted analysis. RESULTS In-hospital morbidity, bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis occurred in 58%, 48%, 9.5%, and 7.1% of patients, respectively; the in-hospital mortality was 5.4%. After 1:4 propensity score matching, no significant difference was observed regarding mortality (7.1 vs. 5.7%), in-hospital morbidity (55 vs. 50%), bronchopulmonary dysplasia (44 vs. 41%), intraventricular hemorrhage (7.8 vs. 9.1%), necrotizing enterocolitis (8.5 vs. 8.9%), retinopathy of prematurity (21 vs. 22%), or total hospitalization costs (median: approximately 86,000 vs. 82,000 US dollars) between milrinone users (n = 425) and nonusers (n = 1,698). Sensitivity analyses yielded consistent results. CONCLUSIONS Milrinone use after PDA ligation was not associated with improved in-hospital outcomes, such as mortality and morbidity.
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Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Ito
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Asahi Fujita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Habibi-Kavashkohie MR, Scorza T, Oubaha M. Senescent Cells: Dual Implications on the Retinal Vascular System. Cells 2023; 12:2341. [PMID: 37830555 PMCID: PMC10571659 DOI: 10.3390/cells12192341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
Cellular senescence, a state of permanent cell cycle arrest in response to endogenous and exogenous stimuli, triggers a series of gradual alterations in structure, metabolism, and function, as well as inflammatory gene expression that nurtures a low-grade proinflammatory milieu in human tissue. A growing body of evidence indicates an accumulation of senescent neurons and blood vessels in response to stress and aging in the retina. Prolonged accumulation of senescent cells and long-term activation of stress signaling responses may lead to multiple chronic diseases, tissue dysfunction, and age-related pathologies by exposing neighboring cells to the heightened pathological senescence-associated secretory phenotype (SASP). However, the ultimate impacts of cellular senescence on the retinal vasculopathies and retinal vascular development remain ill-defined. In this review, we first summarize the molecular players and fundamental mechanisms driving cellular senescence, as well as the beneficial implications of senescent cells in driving vital physiological processes such as embryogenesis, wound healing, and tissue regeneration. Then, the dual implications of senescent cells on the growth, hemostasis, and remodeling of retinal blood vessels are described to document how senescent cells contribute to both retinal vascular development and the severity of proliferative retinopathies. Finally, we discuss the two main senotherapeutic strategies-senolytics and senomorphics-that are being considered to safely interfere with the detrimental effects of cellular senescence.
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Affiliation(s)
- Mohammad Reza Habibi-Kavashkohie
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montréal, QC H2L 2C4, Canada; (M.R.H.-K.); (T.S.)
- The Center of Excellence in Research on Orphan Diseases, Courtois Foundation (CERMO-FC), Montreal, QC H3G 1E8, Canada
| | - Tatiana Scorza
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montréal, QC H2L 2C4, Canada; (M.R.H.-K.); (T.S.)
- The Center of Excellence in Research on Orphan Diseases, Courtois Foundation (CERMO-FC), Montreal, QC H3G 1E8, Canada
| | - Malika Oubaha
- Department of Biological Sciences, Université du Québec à Montréal (UQAM), Montréal, QC H2L 2C4, Canada; (M.R.H.-K.); (T.S.)
- The Center of Excellence in Research on Orphan Diseases, Courtois Foundation (CERMO-FC), Montreal, QC H3G 1E8, Canada
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Ghouse F, Idrobo Zapata C, Kasam Shiva PK, Aguilar A, Siripragada R, Nair N, Vera E, Suresh A. Closing the Gap: Investigation of Various Approaches in the Management of Patent Ductus Arteriosus. Cureus 2023; 15:e45009. [PMID: 37829984 PMCID: PMC10565609 DOI: 10.7759/cureus.45009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
In preterm newborns with extremely low birth weights, patent ductus arteriosus (PDA), which is defined as a remnant connection between the aorta and pulmonary artery after 72 hours of birth, is frequently linked to substantial morbidity and mortality. If left untreated, a hemodynamically significant PDA (hsPDA) increases the risk for bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage among other morbidities, and can even lead to death. While instances of patent ductus arteriosus (PDA) resolving on their own are frequent, the primary approach for managing PDA closure in premature infants involves pharmacological interventions, commonly utilizing indomethacin, ibuprofen, or paracetamol. However, with these pharmacological treatment options, there is an increased risk of renal toxicity, gastrointestinal bleeding, and reopening of PDA among other complications. If pharmacological interventions are not successful or contraindicated, PDA can be closed via transcatheter closure or surgical ligation. As with any medically invasive procedure, it is not without risks and can lead to long-term complications. This review explores the different management options and the benefits and outcomes of conservative management vs. active management in order to get one step closer to standardizing the treatment for PDA. With so much controversy surrounding the best management option, there is a lack of evidence to support one treatment method superior to the other in reducing overall mortality, and this needs to be explored further.
