scholarly journals Pulmonary Hypertension with Prolonged Patency of the Ductus Arteriosus in Preterm Infants

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 139
Author(s):  
Ranjit Philip ◽  
Vineet Lamba ◽  
Ajay Talati ◽  
Shyam Sathanandam
Keyword(s):  
Decision Making ◽  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Pulmonary Vasculature ◽  
Short Term ◽  
Diagnostic Cardiac Catheterization ◽  
Patent Ductus

There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a difference in long-term benefits remains. This article intends to review the pulmonary vasculature changes that can occur with a chronic hemodynamically significant PDA in a preterm infant. It also explains the rationale and decision-making involved in a diagnostic cardiac catheterization and transcatheter PDA closure in these preterm infants.

ASSOCIATION OF PATENT DUCTUS ARTERIOSUS SIZE WITH CLINICAL FEATURES AND SHORT-TERM OUTCOMES IN PRETERM INFANTS LESS THAN 34 WEEKS

2020 ◽  
Vol 07 (03) ◽  
pp. 105-108
Author(s):  
Chandrakala Bada Shekharappa ◽  
Edison Albert Balakrishnan Elizabeth ◽  
Bharathi Balachander
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Clinical Features ◽  
Ductus Arteriosus ◽  
Short Term ◽  
Patent Ductus

scholarly journals ORAL VERSUS INTRAVENOUS IBUPROFEN FOR THE EARLY CLOSURE OF PATENT DUCTUS ARTERIOSUS IN LOW BIRTH WEIGHT PRETERM INFANTS

2013 ◽  
Vol 6 ◽  
Author(s):  
Alketa Hoxha ◽  
Ermira Kola ◽  
Numila Kuneshka ◽  
Eduard Tushe
Keyword(s):  
Birth Weight ◽  
Adverse Effects ◽  
Preterm Infants ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Ductal Closure ◽  
Oral Ibuprofen ◽  
Intravenous Ibuprofen ◽  
Ibuprofen Group ◽  
Patent Ductus

Background Patent ductus arteriosus (PDA) is common in very premature infants. Pharmacological closure of PDA with indomethacin, a prostaglandin inhibitor, has remained the mainstay of treatment in premature infants over the last three decades. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reaction in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route.This study was designed to assess the efficacy and safety of oral ibuprofen and intravenous ibuprofen for the early pharmacological treatment of PDA in LBW preterm infants with respiratory distress syndrome.MethodsA randomized, single-blinded, controlled study was performed on premature neonates at the neonatal care unit of the University Hospital for Obstetrics and Gynecology”Koco Gliozheni”, Tirana, Albania, from January 2010 to December 2012. The study enrolled 68 preterm infants with gestational age between 28-32 weeks, birth weight ≤ 2000 g, postnatal age 48-96 h, and had echocardiographically confirmed significant PDA. The preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. After the first dose of treatment in both groups, echocardiographic evaluation was performed, to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patient’s clinical course were recorded.Results All patients were born after 28 until 32 weeks’ gestation. 36 patients were treated with oral ibuprofen and 32 with intravenous ibuprofen in this period. After the first course of the treatment, the PDA closed in 30 (83.3%) of the patients assigned to the oral ibuprofen group versus 23 (71.8%) of those enrolled in the intravenous ibuprofen group (p = 0.355). There was no difference between treatment groups in demographics or baseline renal function. In the evaluation of renal tolerance, none of the patients had oliguria. There were no significant differences with respect to complications during the stay.Conclusions In low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route.  Oral ibuprofen is associated with fewer adverse effects

scholarly journals Multi-centre, randomised non-inferiority trial of early treatment versus expectant management of patent ductus arteriosus in preterm infants (the BeNeDuctus trial): statistical analysis plan

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tim Hundscheid ◽  
Rogier Donders ◽  
Wes Onland ◽  
Elisabeth M. W. Kooi ◽  
Daniel C. Vijlbrief ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Pharmacological Treatment ◽  
Ductus Arteriosus ◽  
Expectant Management ◽  
The United States ◽  
Statistical Analysis Plan ◽  
Short Term ◽  
Patent Ductus

Abstract Background Controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants. A persistent PDA is associated with neonatal mortality and morbidity, but causality remains unproven. Although both pharmacological and/or surgical treatment are effective in PDA closure, this has not resulted in an improved neonatal outcome. In most preterm infants, a PDA will eventually close spontaneously, hence PDA treatment potentially increases the risk of iatrogenic adverse effects. Therefore, expectant management is gaining interest, even in the absence of convincing evidence to support this strategy. Methods/design The BeNeDuctus trial is a multicentre, randomised, non-inferiority trial assessing early pharmacological treatment (24–72 h postnatal age) with ibuprofen versus expectant management of PDA in preterm infants in Europe. Preterm infants with a gestational age of less than 28 weeks and an echocardiographic-confirmed PDA with a transductal diameter of > 1.5 mm are randomly allocated to early pharmacological treatment with ibuprofen or expectant management after parental informed consent. The primary outcome measure is the composite outcome of mortality, and/or necrotizing enterocolitis Bell stage ≥ IIa, and/or bronchopulmonary dysplasia, all established at a postmenstrual age of 36 weeks. Secondary short-term outcomes are comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. This statistical analysis plan focusses on the short-term outcome and is written and submitted without knowledge of the data. Trial registration ClinicalTrials.gov NTR5479. Registered on October 19, 2015, with the Dutch Trial Registry, sponsored by the United States National Library of Medicine Clinicaltrials.gov NCT02884219 (registered May 2016) and the European Clinical Trials Database EudraCT 2017-001376-28.

