Assessing the clinical significance of echocardiograms in determining treatment of patent ductus arteriosus in neonates

BACKGROUND: To evaluate the utility of echocardiogram (ECHO) in detection and treatment of patent ductus arteriosus (PDA) and hemodynamically significant PDA (hsPDA) in preterm neonates. METHODS: This was a retrospective case-control study of all preterm infants born or admitted to the level III Neonatal Intensive Care Unit in McMaster Children’s Hospital from January 2009 to January 2013. These cases were further classified into the following sub-groups: group A) hsPDA confirmed on ECHO; and the control, group B) PDA (but not hemodynamically significant) confirmed on ECHO. Patients without an ECHO were excluded from all analyses. The primary outcome was incidence of treatment for PDA. RESULTS: PDA treatment was administered in 83.3% and 11.2% of patients in groups A and B respectively (P < 0.05). Among patients with a hsPDA within group A, 17% did not receive treatment, while 11% of patients with non-hemodynamically significant PDA received treatment for the PDA. Within the cohort of patients who received treatment for a hsPDA, gestational age below 35 weeks as well as murmurs heard on auscultation were both found to be predictors of treatment. CONCLUSION: While the ECHO remains the gold standard for detecting pathological PDA, there is evidence that other traditional clinical measures continue to guide clinical practice and treatment decisions. Further research is required to gain an understanding of how clinical measures and ECHO may be used in conjunction to optimize resource utilization.

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Phototherapy Effect on the Incidence of Patent Ductus Arteriosus in Premature Infants: Prevention With Chest Shielding

PEDIATRICS ◽

10.1542/peds.78.1.10 ◽

1986 ◽

Vol 78 (1) ◽

pp. 10-14 ◽

Cited By ~ 1

Author(s):

Warren Rosenfeld ◽

Shashi Sadhev ◽

Verlaine Brunot ◽

Ramesh Jhaveri ◽

Ignacio Zabaleta ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Premature Infants ◽

Distress Syndrome ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Control Group ◽

Patent Ductus

Patent ductus arteriosus is common among premature neonates, especially those with birth weights less than 1,500 g. In vitro, room light inhibits the contraction of immature piglet's ductal rings. Because phototherapy is used frequently from the first days of life to treat jaundice in preterm neonates, we compared the occurrence of patent ductus arteriosus among premature infants exposed to this intense light source with those whose chests were shielded. Seventy-four babies with respiratory distress syndrome were randomly assigned to either a treatment group (chest shielded with aluminum foil while on phototherapy, 36 babies) or control group (no shield, 38 babies). All were on radiant warmers, received mechanical ventilation for respiratory distress syndrome, and phototherapy (Air Shields model PTU 78-1) from day 1 of life. Irradiance was maintained at >4.0 µW/cm2/nm in all cases. Although both groups had similar birth weights, gestational ages, severity of respiratory distress syndrome, intravenous fluid intake, and duration of phototherapy, the incidence of patent ductus arteriosus was significantly less in the shield group (shield 11/36 v No shield 23/38; P = .009). Patent ductus arteriosus murmurs developed in shielded patients at a later date, they required less vigorous treatment (ie, indomethacin), and they had shorter hospitalizations (74 v 85 days; P < .05). The significant reduction of patent ductus arteriosus with shielding suggests that phototherapy may play a role in the occurrence of patent ductus arteriosus in premature infants. Shielding may be a practical method to decrease this common complication should this initial observation be confirmed.

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Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300106 ◽

2005 ◽

Vol 13 (1) ◽

pp. 24-29 ◽

Cited By ~ 26

Author(s):

M Omar Galal ◽

Mohamed Amin ◽

Arif Hussein ◽

Amjad Kouatli ◽

Jameel Al-Ata ◽

...

Keyword(s):

Ejection Fraction ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Intervention Group ◽

Left Ventricular ◽

Left Ventricular Performance ◽

Ventricular Performance ◽

Group A ◽

Group B ◽

Patent Ductus

Changes in left ventricular dimensions and performance were studied in 43 patients after transcatheter occlusion or surgical ligation of patent ductus arteriosus. The patients were assigned to 2 groups based on their ductal diameter: ≥ 3.1 mm to group A ( n = 27) and ≤ 3 mm to group B ( n = 16). The mean age and weight of the groups were comparable. Before intervention, group A had a significantly larger mean left ventricular end-diastolic diameter than group B, while all patients had normal shortening fraction and ejection fraction. Within 1 month after intervention, left ventricular end-diastolic diameter showed a trend towards regression while shortening fraction and ejection fraction decreased significantly in group A. There were no significant changes in these parameters in group B. Between 1 and 6 months after intervention, left ventricular performance improved in most of the group A patients who were followed up. We conclude that closure of large ductus arteriosus in children leads to significant immediate deterioration of left ventricular performance, which appears to recover within a few months. Echocardiographic study before hospital discharge is recommended in these patients. Serious deterioration of ventricular performance after closure may warrant the use of angiotensin converting enzyme inhibitors.

