scholarly journals SCENARIOS OF THE COURSE OF BRONCHOPULMONARY DYSPLASIA IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS IN FOLLOW-UP TO 3 YEARS

2021 ◽  
Vol 11 (4(42)) ◽  
pp. 15-20
Author(s):  
Y. Sorokolat ◽  
T. Klimenko ◽  
O. Karapetian ◽  
O. Kalutska
Keyword(s):  
Patent Ductus Arteriosus ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Neonatal Period ◽  
Ductus Arteriosus ◽  
Surgical Closure ◽  
Group I ◽  
Perinatal Center ◽  
Patent Ductus

Summary. Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications associated with preterm birth. The severity of BPD is associated with immaturity of a child's body, perinatal infections, and patent ductus arteriosus (PDA).The aim of the study was to identify the features of BPD in the 1st year of life of a child and in the follow- up to 3 years, depending on the condition of the ductus arteriosus.Material and methods. The observations of 146 premature infants with BPD, who were divided into groups depending on the state of the ductus arteriosus, were analyzed: Group I consisted of 58 children with BPD whose ductus arteriosus closed spontaneously in the early neonatal period; II group – 60 children with hemodynamically insignificant PDA, which remained open for 6-12 months; III group – 28 children with hemodynamically significant (HS) PDA, which required surgical closure during the stay of a child in the perinatal center. Results. There were significantly more cases of severe BPD among children of group II compared to group I: 23.3 vs. 8.6 % (p <0.01) and, accordingly, fewer cases of moderate course: 41.7 vs. 58.6 % (p <0.05) at the stage of children treatment in the perinatal center. At the age of 3 years, there were significantly more healthy children who underwent BPD in group I compared to group III: 62.5 vs. 25.9 % (p <0.01), and severe course was significantly more common in both groups II and III compared to group I: 6.8 and 7.4 % vs. 0 % (p <0.01). No significant differences in the severity of BPD at the age of 2-3 months and in the follow-up to 1 year from the date of surgical closure of HS PDA were detected. Conclusions. Sexual dimorphism was found, namely the prevalence of males among preterm infants with delayed closure of the ductus arteriosus. The presence of hemodynamic disorders connected with PDA is associated with a more severe course of BPD at the age of 3 years compared to children whose ductus arteriosus closed on its own in the early neonatal period. At the average term of surgical closure of PDA 21.5 ± 1.6 days of life, significant differences in the severity of BPD from the term of surgical closure of PDA weren`t detected.

scholarly journals Low-Dose Intravenous Paracetamol for Patent Ductus Arteriosus in Indomethacin-Resistant or Contraindicated Preterm Infants: Three Cases Reports

2017 ◽  
Vol 07 (04) ◽  
pp. e230-e233 ◽  
Author(s):  
Shun Matsumura ◽  
Ayumi Oshima ◽  
Sumie Fujinuma ◽  
Kosuke Tanaka ◽  
Nobuhiko Nagano ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Limited Data ◽  
Gastrointestinal Complications ◽  
Surgical Closure ◽  
Institutional Ethics ◽  
Intravenous Paracetamol ◽  
Administration Protocol ◽  
Patent Ductus

Background Although indomethacin (IND) is the standard treatment for hemodynamically significant patent ductus arteriosus (hsPDA) in Japan, it may be associated with renal impairment and gastrointestinal complications. The use of paracetamol for hsPDA closure has recently increased. Unlike IND, paracetamol does not have a peripheral vasoconstrictive effect and can be given to infants with contraindications to IND. Based on limited data available from randomized trials, paracetamol and IND seem to have similar effects. However, there have been no reports of the use of paracetamol for hsPDA in Japan. Cases Our drug administration protocol was approved by the institutional ethics committee after purchasing a clinical trial insurance. In three premature infants in whom IND was contraindicated or ineffective, a 7.5 mg/kg of paracetamol was intravenously administered every 6 hour for 3 days after obtaining parental consents. A temporary hsPDA closure was observed in two of the three infants. However, all three infants eventually needed surgical closure. No side effects, such as hepatic and renal dysfunctions, and adverse events were reported. Conclusion The intravenous administration of paracetamol was safe and feasible in premature infants with hsPDA. Future clinical trials with optimized dose and timing of administration are needed.