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Affiliation(s)
- Farhana Ghouse
- Medicine, Saint James School of Medicine, Park Ridge, USA
| | | | - Pavan K Kasam Shiva
- Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Anne Aguilar
- Internal Medicine, Universidad Popular Autónoma del Estado de Puebla, Puebla, MEX
| | - Rithika Siripragada
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Nandini Nair
- Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, IND
| | - Emiliano Vera
- Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, MEX
| | - Amrita Suresh
- Internal Medicine, Kasturba Medical College, Mangalore, IND
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Zong H, Huang Y, Huang Z, Zhao J, Lin B, Fu Y, Lin Y, Yu Y, Sun H, Yang C. Lung ultrasound score predicts patent ductus arteriosus ligation among neonates ≤25 weeks. Pediatr Pulmonol 2023; 58:2487-2494. [PMID: 37265422 DOI: 10.1002/ppul.26531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This prospective study aimed to investigate whether lung ultrasound score (LUSs) can predict the patent ductus arteriosus (PDA) ligation. METHODS Preterm infants ≤25 weeks of gestational age (GA) were enrolled. A lung ultrasound was performed on the 14th day of life. Each lung zone was given a score between 0 and 4. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of the LUSs for predicting ligation. RESULTS A total of 81 infants were eligible with a median GA and birth weight (BW) of 25 weeks (24.1-25.2) and 710 g (645-770), respectively. The median time from birth to ligation was 35 days (32-51). Those who underwent ligation had a longer time of mechanical ventilation (34 [26-39] vs. 19 [12-30], p < 0.001), shorter time of noninvasive respiratory support (39 [32-51] vs. 50 [41.5-57], p < 0.01), higher incidence of the bronchopulmonary dysplasia (BPD) (p < 0.01), and severe BPD (p < 0.001). The LUSs had an area under the ROC of 0.96 (95% confidence interval: 0.93-0.99) for the prediction of ligation. A LUSs cutoff of 36 has a sensitivity and specificity of 96% and 86% and positive and negative predictive values of 82% and 98%, respectively. CONCLUSIONS LUSs at an early stage of life can predict PDA ligation in extremely preterm infants. It would be helpful to reduce morbidity by reducing the duration and magnitude of respiratory support.
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Affiliation(s)
- Haifeng Zong
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yichu Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Zhifeng Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jie Zhao
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yongping Fu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanqing Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanliang Yu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Hongyan Sun
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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Yilmaz A, Ozer Y, Kaya N, Cakir AD, Culpan HC, Perk Y, Vural M, Evliyaoglu O. Clinical indicators that influence a clinician's decision to start L-thyroxine treatment in prematurity with transient hypothyroxinemia. Ital J Pediatr 2023; 49:105. [PMID: 37644575 PMCID: PMC10466863 DOI: 10.1186/s13052-023-01516-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Transient hypothyroxinemia of prematurity (THOP) is defined as a low level of circulating thyroxine (T4), despite low or normal thyroid-stimulating hormone (TSH) levels. AIMS We aimed to evaluate the incidence of THOP, the clinical and laboratory findings of preterm infants with this condition and the levothyroxine (L-T4) treatment. METHODS Preterm infants (n = 181) delivered at 24-34 weeks of gestation were evaluated by their thyroid function tests that were performed between the 10th and 20th days of postnatal life and interpreted according to the gestational age (GA) references. Clinical and laboratory characteristics of the patients with THOP and normal thyroid function tests were compared. Patients with THOP and treated with L-T4 were compared with the ones who were not regarding laboratory, and clinical characteristics. RESULTS Incidence of hypothyroxinemia of prematurity was 45.8% (n = 83). Euthyroidism, primary hypothyroidism, and subclinical hypothyroidism were diagnosed in 47.5% (n = 86), 5% (n = 9) and 1.7% (n = 3) of the patients, respectively. Mean birth weight (BW) and GA were significantly lower in the hypothyroxinemia group than in the euthyroid group (p < 0.001). L-T4 was started in 43% (n = 36) of the patients with THOP. Treatment initiation rate was 44.4% (n = 16) in 24-27 wk, 41.6% (n = 15) in 28-30 wk, and 13.8% (n = 5) in 31-34 wk. As the GA increased, the incidence of THOP and the rate of treatment initiation decreased (p < 0.001). The lowest free thyroxine (FT4) cut-off value was 0.72 ng/dl in the treated group. In addition, incidences of vancomycin + amikacin, caffeine, dopamine treatments, RDS, IVH, BPD, central catheter, FFP transfusion, and ventilator support were higher in the treated group (P < 0.05). CONCLUSION This study revealed that prevalence of THOP increased as the GA and BW decreased. As the GA decreased, THOP patients requiring L-T4 treatment increased. Additionally, association with comorbid diseases increased the requirement of treatment.
