scholarly journals The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 316-323
Author(s):  
Stefano Ghirardello ◽  
Genny Raffaeli ◽  
Beatrice Letizia Crippa ◽  
Silvia Gulden ◽  
Ilaria Amodeo ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Maximum Amplitude ◽  
Treated Group ◽  
Full Blood Count ◽  
Vlbw Infants ◽  
Preterm Newborns ◽  
Patent Ductus

<b><i>Background:</i></b> The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. <b><i>Objective:</i></b> To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. <b><i>Methods:</i></b> This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of &#x3c;33 weeks’ gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. <b><i>Results:</i></b> We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (<i>p</i> &#x3c; 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; <i>p</i> = 0.01) and platelet count (187 and 216 × 10<sup>3</sup>/μL; <i>p</i> = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (<i>n</i> = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; <i>p</i> = 0.02). <b><i>Conclusion:</i></b> TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.

scholarly journals Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

2021 ◽  
Vol 9 ◽  
Author(s):  
Junyan Zhong ◽  
Binchun Lin ◽  
Yongping Fu ◽  
Yanliang Yu ◽  
Jie Zhao ◽  
...  
Keyword(s):  
Platelet Count ◽  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Multivariate Logistic Regression Analysis ◽  
Concurrent Infection ◽  
Vlbw Infants ◽  
Oral Ibuprofen ◽  
Patent Ductus

Background: Platelet-rich thrombosis leads to the occlusion of arteries. Whether the association between platelet count and closure of hemodynamically significant patent ductus arteriosus (hsPDA) exists remains inconclusive. Given that neonatal platelet count is significantly affected by infection, this study aims to evaluate the association of platelet parameters before ibuprofen treatment with the closure of hsPDA in very low birth weight (VLBW) infants without concurrent infection.Methods: A retrospective study was conducted at the NICU of Shenzhen Maternity and Child Healthcare Hospital from January 2016 to August 2020. VLBW infants diagnosed with hsPDA, treated with oral ibuprofen and without concurrent infection were included in this study. The platelet parameters were retrieved from the whole-blood test routinely performed within 24 h before starting treatment of oral ibuprofen. A multiple regression model was built to evaluate the association between platelet parameters before ibuprofen treatment and successful closure of hsPDA.Results: A total of 129 premature infants with hsPDA were analyzed in this study. After oral ibuprofen treatment, successful closure of hsPDA was achieved in 70 (54.3%) infants. The gestational age at birth and birth weight in infants with successful or failed closure of hsPDA after ibuprofen treatment were 28.3 vs. 27.6 weeks (p = 0.016) and 1,120 vs. 960 g (p = 0.043), respectively. The rate of mechanical ventilation in infants with successful closure of hsPDA was significantly lower compared to those with failed closure of hsPDA, 31.4 vs. 54.2%, p = 0.014. The platelet count in infants with successful closure of hsPDA after ibuprofen treatment was significantly higher compared to those with failed closure of hsPDA, 212 vs. 183 (in a unit of 109/L), respectively (p = 0.024). Multivariate logistic regression analysis showed that a higher platelet count (≥181 × 109/L) before ibuprofen treatment was independently associated with successful closure of hsPDA [odds ratio 2.556, 95% confidence interval (1.101–5.932), p = 0.029].Conclusion: The findings in this study suggest that a higher platelet count before oral ibuprofen treatment may predict the probability of successful closure of hsPDA in VLBW infants.

scholarly journals Morbidity Associated with Patent Ductus Arteriosus in Preterm Newborns: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Gianluca Terrin ◽  
Maria Di Chiara ◽  
Giovanni Boscarino ◽  
Valentina Metrangolo ◽  
Francesca Faccioli ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Case Control Study ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Case Control ◽  
Extremely Preterm ◽  
Preterm Newborns ◽  
Control Study ◽  
Patent Ductus