Consequences of Delayed Surgical Closure of Patent Ductus Arteriosus in Very Premature Infants

2006 ◽  
Vol 81 (1) ◽  
pp. 231-234 ◽  
Author(s):  
Sophie Jaillard ◽  
Benoît Larrue ◽  
Thameur Rakza ◽  
Eric Magnenant ◽  
Henri Warembourg ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Surgical Closure ◽  
Very Premature Infants ◽  
Patent Ductus

scholarly journals Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus

2013 ◽  
Vol 75 (4) ◽  
pp. 570-575 ◽  
Author(s):  
Valerie Y. Chock ◽  
Rajesh Punn ◽  
Anushri Oza ◽  
William E. Benitz ◽  
Krisa P. Van Meurs ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Patent Ductus

Surgical closure of patent ductus arteriosus in premature infants

1975 ◽  
Vol 35 (1) ◽  
pp. 165
Author(s):  
Edward A. Rittenhouse ◽  
Donald B. Doty ◽  
Ronald M. Lauer ◽  
Johann L. Ehrenhaft
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Surgical Closure ◽  
Patent Ductus

scholarly journals The effect of chronic infection foci in the mother on the development of acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

2020 ◽  
pp. 13-18
Author(s):  
T.P. Borysova ◽  
◽  
O.U. Obolonska ◽  
◽  
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Maternal Infection ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Patent Ductus

Nephrogenesis may be disrupted antenatally because of chronic infection foci (CIF) in the mother, the development of chorioamnionitis, feto-placental insufficiency. As a result, in the postnatal period, the kidneys are more sensitive to hypoperfusion, which occurs in premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) and can lead to the development of acute kidney injury (AKI). Purpose — to study the influence of CIF in the mother on the development of AKI in premature infants with HSPDA. Materials and methods. 74 premature infants (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Neonatal Intensive Care MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council» were examined. Patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: Group I — 40 children with HSPDA, Group II — 17 children with PDA without hemodynamic disorders, Group III — 17 children with a closed ductus arteriosus. The presence of CIF in the mother was determined according to medical records, chorioamnionitis on the basis of histopathological examination of the placenta. Patients with HSPDA were divided into two subgroups: 28 children from mothers with CIF, 12 — without CIF. Clinical examination and treatment of premature infants was carried out according to generally accepted methods. Echocardiography with Doppler was performed at 5–11 hours of life and then daily to determine PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. Results. Chronic foci of infection were found in 28 (70.0%) mothers of group I, in 5 (29.4%) — group II, in 6 (35.2%) — group III. Chorioamnionitis in group I — 10 (25%) cases, in group II–ІII — 6 (17.6%). The presence of CIF in the mother caused a significant increase in the size of the PDA on the first day of life in the group of HSPDA against groups II–III: 2.61±0.861 (2.3; 2–3.5) mm against 1.79±0.365 (1.7; 1.5–2) mm, p<0.001. Patent arterial duct with a diameter of >2 mm on the first day of life in premature infants of group I from mothers with foci of infection was observed more often — 19 (67.9%) against 2(6.7%) of groups II–III (OR=10.56; CI: 1.9–58.53, p<0.005). Analysis of the incidence of AKI on the third day of life depending on HSPDA and the presence of CIF showed that 64.3% of preterm infants with HSPDA and maternal infection developed AKI — 6.6 times more often than in groups without HSPDA (OR=8.40; CI: 2.60–27.14; p<0.001), and 2.6 times more often compared to children of the subgroup HSPDA without recorded maternal infection (OR=5.40; CI: 1.18–24.65; p<0.03). On the background of HSPDA and CIF stage II–III AKI was observed in every third child. Comparative analysis within group I depending on the CIF revealed that the frequency of AKI for 10 days in the subgroup with infection was almost three times higher than the level of the subgroup without infection: 71.4% vs. 25.0% (OR=7.50; CI: 1.60–35.07; p<0.009). Conclusions. The presence of CIF in the mother is a risk factor for AKI in premature infants with HSPDA. Therefore, such children should be classified as at risk of developing AKI. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute kidney injury, chronic foci of maternal infection, hemodynamically significant patent ductus arteriosus, premature infants.