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Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey.
| | - Yavuz Ozer
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Nesrin Kaya
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Aydilek Dagdeviren Cakir
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Hazal Cansu Culpan
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
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Lembo C, El-Khuffash A, Fusch C, Iacobelli S, Lapillonne A. Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications. Pediatr Res 2023:10.1038/s41390-023-02754-4. [PMID: 37563451 DOI: 10.1038/s41390-023-02754-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.
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Affiliation(s)
- Chiara Lembo
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Afif El-Khuffash
- Department of Pediatrics (School of Medicine), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christoph Fusch
- Neonatology, Department of Pediatrics, General Hospital, Paracelsus Medical School, Nuernberg, Germany
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Silvia Iacobelli
- Réanimation Néonatale et Pédiatrique, CHU La Réunion, Saint-Pierre, France
| | - Alexandre Lapillonne
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France.
- EHU 7328 PACT, Paris Cite University, Paris, France.
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Murphy C, Baskind S, Aladangady N, Banerjee J. Measuring gut perfusion and blood flow in neonates using ultrasound Doppler of the superior mesenteric artery: a narrative review. Front Pediatr 2023; 11:1154611. [PMID: 37601136 PMCID: PMC10433905 DOI: 10.3389/fped.2023.1154611] [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: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 08/22/2023] Open
Abstract
The gut is a relatively silent organ in utero but takes on a major role after birth for the absorption and digestion of feed for adequate nutrition and growth. The neonatal circulation undergoes a transition period after birth, and gut perfusion increases rapidly to satisfy the oxygen demand and consumption. If this process is compromised at any stage, preterm and fetal growth restricted infants are at particular risk of gut tissue injury secondary to hypoxia, leading to necrotizing enterocolitis. Feeding can also be a challenge in these high-risk groups due to gut dysmotility. Superior mesenteric artery (SMA) Doppler is a safe, bedside investigation that could rapidly aid clinicians with feeding strategies and in monitoring high-risk infants. This article aims to establish normal patterns of gut blood flow velocity in neonates using SMA Doppler and reviews how it might be used clinically in pathologic states.
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Affiliation(s)
- C. Murphy
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Queen Mary University of London, London, United Kingdom
| | - S. Baskind
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - N. Aladangady
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Queen Mary University of London, London, United Kingdom
| | - J. Banerjee
- Neonatal Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Imperial College London, London, United Kingdom
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Rogel-Ayala DG, Muñoz-Medina JE, Vicente-Juárez VD, Grether-González P, Morales-Barquet DA, Martínez-García ADJ, Echaniz-Aviles MOL, Sevilla-Montoya R, Martínez-Juárez A, Artega-Vázquez J, Angeles-Martínez J, Vargas-Alarcón G, Hidalgo-Bravo A, Monroy-Muñoz IE. Association of the EPAS1 rs7557402 Polymorphism with Hemodynamically Significant Patent Ductus Arteriosus Closure Failure in Premature Newborns under Pharmacological Treatment with Ibuprofen. Diagnostics (Basel) 2023; 13:2558. [PMID: 37568921 PMCID: PMC10417126 DOI: 10.3390/diagnostics13152558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Patent ductus arteriosus (PDA) is frequent in preterm newborns, and its incidence is inversely associated with the degree of prematurity. The first choice of pharmacological treatment is ibuprofen. Several genes, including EPAS1, have been proposed as probable markers associated with a genetic predisposition for the development of PDA in preterm infants. EPAS 1 NG_016000.1:g.84131C>G or rs7557402 has been reported to be probably benign and associated with familial erythrocytosis by the Illumina Clinical Services Laboratory. Other variants of EPAS1 have been previously reported to be benign for familial erythrocytosis because they decrease gene function and are positive for familial erythrocytosis because the overexpression of EPAS1 is a key factor in uncontrolled erythrocyte proliferation. However, this could be inconvenient for ductal closure, since for this process to occur, cell proliferation, migration, and differentiation should take place, and a decrease in EPAS1 gene activity would negatively affect these processes. Single-nucleotide polymorphisms (SNPs) in EPAS1 and TFAP2B genes were searched with high-resolution melting and Sanger sequencing in blood samples of preterm infants with hemodynamically significant PDA treated with ibuprofen at the National Institute of Perinatology. The variant rs7557402, present in the EPAS1 gene eighth intron, was associated with a decreased response to treatment (p = 0.007, OR = 3.53). The SNP rs7557402 was associated with an increased risk of pharmacological treatment failure. A probable mechanism involved could be the decreased activity of the product of the EPAS1 gene.
