A Mystery of Patent Ductus Arteriosus and Serum Osmolality in Preterm Infants

Objective Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. Study Design Our study was conducted between January 2013 and December 2017. Premature infants with birth weight <1,500 g and gestational age <32 weeks were included in the study. Serum osmolality was compared between infants with hemodynamically significant PDA (hsPDA) and non-hsPDA. Results During the study period, 799 patients were evaluated. Mean serum osmolality levels were higher in the “hsPDA” group (297 ± 10.9 vs. 292 ± 8.3 mOsm/L) (p = 0.001). The area under the curve for osmolality was 0.582 (p = 0.0006, 95% confidence interval: 0.541–0.622) at the time of diagnosis for predicting hsPDA, with a cutoff value for osmolality of 300 mOsm/L. Conclusion Serum osmolality may be recognized as an important contributing factor for ductal patency especially among extremely preterm infants who are most likely to have hsPDA in the early days of life.

Download Full-text

Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2020.605134 ◽

2020 ◽

Vol 8 ◽

Author(s):

Se In Sung ◽

Yun Sil Chang ◽

So Yoon Ahn ◽

Heui Seung Jo ◽

Misun Yang ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Ductus Arteriosus ◽

Intervention Approach ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surgical Treatments ◽

Minimal Evidence ◽

Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

Download Full-text

Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants

Journal of Perinatology ◽

10.1038/s41372-019-0496-5 ◽

2019 ◽

Vol 39 (12) ◽

pp. 1648-1655 ◽

Cited By ~ 6

Author(s):

Hussnain Mirza ◽

Jorge Garcia ◽

Genevieve McKinley ◽

Laura Hubbard ◽

Wendla Sensing ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Ductus Arteriosus ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

Download Full-text

Timing of Pharmacological Treatment for Patent Ductus Arteriosus and Risk of Secondary Surgery, Death or Bronchopulmonary Dysplasia: A Population-Based Cohort Study of Extremely Preterm Infants

Neonatology ◽

10.1159/000367887 ◽

2014 ◽

Vol 107 (2) ◽

pp. 87-92 ◽

Cited By ~ 19

Author(s):

Anna Gudmundsdottir ◽

Stefan Johansson ◽

Stellan Håkansson ◽

Mikael Norman ◽

Karin Källen ◽

...

Keyword(s):

Cohort Study ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Pharmacological Treatment ◽

Ductus Arteriosus ◽

Population Based ◽

Secondary Surgery ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

Download Full-text

Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants

Acta Paediatrica ◽

10.1111/apa.14752 ◽

2019 ◽

Vol 108 (9) ◽

pp. 1590-1596

Author(s):

Karl Wilhelm Olsson ◽

Anders Jonzon ◽

Richard Sindelar

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

Download Full-text

Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

Journal of Clinical Medicine ◽

10.3390/jcm9030699 ◽

2020 ◽

Vol 9 (3) ◽

pp. 699 ◽

Cited By ~ 2

Author(s):

Eun Seo ◽

Se Sung ◽

So Ahn ◽

Yun Chang ◽

Won Park

Keyword(s):

Acute Kidney Injury ◽

Patent Ductus Arteriosus ◽

Serum Creatinine ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Kidney Injury ◽

Adverse Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

Changes in kidney function in extremely preterm infants (EPT) with conservatively managed hemodynamically significant (HS) patent ductus arteriosus (PDA) are not known well. We aimed to present the postnatal course in serum creatinine levels (sCr), prevalence of acute kidney injury (AKI), then relevance between AKI and adverse outcomes in EPT with conservatively managed HS PDA. By review of medical records, we analyzed the postnatal course of sCr and prevalence of stage 3 AKI defined by the modified Kidney Disease Improving Global Outcome (KDIGO) in EPT at gestational age of 23 to 26 weeks with conservatively treated HS PDA. We investigated if the presence and/or prolonged duration of stage 3 AKI elevated the risk of adverse outcomes. The results showed that, neither factor was associated with adverse outcomes. While the average PDA closure date was at postnatal day (P) 41 and 53, sCr peaked at P 10 and 14 and the cumulative prevalence of stage 3 AKI was 57% and 72% in the EPT of 25–26 and 23–24 weeks’ gestation, respectively. The high prevalence of stage 3 AKI without adverse outcomes in EPT with conservatively managed HS PDA suggests that it might reflect renal immaturity rather than pathologic conditions.

Download Full-text