Abstract Introduction: Association between persistency of a patent ductus arteriosus (PDA) and morbidity in preterm newborns is still controversial. We aimed to investigate the relation between PDA and morbidity in a large retrospective study.Methods: A case-control study including neonates consecutively admitted to the Neonatal Intensive Care Unit (NICU), with gestational age (GA) ≤ 32 weeks or body birth weight (BW) ≤ 1500 g, over a 5-year period. Newborns were divided into Cases and Controls, according with the presence or absence of a hemodynamically significant PDA (hs-PDA).Results: We enrolled 85 Cases and 193 Controls. Subjects with hs-PDA had significantly (p<0.001) lower GA (26.7 w, 95%CI 27.1-28.0 vs. 30.1 w, 95%CI 29.7-30.4), BW (1024 g, 95% CI 952-1097 vs. 1310 g 95%CI 1263-1358) and an increased morbidity (60.0% vs. 18.7%). In a sub-group of extremely preterm newborns (GA < 29 weeks and BW < 1000 g), the rate of BPD was significantly increased in Cases (31.7%) compared with Controls (5.9%, p=0.033). Multivariate analysis showed that morbidity significantly depended on hs-PDA, GA and BW, and that, in extremely preterms, the hs-PDA represented an independent risk factor for BPD.Conclusions: The presence of hs-PDA seemed to increase the risk of morbidity in very low birth weight (VLBW) infants. In extremely preterm newborns, the risk of bronchopulmonary dysplasia (BPD) depended on the occurrence of hs-PDA.

scholarly journals Comparing Death or Neurodevelopmental Outcomes of Haemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight Preterm Infants

2021 ◽  
Author(s):  
Jia-Ying Jania Wu ◽  
Krishnamoorthy Niduvaje ◽  
Le Ye Lee ◽  
Zubair Amin
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Group Analysis ◽  
Short Term ◽  
Neurodevelopmental Outcomes ◽  
Vlbw Infants ◽  
Patent Ductus

Abstract BackgroundOptimal management of haemodynamically significant patent ductus arteriosus (HsPDA) remains controversial for premature infants. Treatment options include conservative treatment with fluid restriction and diuretics, medical treatment with cyclo-oxygenase (COX) inhibitors or surgical ligation. Our primary objective is to compare the death and/or adverse neurodevelopmental outcomes among very low birth weight (VLBW) infants with HsPDA who were managed with conservative, medical and/or surgical treatment. The secondary objectives are to examine antenatal factors predisposing to surgical treatment and the neonatal short-term morbidities between three groups.MethodsThis was a retrospective, gestational age-stratified study of VLBW infants born in National University Hospital (NUH) in Singapore and admitted to the intensive care unit from 2007–2016.. Perinatal variables, short-term neonatal outcomes and neurodevelopmental outcomes were studied. Statistical analysis were performed with chi square and t-test.. Results124 infants were included. 17 VLBW infants managed conservatively [C] were identified and compared with 83 VLBW infants managed medically [M] and 24 VLBW infants managed surgically [S]. The main group analysis compared outcomes between infants managed [C] and those who received either medical or surgical treatment [M+S]. The subgroup analysis compared outcomes between infants managed [C] vs [M] and [C] vs [S]. The main group analysis found group M+S infants had a higher incidence of chronic lung disease (CLD) (p=0.005) than group C. The odds ratio (OR) of group M+S developing CLD was significant (OR 6.83). They were significantly shorter (p=0.017) and had a smaller head circumference (p=0.039) at discharge. Group S infants were older at discharge, due to a longer NICU stay , and were lighter , shorter and had a smaller head circumference (p<0.05). No significant differences in death, composite outcome of death and global development delay and neurological outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. Conclusions: Comparing the management, infants requiring surgical treatment for hsPDA were more likely to have short-term complications such as CLD, longer hospitalization, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in these infants. Further randomized control studies will be useful to verify these findings.

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 &lt; .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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