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Affiliation(s)
- Diana G. Rogel-Ayala
- Reproductive and Perinatal Health Research Department, National Institute of Perinatology, Mexico City 11000, Mexico; (D.G.R.-A.)
| | - José Esteban Muñoz-Medina
- Quality of Supplies and Specialized Laboratories Coordination, Mexican Social Security Institute, Mexico City 37320, Mexico
| | - Valeria Dejanira Vicente-Juárez
- Reproductive and Perinatal Health Research Department, National Institute of Perinatology, Mexico City 11000, Mexico; (D.G.R.-A.)
| | | | | | | | | | - Rosalba Sevilla-Montoya
- Reproductive and Perinatal Health Research Department, National Institute of Perinatology, Mexico City 11000, Mexico; (D.G.R.-A.)
| | | | - Jazmin Artega-Vázquez
- Department of Genetics, National Institute of Medical Science and Nutrition, Mexico City 14080, Mexico
| | - Javier Angeles-Martínez
- Specialized Laboratories Division, Mexican Social Security Institute, Mexico City 06700, Mexico
| | - Gilberto Vargas-Alarcón
- Department of Molecular Biology, National Institute of Cardiology, Mexico City 14080, Mexico
| | - Alberto Hidalgo-Bravo
- Genomics Medicine Department, National Institute of Rehabilitation, Mexico City 14610, Mexico
| | - Irma Eloisa Monroy-Muñoz
- Reproductive and Perinatal Health Research Department, National Institute of Perinatology, Mexico City 11000, Mexico; (D.G.R.-A.)
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Shen X, Patel N, Zhu W, Chen X, Lu K, Cheng R, Mo X. A nomogram for predicting the risk of Bronchopulmonary dysplasia in premature infants. Heliyon 2023; 9:e18964. [PMID: 37609396 PMCID: PMC10440517 DOI: 10.1016/j.heliyon.2023.e18964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is a prevalent and critical complication among premature infants, with potentially long-lasting adverse effetcs. The present study aimed to establish a nomogram model to predict the risk of BPD in premature infants born at <32 weeks gestational age. Methods A retrospective single-center study was conducted on premature infants admitted to the neonatal intensive care unit (NICU) of the Children's Hospital of Nanjing Medical University from January 2018 to December 2020. Data were collected from clinical medical records, including the perinatal data and the critical information after birth. Clinical parameters and features were analyzed using univariate and multivariate logistic regression. A nomogram based on clinical data was established and validated using bootstrapping samples. The specificity and sensitivity of the nomogram were estimated using the receiver operating characteristic (ROC) based area under the curve (AUC). Results A total of 542 premature babies were included, and 152 infants (28.04%) were diagnosed with BPD. Birth weight, cesarean delivery, invasive/non-invasive ventilation at day 7 and 14 were identified as significant factors (p < 0.05) using univariate and the multivariate logistic regression analysis, and were entered into a nomogram. The calibration curve for BPD probability demonstrated a favorable concurrence between actual probability and predicted ability of the BPD nomogram. The nomogram showed potential differentiation, with an AUC of 0.925, 89.90% sensitivity, 76.71% specificity, and 86.35% accuracy. Conclusion The nomogram developed in this study provides a straightforward tool to predict the probability of BPD and assist clinicians in optimizing treatment regimens for premature infants born at <32 weeks gestational age. This study highlights the importance of identifying and monitoring significant clinical factors associated with BPD in premature infants to improve clinical outcomes.
