Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

Paediatrica Indonesiana ◽

10.14238/pi57.4.2017.198-204 ◽

2017 ◽

Vol 57 (4) ◽

pp. 198

Author(s):

Rizky Adriansyah ◽

Nikmah S. Idris ◽

Mulyadi M. Djer ◽

Sukman T. Putra ◽

Rinawati Rohsiswatmo

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Liver Toxicity ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Mean Velocity ◽

Diastolic Velocity ◽

Intravenous Paracetamol ◽

Patent Ductus

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001).Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.

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Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

Paediatrica Indonesiana ◽

10.14238/pi57.4.2017.1350 ◽

2017 ◽

Vol 57 (4) ◽

pp. 198

Author(s):

Rizky Adriansyah ◽

Nikmah S. Idris ◽

Mulyadi M. Djer ◽

Sukman T. Putra ◽

Rinawati Rohsiswatmo

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Liver Toxicity ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Mean Velocity ◽

Diastolic Velocity ◽

Intravenous Paracetamol ◽

Patent Ductus

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001).Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.

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