Renal Calcifications: A Complication of Long-Term Furosemide Therapy in Preterm Infants

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 360-363 ◽  
Author(s):  
Karen G. Hufnagle ◽  
Shadid N. Khan ◽  
Duna Penn ◽  
Alexander Cacciarelli ◽  
Paul Williams
Keyword(s):  
Calcium Phosphate ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Stone Formation ◽  
Ductus Arteriosus ◽  
Probable Mechanism ◽  
Calcium Excretion ◽  
Patent Ductus

During the last four years ten premature infants developed renal calcifications while receiving long-term furosemide therapy. The drug was used in infants with patent ductus arteriosus and later in the same infants with chronic lung disease. They had received furosemide in a dose of at least 2 mg/kg/day for at least 12 days before calcifications were noted on abdominal roentgenograms. Calcifications included small flecks, isolated stones, staghorn calculi, and nephrocalcinosis. Analysis of stones received from four infants showed calcium oxalate and calcium phosphate. Infants who were not receiving furosemide had no calcifications. The infants with renal calcifications had rates of calcium excretion ten to 20 times that of normal, age-matched premature infants in our nursery. When chlorothiazide was given to the infants, in addition to furosemide, a four- to 15-fold decrease in calcium excretion and a radiologic dissolution of the renal calcifications were documented. It is concluded that furosemide, in doses of at least 2 mg/kg/day for at least 12 days can be associated with renal calcifications. The probable mechanism of the stone formation is hypercalciuria, primarily caused by furosemide.

Elongated Patent Ductus Arteriosus with Intermittent Shunting

PEDIATRICS ◽  
1967 ◽  
Vol 39 (3) ◽  
pp. 446-448
Author(s):  
COLETTE M. KOHLER ◽  
DAN G. MCNAMARA
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Cardiac Defects ◽  
Cardiac Catheterizations ◽  
Delayed Closure ◽  
Patent Ductus

The presence of patent ductus arteriosus without a typical continuous murmur has long been recognized, especially in the presence of pulmonary hypertension, or a small ductus, or with associated cardiac defects; however, there are only a few reports of documented, intermittently disappearing murmurs occurring in individuals over 6 months of age with a substantial shunt in the absence of pulmonary hypertension or associated defects. Danilowicz, et al. have recently reported delayed closure of the ductus anteriosus up to 6 months of age in some premature infants. We present this case report of a 2½-year-old boy with patent ductus arteriosus with cardiac catheterizations during the disappearance and subsequent reappearance of a continuous murmur with documentation of absence of shunting when the murmur was absent and substantial shunting if the murmur was present.

Patent Ductus Arteriosus and Short- and Long-Term Respiratory Outcomes

2016 ◽  
Vol 33 (11) ◽  
pp. 1055-1057 ◽  
Author(s):  
Eduardo Bancalari
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Lung Damage ◽  
Early Closure ◽  
Short And Long Term ◽  
Respiratory Outcomes ◽  
Patent Ductus

The patency of the ductus arteriosus is very common in extremely premature infants. The increased pulmonary blood flow that results from left-to-right ductal shunting can produce an acute deterioration in lung function and some data suggest that it may increase the risk of chronic lung damage. However, there is no clear evidence that prophylactic or early closure of the patent ductus arteriosus (PDA) results in a clear reduction in bronchopulmonary dysplasia. For this reason, and because of the side effects of the available therapies to close the ductus, there is a wide variation in the approach to the PDA in this population and most clinicians will intervene to close the ductus only in cases of significant shunt with hemodynamic decompensation.

Long-Term Neurodevelopment of Low-Birthweight, Preterm Infants with Patent Ductus Arteriosus

2018 ◽  
Vol 203 ◽  
pp. 170-176.e1 ◽  
Author(s):  
R. Thomas Collins ◽  
Robert E. Lyle ◽  
Mallikarjuna Rettiganti ◽  
Jeffrey M. Gossett ◽  
James M. Robbins ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Patent Ductus

Long-Term Variability of Heart Rate Increases with Successful Closure of Patent Ductus arteriosus in Preterm Infants

Neonatology ◽  
1992 ◽  
Vol 61 (3) ◽  
pp. 142-149 ◽  
Author(s):  
Viola Prietsch ◽  
Rolf Maier ◽  
Lothar Schmitz ◽  
Michael Obladen
Keyword(s):  
Heart Rate ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Patent Ductus
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