Hydrocortisone for refractory hypotension of very low birth weight infant with patent ductus arteriosus: a case report

2011 ◽  
Vol 26 (1) ◽  
pp. 134-135
Author(s):  
Hyun Young Lee ◽  
Sang Hun Kim ◽  
Ki Tae Jung ◽  
Keum young So
Keyword(s):  
Case Report ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Low Birth Weight Infant ◽  
Refractory Hypotension ◽  
Patent Ductus

Indomethacin Therapy for Large Patent Ductus Arteriosus in the Very Low Birth Weight Infant: Results and Complications

PEDIATRICS ◽  
1979 ◽  
Vol 64 (2) ◽  
pp. 154-159
Author(s):  
H. L. Halliday ◽  
T. Hirata ◽  
J. P. Brady
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Base Deficit ◽  
Low Birth Weight Infants ◽  
Low Birth Weight Infant ◽  
Surgical Ligation ◽  
Patent Ductus

Of 36 very low birth weight infants (<1,500 gm) with large patent ductus arteriosus, 24 (67%) showed satisfactory constriction or closure after indomethacin therapy (mean total dose 0.4 mg/kg). Twelve infants (33%) responded inadequately with seven infants requiring surgical ligation. Response was better in infants 8 to 14 days old compared to those more than 14 days old (89% vs 33%, P = .048) irrespective of birth weight or gestational age. Major complications were renal and unrelated to ductus response. Urine output fell significantly (3.65 to 1.63 ml/kg/hr, P < .001) and in 47% of infants serum creatinine increased ≥1.5 mg/dl. Creatinine was less likely to rise in infants more than 14 days old. Hyponatremia was found in 36% of infants. Serum potassium increased more frequently in infants more than 8 days old and was >6.0 mEq/liter in 25%. Indomethacin caused a reduction in PaCO2 (41 to 37 mm Hg, P < .01) and an increase in pH (7.32 to 7.36, P < .02) with no change in base deficit. These changes occurred even in the absence of clinical ductus closure. No other side effects of indomethacin therapy were noted. Three infants died but death was unrelated to indomethacin therapy. Overall survival was 92%, and nine infants (25%) developed mild bronchopulmonary dysplasia.

scholarly journals Role of Sequential Functional Echocardiography in Predicting Clinically Apparent Patent Ductus Arteriosus in Preterm Very Low Birth Weight Newborns-An Observational Study

2020 ◽  
Author(s):  
Anchala Bhardwaj ◽  
ARVIND SAILI ◽  
Dinesh Kumar Yadav ◽  
Ajay Kumar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Left Atrial ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Predictive Utility ◽  
Patent Ductus

Abstract Background The management of patent ductus arteriosus in preterm neonates continues to be a topic of discussion and controversy. Prolonged ductal patency in preterm neonates has been associated with significant short and long term morbidities and with increased mortality however, policy of routine treatment of all during neonatal period has failed to show significant improvement in long term outcome. Echocardiography has emerged as a promising modality to screen the newborns at risk of adverse effects of ductal shunting. This helps in identifying PDAs that require treatment to ultimately prevent unnecessary therapy or delay of necessary therapy. There are multitude of studies that have evaluated large number of echocardiographic markers for their predictive utility but only few have included all ductal markers together in a single study. The reported sensitivity (26-100%) and specificity (6-100%) of echocardiographic markers vary over a wide range. Thus, this study was planned with an aim to assess the predictive utility of all available ductal markers and their added advantage of having all over few ones in clinically apparent PDA in preterm VLBW newborns.Methods It was an observational prospective study conducted in tertiary care NICU at Lady Hardinge Medical College, Delhi. Fifty preterm very low birth weight (VLBW) newborns underwent four sequential Echo scans within first 72 hrs; first scan within 12 hours then at 24 hrs ,48 hrs and 72 hrs of age and were monitored clinically for the signs of PDA up to two weeks of life or discharge whichever comes later.Results The Ductal diameter, pulsatile ductal flow pattern, Left pulmonary artery (LPA) velocity, Left atrial to aortic width (La/Ao) ratio, Left atrial volume index (LAVI), Left ventricle to aortic width (Lv/Ao) ratio, E/A ratio and Left ventricular output/superior vena caval (LVO/SVC) flow ratio predicted clinically apparent PDA during first 72 hours of life.Conclusion This study provides insights into the predictive utility of other ductal echo markers along with the routinely measured conventional ones during first 72 hours of life in preterm VLBW newborns.

Low-Dose Indomethacin and Prevention of Intraventricular Hemorrhage: A Multicenter Randomized Trial

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 543-550
Author(s):  
Laura R. Ment ◽  
Richard A. Ehrenkranz ◽  
Charles C. Duncan ◽  
David T. Scott ◽  
Kenneth J.W. Taylor ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Intraventricular Hemorrhage ◽  
Low Dose ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Trend Test ◽  
Cranial Ultrasound ◽  
Patent Ductus

Objectives. Parenchymal involvement of intraventricular hemorrhage (IVH) is a major risk factor for neurodevelopmental handicap in very low birth weight neonates. Previous trials have suggested that indomethacin would lower the incidence and severity of IVH in very low birth weight neonates. Methods. We enrolled 431 neonates of 600- to 1250-g birth weight with no evidence for IVH at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that low-dose indomethacin (0.1 mg/kg intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would lower the incidence and severity of IVH. Serial cranial ultrasound examinations and echocardiographs were performed. Results. There were no differences in the birth weight, gestational age, sex, Apgar scores, and percent of neonates treated with surfactant between the indomethacin and placebo groups. Within the first 5 days, 25 (12%) indomethacin-treated and 40 (18%) placebo-treated neonates developed IVH (P = .03, trend test). Only one indomethacin-treated patient experienced grade 4 IVH compared with 10 placebo-treated neonates (P = .01). Sixteen indomethacin-treated neonates and 29 control neonates died (P = .08); there was a difference favoring indomethacin with respect to survival time (P = .06). Eighty-six percent of all neonates had a patent ductus arteriosus on the first postnatal day; indomethacin was associated with significant ductal closure by the fifth day of life (P < .001). There were no differences in adverse events attributed to indomethacin between the two treatment groups. Conclusions. Low-dose prophylactic indomethacin significantly lowers the incidence and severity of IVH, particularly the severe form (grade 4 IVH). In addition,indomethacin closes the patent ductus arteriosus and is not associated with significant adverse drug events in very low birth weight neonates.

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