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.

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.

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 Percutanous closure of patent ductus arteriosus in small infants of less than 8�kg body weight using different devices

2004 ◽  
Author(s):  
Walter Knirsch ◽  
NikolausA. Haas ◽  
MartinA.G. Lewin ◽  
Ingo D�hnert ◽  
Deniz Kececioglu ◽  
...  
Keyword(s):  
Body Weight ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Patent Ductus

ASSA14-14-04 Transcatheter Closure of Patent Ductus Arteriosus in Children with Body Weight ≤ 8 kg

Heart ◽  
2014 ◽  
Vol 101 (Suppl 1) ◽  
pp. A42.1-A42
Author(s):  
Q Wang ◽  
X Zhu ◽  
D Zhang ◽  
C Cui ◽  
H Chen ◽  
...  
Keyword(s):  
Body Weight ◽  
Patent Ductus Arteriosus ◽  
Transcatheter Closure ◽  
Ductus Arteriosus ◽  
Patent Ductus

scholarly journals Short-term follow-up after percutaneous patent ductus arteriosus occlusion between low and high weight pediatric patients: a single center experience

2020 ◽  
Vol 29 (3) ◽  
pp. 305-9
Author(s):  
Ni Putu Eka Suwitri ◽  
Ni Putu Veny Kartika Yantie ◽  
Eka Gunawijaya
Keyword(s):  
Body Weight ◽  
Patent Ductus Arteriosus ◽  
Success Rate ◽  
Pediatric Patients ◽  
High Weight ◽  
Ductus Arteriosus ◽  
Massive Bleeding ◽  
Success Rates ◽  
Patent Ductus

BACKGROUND Device occlusion is a preferred treatment for patent ductus arteriosus (PDA) in adult and children patients; however, the exact limit of body weight requirement has not been established. This study aimed to describe the outcome and safety of transcatheter PDA occlusion in low and high weight pediatric patients. METHODS This was a retrospective study in Sanglah Hospital, Denpasar, Bali, Indonesia, in patients aged <12 years who had undergone transcatheter PDA occlusions from 2010 to 2017. Data were obtained from the registry including baseline characteristics (age, sex, body weight, and height), procedural-specific data (PDA characteristics, pulmonary and systemic pressures, and flow ratio intra-procedure), and procedural complications. Success rate and adverse events at 24 hours, 1 month, and 3 months after the procedure were assessed. RESULTS A total of 175 subjects were grouped into two categories: low weight, ?6 kg (n = 50) and high weight, >6 kg (n = 125). The success rates (complete closure) in the ?6 and >6 kg groups were, 90.0% and 75.9% at 24 hours follow-up, 92.9% and 85.5% at 1 month, and 95.8% and 91.1% at 3 months, respectively. Major complications related to the procedure in patients ?6 kg included transient dysrhythmia (n = 6) and massive bleeding (n = 2), and complications in patients >6 kg were transient dysrhythmia (n = 14), massive bleeding (n = 1), embolization (n = 1), and death (n = 1). CONCLUSIONS Transcatheter PDA occlusion had similar success rate and safety in both low and high weight pediatric patients.

scholarly journals Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants With Very Low Birth Weight

2021 ◽  
Vol 8 ◽  
Author(s):  
Jieh-Neng Wang ◽  
Yung-Chieh Lin ◽  
Min-Ling Hsieh ◽  
Yu-Jen Wei ◽  
Ying-Tzu Ju ◽  
...  
Keyword(s):  
Body Weight ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Vascular Plug ◽  
The Mean ◽  
Patent Ductus

Background: The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature infants.Methods: We performed a retrospective study of infants born with a birth body weight of &lt; 2,000 g and admitted to National Cheng Kung University Hospital from September 2014 to December 2019. Basic demographic and clinical information as well as echocardiographic and angiographic data were recorded.Results: Twenty-five premature infants (11 boys and 14 girls) born at gestational ages ranging between 22 and 35 weeks (mean, 25 weeks) were identified. The mean age at procedure was 34.5 ± 5.5 days, and the mean weight was 1,209 ± 94 g (range, 478–1,980 g). The mean diameter of the PDA was 3.4 ± 0.2 mm (range, 2.0–5.4 mm). The following devices were used in this study: Amplatzer Ductal Occluder II additional size (n = 20), Amplatzer Vascular Plug I (n = 1), and Amplatzer Vascular Plug II (n = 4). Complete closure was achieved in all patients. The mean follow-up period was 30.1 ± 17.3 months (range, 6–68 months). In total, 3 patients had left pulmonary artery (LPA) stenosis and 1 patient had coarctation of the aorta during the follow-up period. Younger procedure age and smaller procedure body weight were significantly associated with these obstructions.Conclusions: Performing transcatheter PDA closure in symptomatic premature infants weighing more than 478 g is feasible using currently available devices; moreover, the procedure serves as an alternative to surgery.

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