scholarly journals Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 545
Author(s):  
Yen-Ju Chen ◽  
Wei-Ying Chu ◽  
Wen-Hao Yu ◽  
Chau-Jing Chen ◽  
Shu-Ti Chia ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Gastric Lavage ◽  
Arterial Line ◽  
Gastric Bleeding ◽  
Rare Presentation ◽  
Gastrointestinal Complications ◽  
Extremely Preterm

Indomethacin has been widely used in preterm infants with hemodynamically significant patent ductus arteriosus (PDA). Gastrointestinal complications of indomethacin have been reported in 5% of treated neonates. However, massive gastric mucosa hemorrhage is a rarely reported complication. To the best of our knowledge, the infant in this report is the smallest reported in the literature to have undergone successful surgery for such a complication. A male preterm infant weighing 566 g was born at 252/7 weeks of gestational age without a complicated maternal history. Soon after birth, he received nasal noninvasive respiratory support and minimal feeding. PDA was observed since the first day of life (DOL), treatments were initiated on the second DOL for the hemodynamical significance, and PDA was closed after two courses of indomethacin therapy (0.2 mg/kg). At midnight on the seventh DOL, generalized pallor, bloody gastric drainage, and a distended stomach were observed. Massive gastric bleeding was suspected. He suffered from intermittent hypotension, which was corrected with blood products and fluid resuscitation under monitoring with a radial arterial line. Gastric lavage with cooling saline was performed twice but in vain. Prior to surgical consultation, intravascular volume transfusion was given twice. An exploratory laparotomy was arranged after obtaining the parents’ consent. Blood oozing from the gastric mucosa was observed through gastrostomy and was successfully stopped via epinephrine-soaked gauze compression. After the operation, his clinical course remained uneventful, and he was discharged without neurological anomaly at two-year follow-up. Physicians need to be cautious of indomethacin’s effect on platelet dysfunction in preterm infants with multiple predisposing factors. The tendency for mucosal bleeding should be continuously monitored after indomethacin therapy.

Hypertrophic cardiomyopathy in an extremely preterm infant

2021 ◽  
Vol 14 (3) ◽  
pp. e239787
Author(s):  
Apoorva Aiyengar ◽  
Claire Howarth ◽  
Sujith Pereira
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Patent Ductus Arteriosus ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Careful Consideration ◽  
Differential Diagnoses ◽  
Cardiac Remodelling ◽  
Extremely Preterm ◽  
Patent Ductus

We present a case of an extreme preterm infant (Baby X) born at 24-week gestation. The echocardiogram showed evidence of hypertrophic cardiomyopathy (HCM) and a patent ductus arteriosus (PDA). There are a number of well-known causes of neonatal HCM including genetic, metabolic and endocrine. PDA is commonly present in preterm infants, and this can contribute to cardiac remodelling and result in cardiac changes mimicking HCM. Furthermore, medications such as steroids can also cause HCM through various mechanisms. A careful consideration of all the different aetiologies for HCM is important for appropriate management of such cases. This report examines the evidence in the literature for the above differential diagnoses and highlights the challenges in diagnosing the underlying cause of HCM in a preterm infant.

scholarly journals Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

2020 ◽  
Vol 8 ◽  
Author(s):  
Se In Sung ◽  
Yun Sil Chang ◽  
So Yoon Ahn ◽  
Heui Seung Jo ◽  
Misun Yang ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Ductus Arteriosus ◽  
Intervention Approach ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Surgical Treatments ◽  
Minimal Evidence ◽  
Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants

2019 ◽  
Vol 39 (12) ◽  
pp. 1648-1655 ◽  
Author(s):  
Hussnain Mirza ◽  
Jorge Garcia ◽  
Genevieve McKinley ◽  
Laura Hubbard ◽  
Wendla Sensing ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Ductus Arteriosus ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Patent Ductus

Fluid Intake in the First Week of Life and the Duration of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

2021 ◽  
Author(s):  
Hussnain Mirza ◽  
Jorge Garcia ◽  
Chelsea Bell ◽  
Kristen Jones ◽  
Vicki Flynn ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Preterm Infants ◽  
Fluid Intake ◽  
Ductus Arteriosus ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Prolonged Duration ◽  
Group A ◽  
Group B ◽  
Patent Ductus

Objective This study aimed to determine the association between daily fluid intake and the duration of hemodynamically significant patent ductus arteriosus (hsPDA). Methods This is a retrospective cohort study of extremely preterm infants (<29 weeks) admitted in the Neonatal Intensive Care Unit of the Advent Health for Children from January 2013 to March 2016, if hsPDA was diagnosed in first week of life and serial echocardiograms were available. Diagnosis of hsPDA was based on a scoring system and its duration was estimated from serial echocardiograms. Cohort was divided into two groups based on duration of hsPDA (<1week, group A and ≥1 week, group B). Daily fluid intake was categorized as prescribed and actual. Prescribed volume was ordered by clinicians based on birth weight, not including trophic feeds, intravenous (IV) boluses or transfusions, etc. Actual intake was calculated by the electronic medical records based on daily weights and included all enteral or parenteral fluids. Multivariate analysis was performed to determine an association between total daily fluid intake over the first week of life and the duration of hsPDA. Two groups were compared to observe the difference between prescribed and actual daily fluid intakes. Results We enrolled 50 infants in group A and 76 in group B. Infants in group B were of significantly lower gestation and required prolonged ventilation and hospitalization. An association between higher fluid intake in the first 2 days of life and prolonged duration of hsPDA was confirmed by multivariate analysis. Actual fluid intake was significantly higher than prescribed total fluid intake in first 4 days of life for infants in both groups. Conclusion In extremely preterm infants, higher fluid intake in first 2 days of life is associated with prolonged duration of hsPDA. Actual daily fluid intake can be significantly higher than prescribed daily fluids due to daily weight changes and additional fluid administration. Key Points

scholarly journals Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

2020 ◽  
Vol 9 (3) ◽  
pp. 699 ◽  
Author(s):  
Eun Seo ◽  
Se Sung ◽  
So Ahn ◽  
Yun Chang ◽  
Won Park
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Patent Ductus

Changes in kidney function in extremely preterm infants (EPT) with conservatively managed hemodynamically significant (HS) patent ductus arteriosus (PDA) are not known well. We aimed to present the postnatal course in serum creatinine levels (sCr), prevalence of acute kidney injury (AKI), then relevance between AKI and adverse outcomes in EPT with conservatively managed HS PDA. By review of medical records, we analyzed the postnatal course of sCr and prevalence of stage 3 AKI defined by the modified Kidney Disease Improving Global Outcome (KDIGO) in EPT at gestational age of 23 to 26 weeks with conservatively treated HS PDA. We investigated if the presence and/or prolonged duration of stage 3 AKI elevated the risk of adverse outcomes. The results showed that, neither factor was associated with adverse outcomes. While the average PDA closure date was at postnatal day (P) 41 and 53, sCr peaked at P 10 and 14 and the cumulative prevalence of stage 3 AKI was 57% and 72% in the EPT of 25–26 and 23–24 weeks’ gestation, respectively. The high prevalence of stage 3 AKI without adverse outcomes in EPT with conservatively managed HS PDA suggests that it might reflect renal immaturity rather than pathologic conditions.

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