Interaction between pulmonary vasculature and the patent ductus arteriosus in very premature infants

2020 ◽  
pp. 1-3
Author(s):  
Julien I.E. Hoffman
Keyword(s):  
Patent Ductus Arteriosus ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Pulmonary Vasculature ◽  
Very Preterm Infants ◽  
Platelet Endothelial Cell Adhesion ◽  
Very Premature Infants ◽  
Patent Ductus

BACKGROUND: The benefits of closing the ductus arteriosus in very preterm infants have not been convincingly shown in numerous clinical trials. Because a large untreated ductus arteriosus can cause death from congestive heart failure in infants born at term, we need to explain why this might not occur in premature infants born at <28 weeks’ gestation. METHODS: Based on information in the literature, I have commented on the possible relationship between the pulmonary vasculature and the shunt through the patent ductus arteriosus. RESULTS: Many of these infants have bronchopulmonary dysplasia, in which animal and human studies have shown a reduced number of capillaries and small pulmonary arteries as well as reduction in vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1). Both of these import angiogenic factors. Some who do not have bronchopulmonary dysplasia may have a restricted pulmonary vascular bed. CONCLUSIONS: The increased pulmonary vascular resistance in very premature infants may restrict pulmonary blood flow even if the ductus is large, thus reducing the urgency for ductus closure.

scholarly journals Safety and Feasibility of Intravenous Paracetamol for Patent Ductus Arteriosus in Indomethacin-/Ibuprofen-Resistant or -Contraindicated Preterm Infants: A Case Series

2020 ◽  
Vol 10 (01) ◽  
pp. e49-e53
Author(s):  
Ayumi Oshima ◽  
Shun Matsumura ◽  
Ayaka Iwatani ◽  
Machiko Morita ◽  
Sumie Fujinuma ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Case Series ◽  
High Plasma ◽  
Gastrointestinal Complications ◽  
Surgical Closure ◽  
Intravenous Paracetamol ◽  
Patent Ductus

Abstract Background Although indomethacin and ibuprofen are the standard treatments for hemodynamically significant patent ductus arteriosus (hsPDA), they are associated with renal impairment and gastrointestinal complications. Paracetamol for hsPDA closure does not provoke a peripheral vasoconstrictive effect and seems to have effects similar to those of indomethacin and ibuprofen. We have previously reported the safety of low-dose (7.5 mg/kg) intravenous paracetamol for preterm infants with hsPDA, who were indomethacin-resistant or -contraindicated but did not affect the need for surgical PDA ligation. However, reports considering the use of higher-dose (15 mg/kg) paracetamol for hsPDA have not been published in Japan. Cases In 16 premature infants in whom indomethacin or ibuprofen was contraindicated or ineffective, 15 mg/kg of paracetamol was intravenously administered every 6 hours for 3 days after obtaining parental consent. hsPDA closure or narrowing was observed in 14 infants (88%), with the need for surgical closure totally avoided in nine cases (56%). High plasma paracetamol levels were observed in three cases. No paracetamol-related side effects or adverse events were reported. Conclusion The intravenous administration of higher dose paracetamol was safe and feasible in premature infants with hsPDA. Future clinical trials to explore the optimized dose and timing of administration are needed.

scholarly journals Adult patent Ductus Arteriosus complicated by endocarditis and hemolytic anemia

2015 ◽  
pp. 80-83 ◽  
Author(s):  
Feridoun Sabzi ◽  
Reza Faraji
Keyword(s):  
Patent Ductus Arteriosus ◽  
Hemolytic Anemia ◽  
Ductus Arteriosus ◽  
Peripheral Blood Smear ◽  
Rare Presentation ◽  
Surgical Closure ◽  
Reactive Protein ◽  
Patent Ductus

An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.

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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