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Affiliation(s)
- Xian Shen
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Nishant Patel
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Wen Zhu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xu Chen
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Keyu Lu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
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Kakatsaki I, Papanikolaou S, Roumeliotaki T, Anagnostatou NH, Lygerou I, Hatzidaki E. The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors. Nutrients 2023; 15:3290. [PMID: 37571226 PMCID: PMC10420820 DOI: 10.3390/nu15153290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Monitoring the growth of neonates in the Neonatal Intensive Care Unit (NICU) using growth charts constitutes an essential part of preterm infant care. Preterm infants are at increased risk for extrauterine growth restriction (EUGR) due to increased energy needs and clinical complications. This retrospective study compares the prevalence of small for gestational age (SGA) at birth and EUGR at discharge in extremely and very preterm neonates hospitalized in the NICU of a tertiary hospital in Greece, using different growth curves, and it examines the associated nutritional and clinical factors. Fenton2013 and INTERGROWTH-21st growth curves were used to calculate z-scores of birth weight (BW) and weight, length, and head circumference at discharge. The study includes 462 newborns with a mean BW of 1341.5 g and mean GA of 29.6 weeks. At birth, 6.3% of neonates were classified as SGA based on Fenton2013 curves compared to 9.3% with INTERGROWTH-21st growth curves. At discharge, 45.9% of neonates were characterized as having EUGR based on the Fenton2013 weight curves and 29.2% were characterized based οn INTERGROWTH-21st curves. Nutritional factors such as the day of initiation, attainment of full enteral feeding, and the duration of parenteral nutrition were associated with EUGR by both curves. The prevalence of SGA and EUGR neonates differs between the two growth references. This shows that further evaluation of these charts is needed to determine the most appropriate way to monitor infant growth.
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Affiliation(s)
- Ioanna Kakatsaki
- Neonatal Intensive Care Unit, Department of Neonatology, University General Hospital of Heraklion, 71500 Crete, Greece; (I.K.); (S.P.); (N.H.A.); (I.L.)
| | - Styliani Papanikolaou
- Neonatal Intensive Care Unit, Department of Neonatology, University General Hospital of Heraklion, 71500 Crete, Greece; (I.K.); (S.P.); (N.H.A.); (I.L.)
| | - Theano Roumeliotaki
- Clinic of Preventive Medicine and Nutrition, Division of Social Medicine, School of Medicine, University of Crete, 70013 Crete, Greece;
| | - Nicolina Hilda Anagnostatou
- Neonatal Intensive Care Unit, Department of Neonatology, University General Hospital of Heraklion, 71500 Crete, Greece; (I.K.); (S.P.); (N.H.A.); (I.L.)
- Neonatology, School of Medicine, University of Crete, 70013 Crete, Greece
| | - Ioanna Lygerou
- Neonatal Intensive Care Unit, Department of Neonatology, University General Hospital of Heraklion, 71500 Crete, Greece; (I.K.); (S.P.); (N.H.A.); (I.L.)
| | - Eleftheria Hatzidaki
- Neonatal Intensive Care Unit, Department of Neonatology, University General Hospital of Heraklion, 71500 Crete, Greece; (I.K.); (S.P.); (N.H.A.); (I.L.)
- Neonatology, School of Medicine, University of Crete, 70013 Crete, Greece
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Zong H, Huang Z, Lin B, Zhao J, Fu Y, Yu Y, Sun H, Yang C. The Predictive Value of Lung Ultrasound Score on Hemodynamically Significant Patent Ductus Arteriosus among Neonates ≤25 Weeks. Diagnostics (Basel) 2023; 13:2263. [PMID: 37443657 DOI: 10.3390/diagnostics13132263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Lung ultrasound (LU) is increasingly used to diagnose and monitor neonatal pulmonary disorders; however, its role in hemodynamically significant patent ductus arteriosus (hsPDA) has not been elucidated. This prospective study investigated the predictive value of the LU score (LUS) for hsPDA in preterm infants with gestational age (GA) ≤ 25 weeks. Preterm infants with GA ≤ 25 weeks were enrolled in this study. LU was conducted on the fourth day of life (DOL). Six lung regions in every lung were scanned, with each region rated as 0-4 points. The performance of the LUS in predicting hsPDA among infants aged ≤25 weeks was analyzed by plotting the receiver operating characteristic (ROC) curve. A total of 81 infants were included in this study. GA, birth weight (BW), gender, Apgar score, delivery mode, antenatal steroids, meconium-stained amniotic fluid, premature rapture of membrane, and early-onset sepsis were not significantly different, but infants in the hsPDA group had increased LUS (38.2 ± 2.8 vs. 30.3 ± 4.3, p < 0.001) compared with non-hsPDA group. The area under the ROC curve (AUC) value of the LUS on the fourth DOL was 0.94 (95% CI: 0.93-0.99) in predicting hsPDA. The LUS threshold at 33 achieved 89% sensitivity and 83% specificity, with the positive and negative predictive values (PPV and NPV) being 87 and 86%, respectively. The LUS can predict hsPDA in extremely preterm infants at an early stage.
