scholarly journals Prostaglandin E2 in a preterm infant with coarctation of the aorta

2019 ◽  
Vol 12 (9) ◽  
pp. e230910 ◽  
Author(s):  
Bernadette Khodaghalian ◽  
Nimish V Subhedar ◽  
Ashish Chikermane
Keyword(s):  
Surgical Intervention ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Preterm Neonates ◽  
Term Therapy ◽  
Prostaglandin E ◽  
Aortic Blood Flow ◽  
Aortic Constriction ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Prostaglandins are widely used in aortic coarctation to maintain ductal patency and preserve systemic perfusion until surgical intervention can be performed. Although the short-term use of prostaglandins to ameliorate aortic narrowing in neonates with a closed ductus has been reported, it has not been described as a longer term therapy in extremely preterm neonates. A 27-week gestation baby weighing 560 g presented at 40 days of age with coarctation and a closed ductus arteriosus. He was successfully treated with a 7-week course of prostaglandin E2 therapy because surgical intervention was not deemed feasible in view of his size. Treatment resulted in a relaxation of the aortic constriction and improvement in aortic blood flow velocity profile, highlighting the value of long-term prostaglandin therapy in this population and supporting the hypothesis that the presence of ductal tissue contributes to the development of juxtaductal aortic constriction in some extremely preterm infants.

Severe hypothyroidism following a single topical exposure to iodine in a premature neonate

2021 ◽  
Vol 14 (2) ◽  
pp. e240006
Author(s):  
Catherine Mary Breen ◽  
Monica Fahim Salama ◽  
Michael A Boyle
Keyword(s):  
Thyroid Function ◽  
Ductus Arteriosus ◽  
Urinary Iodine ◽  
Premature Neonate ◽  
Thyroid Stimulating Hormone ◽  
Urinary Iodine Excretion ◽  
Free T4 ◽  
Delayed Treatment ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

A neonate, born at 24 weeks, underwent a patent ductus arteriosus ligation, with previous normal thyroid stimulating hormone (TSH) levels, developed severe hypothyroidism from topical exposure to iodine following a single surgical procedure at 28 days of life. A low free T4 level of 0.05 ng/dL and a high TSH level of 228 mIU/L was detected with an increased urinary iodine excretion level of 178 mg/L (reference range 0.30–1.97 mg/L). The thyroid ultrasound was normal. Levothyroxine was started immediately but thyroid function did not recover fully during admission and levothyroxine was required beyond term corrected. This case highlighted how susceptible extremely preterm infants are to iodine induced hypothyroidism, even short-term topical exposure. Delayed treatment of hypothyroidism can lead to profound neurodevelopmental delay. As surgical advances allow for interventions at earlier gestations, the importance of early thyroid function testing postexposure to iodine is highlighted and ultimately topical iodine should be avoided in these susceptible infants.

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

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.

scholarly journals Identification of differentially regulated genes in human patent ductus arteriosus

2016 ◽  
Vol 241 (18) ◽  
pp. 2112-2118 ◽  
Author(s):  
Pratik Parikh ◽  
Haiqing Bai ◽  
Michael F Swartz ◽  
George M Alfieris ◽  
David A Dean
Keyword(s):  
Cultured Cells ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Transient Transfection ◽  
Differentially Expressed ◽  
Luciferase Reporter ◽  
Prostaglandin E ◽  
Promoter Regions ◽  
Mrna Quantitation ◽  
Multiple Patients

In order to identify differentially expressed genes that are specific to the ductus arteriosus, 18 candidate genes were evaluated in matched ductus arteriosus and aortic samples from infants with coarctation of the aorta. The cell specificity of the gene's promoters was assessed by performing transient transfection studies in primary cells derived from several patients. Segments of ductus arteriosus and aorta were isolated from infants requiring repair for coarctation of the aorta and used for mRNA quantitation and culturing of cells. Differences in expression were determined by quantitative PCR using the ΔΔCt method. Promoter regions of six of these genes were cloned into luciferase reporter plasmids for transient transfection studies in matched human ductus arteriosus and aorta cells. Transcription factor AP-2b and phospholipase A2 were significantly up-regulated in ductus arteriosus compared to aorta in whole tissues and cultured cells, respectively. In transient transfection experiments, Angiotensin II type 1 receptor and Prostaglandin E receptor 4 promoters consistently gave higher expression in matched ductus arteriosus versus aorta cells from multiple patients. Taken together, these results demonstrate that several genes are differentially expressed in ductus arteriosus and that their promoters may be used to drive ductus arteriosus-enriched transgene expression.

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

2019 ◽  
Vol 39 (12) ◽  
pp. 1648-1655 ◽  
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

Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

2017 ◽  
Vol 34 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Mohamed Shalabi ◽  
Adel Mohamed ◽  
Brigitte Lemyre ◽  
Khalid Aziz ◽  
Daniel Faucher ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Intestinal Perforation ◽  
Preterm Neonates ◽  
Network Database ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Using Data ◽  
Spontaneous Intestinal Perforation

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

scholarly journals Preterm Birth and Inflammation

2021 ◽  
Author(s):  
Melinda Matyas
Keyword(s):  
Intraventricular Hemorrhage ◽  
Defense Mechanisms ◽  
Periventricular Leukomalacia ◽  
Preterm Births ◽  
Immune Defense ◽  
Preterm Neonates ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Adaptation Processes ◽  
Immature Immune System

Half of all preterm births are caused or triggered by an inflammation at fetal-maternal interface. The sustained inflammation that preterm neonates are exposed is generated by maternal chorioamnionitis, premature rupture of membranes. This inflammation will facilitate the preterm labor, but also plays an important role in development of disease like: bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, intraventricular hemorrhage and periventricular leukomalacia. Preterm neonates have immature immune system. The fragile co-regulation between immune defense mechanisms and immunosuppression (tolerance) is often disturbed at this category of patients. They are at high risk of sepsis due to this imbalance between the defense and suppression mechanisms but also several injuries can contribute to the onset or perpetuation of sustained inflammation. They experience altered antigen exposure in contact with hospital-specific germs, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia. This is more significant at extremely preterm infants less than 28 weeks of gestation as they have not developed adaptation processes to tolerate maternal and self-antigens.

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