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Use of combination therapy with acetaminophen and ibuprofen for closure of the patent ductus arteriosus in preterm neonates

Paediatrics & Child Health ◽

10.1093/pch/pxaa057 ◽

2020 ◽

Author(s):

Susan Kimani ◽

Aimann Surak ◽

Michael Miller ◽

Soume Bhattacharya

Keyword(s):

Adverse Effects ◽

Combination Therapy ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Combination Group ◽

Preterm Neonates ◽

Primary Therapy ◽

Ductal Closure ◽

Patent Ductus

Abstract Objective To compare effectiveness and safety of combination therapy (acetaminophen and ibuprofen) to monotherapy (ibuprofen, indomethacin, or acetaminophen alone) in treatment of the patent ductus arteriosus (PDA) in premature neonates. Methods This was a retrospective cohort study of neonates admitted to a tertiary-level neonatal intensive care unit. Included neonates were born at <32 weeks gestation and received pharmacotherapy for PDA closure. Based on the primary therapy received, our cohort was divided into the following four groups: indomethacin alone, ibuprofen alone, acetaminophen alone, and ibuprofen and acetaminophen (in combination). Baseline characteristics, effectiveness, safety, neonatal mortality, and morbidities rates between these groups were compared. Results One hundred and forty neonates were analyzed; 17 received combination therapy, and 123 neonates received monotherapy: 22 (17.9%) ibuprofen, 29 (23.6%) acetaminophen, and 72 (58.5%) indomethacin. The PDA closure rates were 41.7% for indomethacin, 41.2% for combination therapy, 37.9% for acetaminophen, and 31.8% for ibuprofen (P=0.100). Rates of adverse effects were comparable between the groups. Conclusion The rate of ductal closure was not different between combination therapy and monotherapy. The study did not demonstrate any increased adverse effects in the combination group. Future well-designed prospective clinical trials are needed to guide clinical practice.

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Bedside Surgery to Treat Patent Ductus Arteriosus in Low-Birth-Weight Premature Infants

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s16156 ◽

2014 ◽

Vol 7 ◽

pp. OJCS.S16156

Author(s):

Gökhan Albayrak ◽

Koray Aykut ◽

Mustafa Karacelik ◽

Ramazan Soylar ◽

Kemal Karaarslan ◽

...

Keyword(s):

Birth Weight ◽

Patent Ductus Arteriosus ◽

Medical Treatment ◽

Premature Infants ◽

Ductus Arteriosus ◽

Mortality And Morbidity ◽

Significant Difference ◽

Group A ◽

Group B ◽

Patent Ductus

Background Patent ductus arteriosus (PDA) is commonly seen in premature infants with low birth weights (LBW). It is a condition that has high mortality and morbidity rates. Early closure of the ductus arteriosus may require surgery or medical treatment. However, the decision of first medical approach for symptomatic PDA closure is still debated. In this study, we compared the surgical and medical treatments for the closure of PDA in premature LBW infants. Methods This study included 27 premature infants whose birth weights were lower than 1500 g, who were born in the period between 2011 and 2013 and had symptomatic PDA. Patients were separated into two groups: groups A and B. Group A included patients whose PDAs were closed with medical treatment ( n = 16), and group B included patients who had undergone surgical operations for PDA closure ( n = 11). Results There were no statistically significant differences between groups A and B when the groups were compared in terms of birth weight, gestational age, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and pneumothorax. Although the mortality rate was determined to be lower in group B (2 out of 11, 18.1%) than in group A (7 out of 16, 43.7%), no statistically significant difference was found between the two groups. A statistically significant increase was determined in the incidence of kidney function loss in patient group that received Ibuprofen, a medical treatment, in comparison to the patients who had surgery. Conclusion In conclusion, surgery is a safe method to repair PDA in premature LBW infants. Although there is no remarkable difference between surgery and medical treatment, we suggest that a surgical approach may be used as a first choice to repair PDA considering the lower rate of mortality and morbidity and higher rate of closure compared to medical treatment.