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Affiliation(s)
- Haifeng Zong
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Zhifeng Huang
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Bingchun Lin
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Jie Zhao
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Yongping Fu
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Yanliang Yu
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Hongyan Sun
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Chuanzhong Yang
- Department of Neonatology and Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
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Xiao D, Jin Y, Zhang M, Di X, Fu L, Jiang C, Lai Z, Ge Y, Ji S, Zhang Y, Zheng L, Wang Z, Gong F. Chiral pharmacokinetics of ibuprofen enantiomers in Chinese preterm neonates with patent ductus arteriosus using a validated UHPLC-MS/MS method. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1227:123765. [PMID: 37454407 DOI: 10.1016/j.jchromb.2023.123765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023]
Abstract
Persistent patent ductus arteriosus (PDA) is generally observed in preterm neonates. Oral ibuprofen is the standard treatment for closing PDA in China. To investigate the chiral pharmacokinetics of ibuprofen enantiomers in Chinese premature infants with PDA, a simple, fast, and sensitive analytical enantioselective technology was developed with ultra-performance liquid chromatography (UPLC) - tandem mass spectrometry (MS/MS). Chromatographic separation of (R)-ibuprofen and (S)-ibuprofen was accomplished on a Lux® 3 µm Cellulose-3 (150 mm × 2.0 mm, 3 μm) at a flow rate of 0.2 mL/min within 6 min. UPLC separation was achieved by isocratic elution with a mobile phase consisting of formic acid:water (75:1000000, v/v) and acetonitrile:methanol (1:1, v/v). Only 50 µL of plasma samples were pre-treated with acetonitrile precipitation. Ibuprofen-d3 was used as an internal standard. The standard curves of both enantiomers were linear over a concentration range of 0.0500 μg/mL to 50.00 μg/mL. The method has been validated for selectivity, carryover effect, lower limit of quantification, precision, accuracy, matrix effect, extraction recovery, dilution integrity, and stability based on the existing guidelines of the National Medical Products Administration, the United States Food and Drug Administration, and the European Medicines Agency. This method has been successfully applied to investigate the pharmacokinetics of ibuprofen enantiomers in 9 preterm infants with PDA. Our results showed that a high chiral inversion ratio of (R)- to (S)-ibuprofen exists in Chinese preterm neonates. Further studies should be conducted to monitor drug concentration following oral administration of ibuprofen and to consider the effect of individual variations and ethnic differences in metabolizing enantiomers of ibuprofen in premature neonates with PDA.
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Affiliation(s)
- Dan Xiao
- Department of Pediatrics, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China; Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Ying Jin
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Mengyu Zhang
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Xiangjie Di
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Lisha Fu
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Changke Jiang
- Department of Neonates, Woman and Children Hospital of Yongchuan, Chongqing 402160, China
| | - Zhuoli Lai
- Department of Neonates, Children Hospital of Yongchuan, Chongqing 402160, China
| | - Yating Ge
- Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Shanmian Ji
- Department of Pharmacy, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Yuming Zhang
- West China Medical School, Sichuan University, Chengdu 610041, China
| | - Li Zheng
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China
| | - Zhenlei Wang
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University. Chengdu 610041, China; Clinical Trial Center, West China Hospital, Sichuan University. Chengdu 610041, China.
| | - Fang Gong
- Department of Pediatrics, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China.
