Thrombocytopenia associated with transcatheter closure of giant patent ductus arteriosus

2020 ◽  
Vol 30 (12) ◽  
pp. 1896-1901
Author(s):  
Lei Liu ◽  
Peng Yue ◽  
Xiaolan Zheng ◽  
Hongyu Liao ◽  
Jiawen Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Confidence Interval ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Independent Predictive Factor ◽  
Associated Risk Factors ◽  
Patent Ductus

AbstractIntroduction:Thrombocytopenia occasionally occurs following the closure of some giant patent ductus arteriosus cases. Unfortunately, there is no associated research describing the associated risk factors for thrombocytopenia post-procedure.Methods:We reviewed all patients who received occluders with sizes ≥10/12 mm between January 2013 and June 2019. All the data and information on the characteristics of the patients and their follow-up were recorded. Univariate analysis, receiver operating characteristic curves, and linear regression were used to analyse the risk factors for thrombocytopenia and the predictors of hospitalisation stay.Results:Finally, 32 patients (17.5%) suffered from thrombocytopenia. Univariate analysis revealed the ratio between occluder disc size (mm) and body weight (kg) (1.71 ± 0.51 versus 1.35 ± 0.53) as an independent predictive factor for thrombocytopenia, and the area under the curve of the ratio of occluder size and body weight for predicting thrombocytopenia post-closure was 0.691 (95% confidence interval: 0.589–0.792, p = 0.001). The best cut-off value for the ratio of occluder size and weight was 1.5895, with a sensitivity and specificity of 68.8 and 66.9%, respectively. Each unit of the ratio of occluder size and body weight predicted an average hospitalisation stay of 2.856 days (95% confidence interval: 1.380–4.332). Treatment with medication did not reduce the hospitalisation stay or benefit platelet restoration.Conclusion:Once the ratio of occluder size and body weight is greater than 1.6, thrombocytopenia always exists. Every unit of the ratio of occluder size and body weight represents an additional 3 days of hospitalisation. Treatment does not reduce the duration of hospitalisation.

Differential Determinants of Patent Ductus Arteriosus Outcomes for Prematurity of Varying Birth Body Weight

2019 ◽  
Author(s):  
I-Chun Lin ◽  
Hsi-Yun Liu ◽  
Chih-Cheng Chen ◽  
Yun-Ju Lai ◽  
Eng-Yen Huang ◽  
...  
Keyword(s):  
Body Weight ◽  
Patent Ductus Arteriosus ◽  
Clinical Characteristics ◽  
Multinomial Logistic Regression ◽  
Ductus Arteriosus ◽  
Univariate Analysis ◽  
Neonatal Care ◽  
Medical Progress ◽  
Birth Body Weight ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA) remains critically encountered every day for pediatricians and neonatologists along with the medical progress in prematurity neonatal care. In this study, we aimed to stratify premature neonates by their initial postnatal 24-hour clinical characteristics and maternal and gestational histories to early predict the risk of PDA at unfavorable treatment responses. Methods A retrospective analysis was conducted on preterm newborns who were consecutively admitted to a pediatric-neonatal-intensive-care-unit from 2008 to 2013 except some exclusion criteria. Data relating to birth histories, maternal histories, and clinical data from the first 24 hour of life were collected and analyzed according to three types of PDA outcomes—non-treated, medically-responded, and surgically-ligated PDA. Univariate analysis was performed using Mann-Whitney U test and Chi-square test or Fisher’s exact test. Multivariate analysis was performed using multinomial logistic regression to determine the independent risk factors for the PDA outcome. Results This study involved 682 preterm infants, composed of 352 male and 330 female neonates with median gestational age of 31 (interquartile, IQR: 28–34) week and BBW of 1360 (IQR: 1085–1861) g. Inclusively, 83% of PDAs in prematurity did not need any medical or surgical treatment, 8.8% of PDA medically responded and 7.9% needed surgical ligation. All subjects were further sub-grouped according to birth body weight (BBW) owing to significant differences in clinical characteristics and the rate of surgically-ligated PDA between neonates with BBW less than 1500 g (as the very low birth weight, VLBW group) and those with BBW greater or equal to 1500 g (as the non-VLBW group). The VLBW group had a significantly higher percentage of surgically-ligated PDA. For the VLBW group, the amount of first 24-hour intravenous fluid per kilogram, surfactant use and gynecological disorder were independent factors in predicting PDA outcomes. For the non-VLBW group, placenta previa, parity, BBW and intrauterine growth retardation were independent factors. Conclusions Neonatal care should be meticulously personalized according to their BBW. The first 24-hour perinatal factors, maternal and gestational history plays differential importance on PDA treatment outcome based on BBW.

scholarly journals A Framework for AI-Assisted Detection of Patent Ductus Arteriosus from Neonatal Phonocardiogram

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 169
Author(s):  
Sergi Gómez-Quintana ◽  
Christoph E. Schwarz ◽  
Ihor Shelevytsky ◽  
Victoriya Shelevytska ◽  
Oksana Semenova ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Area Under The Curve ◽  
Clinical Decision ◽  
Heart Sounds ◽  
Decision Tree Classifier ◽  
Support Tool ◽  
Tree Classifier ◽  
Patent Ductus

The current diagnosis of Congenital Heart Disease (CHD) in neonates relies on echocardiography. Its limited availability requires alternative screening procedures to prioritise newborns awaiting ultrasound. The routine screening for CHD is performed using a multidimensional clinical examination including (but not limited to) auscultation and pulse oximetry. While auscultation might be subjective with some heart abnormalities not always audible it increases the ability to detect heart defects. This work aims at developing an objective clinical decision support tool based on machine learning (ML) to facilitate differentiation of sounds with signatures of Patent Ductus Arteriosus (PDA)/CHDs, in clinical settings. The heart sounds are pre-processed and segmented, followed by feature extraction. The features are fed into a boosted decision tree classifier to estimate the probability of PDA or CHDs. Several mechanisms to combine information from different auscultation points, as well as consecutive sound cycles, are presented. The system is evaluated on a large clinical dataset of heart sounds from 265 term and late-preterm newborns recorded within the first six days of life. The developed system reaches an area under the curve (AUC) of 78% at detecting CHD and 77% at detecting PDA. The obtained results for PDA detection compare favourably with the level of accuracy achieved by an experienced neonatologist when assessed on the same cohort.