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Closure of patent ductus arteriosus with oral acetaminophen in preterm neonates: A randomized trial

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i02.418 ◽

2018 ◽

Vol 5 (02) ◽

pp. 2034-2044 ◽

Cited By ~ 6

Author(s):

Homa Babaei ◽

Rahele Nemati ◽

Hooman Daryoshi

Keyword(s):

Side Effects ◽

Patent Ductus Arteriosus ◽

Chronic Lung Disease ◽

Intraventricular Hemorrhage ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Control Group ◽

Case Group ◽

Closure Rate ◽

Patent Ductus

Introduction: Patent ductus arteriosus (PDA) is one of the most common cardiac problems in preterm neonates which could lead to morbidities, such as chronic lung disease, intraventricular hemorrhage and retinopathy. The aim of this study was to evaluate the effect of oral acetaminophen on closure of PDA in preterm neonates. Methods: Sixty-nine neonates with significant PDA (confirmed through echocardiography) were recruited in this study. Ibuprofen and indomethacin were contraindicated in these neonates These newborns were randomly divided into two groups of cases (n=36) and controls (n=33). The case group was treated with oral acetaminophen at a dose of 15 mg/kg/dose every 6 hours for 72 hours. The control group did not receive any intervention. After 72 hours, both groups were re-evaluated by echocardiography. In case of failed closure of PDA, the second course of treatment would be administration of acetaminophen. The main outcome of this study was to evaluate the rate of closure of PDA and the side effects of the acetaminophen. Results: The overall rate of PDA closure in the acetaminophen-receiving group was 94.4%; the ductus arteriosus was closed in 75% of patients with the first course of treatment. Moreover, 19.4% of patients did not respond to the first course of the treatment but their ductus arteriosus was closed with the second course of acetaminophen treatment. Of the patients, 5.6% did not respond to both courses of acetaminophen treatments. For the control group, the closure rate of PDA was 15.1%. Conclusion: The results of the study showed that oral acetaminophen is an effective alternative treatment for PDA in preterm neonates.

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Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1,500 g: A 9-year single center experience

10.21203/rs.3.rs-17138/v2 ◽

2020 ◽

Author(s):

Jun Ho Lee ◽

Hyun Ju Lee ◽

Hyun-Kyung Park ◽

Ja-Hye Ahn ◽

Hee Sun Kim ◽

...

Keyword(s):

Surgical Treatment ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Surgical Ligation ◽

Single Center Experience ◽

Ductal Closure ◽

Low Incidence ◽

Patent Ductus

Abstract Background: The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management.Methods: Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 preterm neonates weighing less than 1,500 g with HSPDA were enrolled in our study. Of these preterm neonates, 134 underwent surgical ligation and were subdivided into the early ligation group (n = 49; within 10 days of age) and the late ligation group (n = 85; after 10 days of age).Results: The mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group (p < 0.001). PDA ductal diameter > 2.0 mm (p < 0.001), low Apgar score at 5 minutes (p = 0.033), and chorioamnionitis (p = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis (p = 0.004), mechanical ventilator time > 4 weeks (p = 0.007), necrotizing enterocolitis stage (NEC) ≥ III (p = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III (p = 0.035).Conclusions: Early surgical ligation minimizes the adverse effects of HSPDA in predicted preterm neonates who subsequently require surgical treatment for PDA. This result suggests that in preterm neonates weighing less than 1,500 g with HSPDA that is unresponsive to medical treatment, delayed ductal closure should be avoided to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.

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Surgical Intervention in Preterm Neonates with Patent Ductus Arteriosus

Current Pediatric Reviews ◽

10.2174/157339631202160506002405 ◽

2016 ◽

Vol 12 (2) ◽

pp. 123-125

Author(s):

Marcus P. Haw

Keyword(s):

Patent Ductus Arteriosus ◽

Surgical Intervention ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Patent Ductus

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Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-020-00046-8 ◽

2020 ◽

Vol 68 (1) ◽

Author(s):

Reem M. Soliman ◽

Fatma Alzahraah Mostafa ◽

Antoine Abdelmassih ◽

Elham Sultan ◽

Dalia Mosallam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Side Effects ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

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