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Mitra S, de Boode WP, Weisz DE, Shah PS. Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev 2023; 4:CD013588. [PMID: 37039501 PMCID: PMC10091483 DOI: 10.1002/14651858.cd013588.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in preterm infants. Several non-pharmacological, pharmacological, and surgical approaches have been explored to prevent or treat a PDA. OBJECTIVES To summarise Cochrane Neonatal evidence on interventions (pharmacological or surgical) for the prevention of PDA and related complications, and interventions for the management of asymptomatic and symptomatic PDA in preterm infants. METHODS We searched the Cochrane Database of Systematic Reviews on 20 October 2022 for ongoing and published Cochrane Reviews on the prevention and treatment of PDA in preterm (< 37 weeks' gestation) or low birthweight (< 2500 g) infants. We included all published Cochrane Reviews assessing the following categories of interventions: pharmacological therapy using prostaglandin inhibitor drugs (indomethacin, ibuprofen, and acetaminophen), adjunctive pharmacological interventions, invasive PDA closure procedures, and non-pharmacological interventions. Two overview authors independently checked the eligibility of the reviews retrieved by the search, and extracted data from the included reviews using a predefined data extraction form. Any disagreements were resolved by discussion with a third overview author. Two overview authors independently assessed the methodological quality of the included reviews using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) tool. We reported the GRADE certainty of evidence as assessed by the respective review authors using summary of findings tables. MAIN RESULTS We included 16 Cochrane Reviews, corresponding to 138 randomised clinical trials (RCT) and 11,856 preterm infants, on the prevention and treatment of PDA in preterm infants. One of the 16 reviews had no included studies, and therefore, did not contribute to the results. Six reviews reported on prophylactic interventions for the prevention of PDA and included pharmacological prophylaxis with prostaglandin inhibitor drugs, prophylactic surgical PDA ligation, and non-pharmacologic interventions (chest shielding during phototherapy and restriction of fluid intake); one review reported on the use of indomethacin for the management of asymptomatic PDA; nine reviews reported on interventions for the management of symptomatic PDA, and included pharmacotherapy with prostaglandin inhibitor drugs in various routes and dosages, surgical PDA ligation, and adjunct therapies (use of furosemide and dopamine in conjunction with indomethacin). The quality of reviews varied. Two reviews were assessed to be high quality, seven reviews were of moderate quality, five of low quality, while two reviews were deemed to be of critically low quality. For prevention of PDA, prophylactic indomethacin reduces severe intraventricular haemorrhage (IVH; relative risk (RR) 0.66, 95% confidence interval (CI) 0.53 to 0.82; 14 RCTs, 2588 infants), and the need for invasive PDA closure (RR 0.51, 95% CI 0.37 to 0.71; 8 RCTs, 1791 infants), but it does not appear to affect the composite outcome of death or moderate/severe neurodevelopmental disability (RR 1.02, 95% CI 0.90 to 1.15; 3 RCTs, 1491 infants). Prophylactic ibuprofen probably marginally reduces severe IVH (RR 0.67, 95% CI 0.45 to 1.00; 7 RCTs, 925 infants; moderate-certainty evidence), and the need for invasive PDA closure (RR 0.46, 95% CI 0.22 to 0.96; 7 RCTs, 925 infants; moderate-certainty evidence). The evidence is very uncertain on the effect of prophylactic acetaminophen on severe IVH (RR 1.09, 95% CI 0.07 to 16.39; 1 RCT, 48 infants). Necrotising enterocolitis (NEC) was lower with both prophylactic surgical ligation (RR 0.25, 95% CI 0.08 to 0.83; 1 RCT, 84 infants), and fluid restriction (RR 0.43, 95% CI 0.21 to 0.87; 4 RCTs, 526 infants). For treatment of asymptomatic PDA, indomethacin appears to reduce the development of symptomatic PDA post-treatment (RR 0.36, 95% CI 0.19 to 0.68; 3 RCTs, 97 infants; quality of source review: critically low). For treatment of symptomatic PDA, all available prostaglandin inhibitor drugs appear to be more effective in closing a PDA than placebo or no treatment (indomethacin: RR 0.30, 95% CI 0.23 to 0.38; 10 RCTs, 654 infants; high-certainty evidence; ibuprofen: RR 0.62, 95% CI 0.44 to 0.86; 2 RCTs, 206 infants; moderate-certainty evidence; early administration of acetaminophen: RR 0.35, 95% CI 0.23 to 0.53; 2 RCTs, 127 infants; low-certainty evidence). Oral ibuprofen appears to be more effective in PDA closure than intravenous (IV) ibuprofen (RR 0.38, 95% CI 0.26 to 0.56; 5 RCTs, 406 infants; moderate-certainty evidence). High-dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (RR 0.37, 95% CI 0.22 to 0.61; 3 RCTs, 190 infants; moderate-certainty evidence). With respect to adverse outcomes, compared to indomethacin administration, NEC appears to be lower with ibuprofen (any route; RR 0.68, 95% CI 0.49 to 0.94; 18 RCTs, 1292 infants; moderate-certainty evidence), oral ibuprofen (RR 0.41, 95% CI 0.23 to 0.73; 7 RCTs, 249 infants; low-certainty evidence), and with acetaminophen (RR 0.42, 95% CI 0.19 to 0.96; 4 RCTs, 384 infants; low-certainty evidence). However, NEC appears to be increased with a prolonged course of indomethacin versus a shorter course (RR 1.87, 95% CI 1.07 to 3.27; 4 RCTs, 310 infants). AUTHORS' CONCLUSIONS This overview summarised the evidence from 16 Cochrane Reviews of RCTs regarding the effects of interventions for the prevention and treatment of PDA in preterm infants. Prophylactic indomethacin reduces severe IVH, but does not appear to affect the composite outcome of death or moderate/severe neurodevelopmental disability. Prophylactic ibuprofen probably marginally reduces severe IVH (moderate-certainty evidence), while the evidence is very uncertain on the effect of prophylactic acetaminophen on severe IVH. All available prostaglandin inhibitor drugs appear to be effective in symptomatic PDA closure compared to no treatment (high-certainty evidence for indomethacin; moderate-certainty evidence for ibuprofen; low-certainty evidence for early administration of acetaminophen). Oral ibuprofen appears to be more effective in PDA closure than IV ibuprofen (moderate-certainty evidence). High dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (moderate-certainty evidence). There are currently two ongoing reviews, one on fluid restriction for symptomatic PDA, and the other on invasive management of PDA in preterm infants.