High Dose Indomethacin for Patent Ductus Arteriosus Closure Increases Neonatal Morbidity

2019 ◽  
Author(s):  
Salome Waldvogel ◽  
Andrew Atkinson ◽  
Mélanie Wilbeaux ◽  
Mathias Nelle ◽  
Markus R. Berger ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Standard Dose ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Univariate Analysis ◽  
High Dose ◽  
Closure Rate ◽  
Patent Ductus

Abstract Objective Symptomatic patent ductus arteriosus (sPDA) is the most common heart abnormality in preterm infants. Optimal duration and dose of medical treatment is still unclear. We assessed undesired effects and closure rate of high-dose indomethacin (HDI) for pharmacological closure of sPDA. Study Design Retrospective single center analysis of 248 preterm infants born between January 2006 and December 2015 with a birth weight <2,000 g and sPDA which was treated with indomethacin. Patients were treated with either standard dose indomethacin (SDI; n = 196) or HDI (n = 52). Undesired effects and PDA closure were compared between patients treated with SDI and HDI. Results In univariate analysis, patients receiving HDI had a significant increase in gastrointestinal hemorrhage (32.7 vs.11.7%, p = 0.001), bronchopulmonary dysplasia (BPD) (77.8 vs. 55.1%, p = 0.003), and retinopathy of prematurity (13.5 vs. 2.6%, p = 0.004). Moreover, HDI patients needed longer mechanical ventilation (2.5 vs. 1.0 days, p = 0.01). Multivariate analyses indicated that necrotizing enterocolitis (17 vs. 7%, p = 0.01) and BPD (79 vs. 55%, p = 0.02) were more frequent in HDI patients. PDA closure rate was 79.0% with HDI versus 65.3% with SDI. Conclusion HDI used for PDA closure is associated with an increase in necrotizing enterocolitis and BPD. Risks of HDI should be balanced against other treatment options.

scholarly journals Blood pressure changes during the first 24 hours of life and the association with the persistence of a patent ductus arteriosus and occurrence of intraventricular haemorrhage

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260377
Author(s):  
Robert Boldt ◽  
Pauliina M. Mäkelä ◽  
Lotta Immeli ◽  
Reijo Sund ◽  
Markus Leskinen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Patent Ductus Arteriosus ◽  
Gestational Age ◽  
Odds Ratio ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Intraventricular Haemorrhage ◽  
Vlbw Infants ◽  
Patent Ductus

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children’s Hospital during 2005–2013. For each infant, we investigated 600 time-points of MAP recorded 4–24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + 1/7 weeks) consisted of infants whose mean MAP was lower at 18–24 hours than at 4–10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + 5/7 weeks) included infants with a higher mean MAP at 18–24 hours than at 4–10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18–24 hours than at 4–10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14–3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23–2.72; p = 0.003).

scholarly journals Risk factors for patent ductus arteriosus in preterm neonates

2014 ◽  
Vol 54 (3) ◽  
pp. 132 ◽  
Author(s):  
Novia Bernati ◽  
Ria Nova ◽  
Julniar M. Tasli ◽  
Theodorus Theodorus
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Prevalence Ratio ◽  
Hyaline Membrane Disease ◽  
Preterm Neonates ◽  
Antenatal Corticosteroids ◽  
Cross Sectional ◽  
Patent Ductus

Background The reported prevalences of patent ductus arteriosus(PDA) in preterm neonates vaty, and are currently unknown inPalembang. Birth weight, ges tational age, asphyxia, histoty ofantenatal steroid use, hyaline membrane disease (HMD), raceand ethnicity, are potential risk factors for PDA.Objective To determine the prevalence of PDA and its riskfactors in preterm neonates at Mohammad Hoesin Hospital,Palembang.Methods This cross-sectional study was conducted from October2011 to April 2012. Echocardiographic examinations wereperformed on 242 preterm neonates aged 15 hours to 7 days. Datawas taken from medical records and interviews, and analyzed byChi square and logistic regression analyses.Results Patent ductus arteriosus was found in 142 (58.7%)preterm neonates with a prevalence ratio of 1.43. Neonates withbirthweight ::;;2,000 grams tended to have 1.9 (95% CI 1.17 to3.32) rimes higher risk for PDA (P=0.01). Neonates ::;;JO weeksgestation were also at 1.9 rimes higher risk for PDA (P=0.16).Probabilities for PDA occurrence in neonates with asphyxia,without antenatal corticosteroids and HMD were 1.6 (95%CI 1.13 to 3.36) rimes, 1.3 (95%CI 0.73 to 2.50) times and 2.2(95%CI 1.29 to 3.72) rimes higher risk for PDA, respectively(P=0.22, 0.41, and 0.005, respectively).Conclusion Birth weight and HMD are statistically significantrisk factors of PDA, but the more significant one is HMD.

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