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Affiliation(s)
- Souvik Mitra
- Departments of Pediatrics, Community Health & Epidemiology, Dalhousie University & IWK Health Centre, Halifax, Canada
| | - Willem P de Boode
- Department of Perinatology, Division of Neonatology, Radboud UMC Amalia Children's Hospital, Nijmegen, Netherlands
| | - Dany E Weisz
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Prakeshkumar S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto Mount Sinai Hospital, Toronto, Canada
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Giesinger RE, Hobson AA, Bischoff AR, Klein JM, McNamara PJ. Impact of early screening echocardiography and targeted PDA treatment on neonatal outcomes in "22-23" week and "24-26" infants. Semin Perinatol 2023; 47:151721. [PMID: 36882362 DOI: 10.1016/j.semperi.2023.151721] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The hemodynamically significant patent ductus arteriosus (hsPDA) is a controversial topic in neonatology, particularly among neonates at the earliest gestational ages of 22+0-23+6 weeks. There is little, to no data on the natural history or impact of the PDA in extremely preterm babies. In addition, these high-risk patients have typically been excluded from randomized clinical trials of PDA treatment. In this work, we present the impact of early hemodynamic screening (HS) of a cohort of patients born 22+0-23+6 weeks gestation who either were diagnosed with hsPDA or died in the first postnatal week as compared to a historical control (HC) cohort. We also report a comparator population of 24+0-26+6 weeks gestation. All patients in the HS epoch were evaluated between 12-18h postnatal age and treated based on disease physiology whereas the HC patients underwent echocardiography at the discretion of the clinical team. We demonstrate a two-fold reduction in the composite primary outcome of death prior to 36 weeks or severe BPD and report a lower incidence of severe intraventricular hemorrhage (n=5, 7% vs n=27, 27%), necrotizing enterocolitis (n=1, 1% vs n=11, 11%) and first-week vasopressor use (n=7, 11% vs n=40, 39%) in the HS cohort. HS was also associated with an increase in survival free of severe morbidity from the already high rate of 50% to 73% among neonates <24 weeks gestation. We present a biophysiological rationale behind the potential modulator role of hsPDA on these outcomes and review the physiology relevant to neonates born at these extremely preterm gestations. These data highlight the need for further interrogation of the biological impact of hsPDA and impact of early echocardiography directed therapy in infants born less than 24 weeks gestation.
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Affiliation(s)
- R E Giesinger
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA
| | - A A Hobson
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA
| | - A R Bischoff
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA
| | - J M Klein
- University of Iowa, Department of Pediatrics, Iowa City, IA, USA
| | - P 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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50
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Sallmon H, Delaney CA. Platelets and ductus arteriosus closure in neonates. Semin Perinatol 2023; 47:151719. [PMID: 36925318 DOI: 10.1016/j.semperi.2023.151719] [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] [Indexed: 03/18/2023]
Abstract
Platelet plug formation is critically involved in murine ductus arteriosus closure and thrombocytopenia in preterm infants seems to negatively affect spontaneous and pharmacologically induced ductal closure. Furthermore, platelet dysfunction may contribute to ductal patency, especially in extremely immature infants. Neonatal platelets likely have multifaceted roles during ductal closure, such as secretion of several signaling molecules and facilitation of specific cell-cell interactions. The only available randomized-controlled trial on platelet transfusions in preterm infants with patent ductus arteriosus demonstrated that a liberal transfusion regimen did not promote ductal closure, but was associated with an increased rate of intraventricular hemorrhage. Herein, we discuss the available mechanistic evidence on the role of platelets in ductus arteriosus closure and their potential clinical implications in preterm infants. We further briefly outline future research directions aimed at a better understanding of platelet-endothelial interactions in neonatal health and disease.
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Affiliation(s)
- Hannes Sallmon
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany; Division of Pediatric Cardiology, Graz Medical University, Graz, Austria.
| | - Cassidy A Delaney
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA
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