Velocity time integral for right upper pulmonary vein in VLBW infants with patent ductus arteriosus

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children’s Hospital during 2005–2013. For each infant, we investigated 600 time-points of MAP recorded 4–24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + 1/7 weeks) consisted of infants whose mean MAP was lower at 18–24 hours than at 4–10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + 5/7 weeks) included infants with a higher mean MAP at 18–24 hours than at 4–10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18–24 hours than at 4–10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14–3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23–2.72; p = 0.003).

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The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

Neonatology ◽

10.1159/000507553 ◽

2020 ◽

Vol 117 (3) ◽

pp. 316-323

Author(s):

Stefano Ghirardello ◽

Genny Raffaeli ◽

Beatrice Letizia Crippa ◽

Silvia Gulden ◽

Ilaria Amodeo ◽

...

Keyword(s):

Birth Weight ◽

Patent Ductus Arteriosus ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Maximum Amplitude ◽

Treated Group ◽

Full Blood Count ◽

Vlbw Infants ◽

Preterm Newborns ◽

Patent Ductus

Background: The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. Methods: This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of <33 weeks’ gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. Results: We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (p < 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; p = 0.01) and platelet count (187 and 216 × 103/μL; p = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (n = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; p = 0.02). Conclusion: TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.

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DIAGNOSIS OF PATENT DUCTUS ARTERIOSUS IN VLBW INFANTS BY PRECORDIAL CONTRAST ECHOCARDIOGRAPHY(CE)

Pediatric Research ◽

10.1203/00006450-198404001-01494 ◽

1984 ◽

Vol 18 ◽

pp. 342A-342A

Author(s):

Philip G Rhodes ◽

Mitzi G Ferguson ◽

James A Joransen ◽

Daksha M Patel

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Contrast Echocardiography ◽

Vlbw Infants ◽

Patent Ductus

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Patent ductus arteriosus treatment trends and associated morbidities in neonates

Scientific Reports ◽

10.1038/s41598-021-89868-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Joonsik Park ◽

So J Yoon ◽

Jungho Han ◽

In G Song ◽

Joohee Lim ◽

...

Keyword(s):

Conservative Treatment ◽

Patent Ductus Arteriosus ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Careful Consideration ◽

Vlbw Infants ◽

Surgical Ligation ◽

Oral Ibuprofen ◽

Intravenous Ibuprofen ◽

Patent Ductus

AbstractTo evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.

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Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants

Children ◽

10.3390/children8050398 ◽

2021 ◽

Vol 8 (5) ◽

pp. 398

Author(s):

Yu-Jen Wei ◽

Yen-Ju Chen ◽

Yung-Chieh Lin ◽

Chung-Dann Kan ◽

Min-Ling Hsieh ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Post Intervention ◽

Vlbw Infants ◽

Transcatheter Occlusion ◽

Surgical Ligation ◽

Group A ◽

Respiratory Outcomes ◽

Patent Ductus ◽

Invasive Intervention

Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.

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Early predictive echocardiographic features of hemodynamically significant patent ductus arteriosus in preterm VLBW infants

Pediatrics International ◽

10.1111/ped.12915 ◽

2016 ◽

Vol 58 (7) ◽

pp. 589-594 ◽

Cited By ~ 4

Author(s):

Tugcin Bora Polat ◽

Istemi Han Celik ◽

Omer Erdeve

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Vlbw Infants ◽

Patent Ductus

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Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

Frontiers in Pediatrics ◽

10.3389/fped.2021.729461 ◽

2021 ◽

Vol 9 ◽

Author(s):

Junyan Zhong ◽

Binchun Lin ◽

Yongping Fu ◽

Yanliang Yu ◽

Jie Zhao ◽

...

Keyword(s):

Platelet Count ◽

Birth Weight ◽

Patent Ductus Arteriosus ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Multivariate Logistic Regression Analysis ◽

Concurrent Infection ◽

Vlbw Infants ◽

Oral Ibuprofen ◽

Patent Ductus

Background: Platelet-rich thrombosis leads to the occlusion of arteries. Whether the association between platelet count and closure of hemodynamically significant patent ductus arteriosus (hsPDA) exists remains inconclusive. Given that neonatal platelet count is significantly affected by infection, this study aims to evaluate the association of platelet parameters before ibuprofen treatment with the closure of hsPDA in very low birth weight (VLBW) infants without concurrent infection.Methods: A retrospective study was conducted at the NICU of Shenzhen Maternity and Child Healthcare Hospital from January 2016 to August 2020. VLBW infants diagnosed with hsPDA, treated with oral ibuprofen and without concurrent infection were included in this study. The platelet parameters were retrieved from the whole-blood test routinely performed within 24 h before starting treatment of oral ibuprofen. A multiple regression model was built to evaluate the association between platelet parameters before ibuprofen treatment and successful closure of hsPDA.Results: A total of 129 premature infants with hsPDA were analyzed in this study. After oral ibuprofen treatment, successful closure of hsPDA was achieved in 70 (54.3%) infants. The gestational age at birth and birth weight in infants with successful or failed closure of hsPDA after ibuprofen treatment were 28.3 vs. 27.6 weeks (p = 0.016) and 1,120 vs. 960 g (p = 0.043), respectively. The rate of mechanical ventilation in infants with successful closure of hsPDA was significantly lower compared to those with failed closure of hsPDA, 31.4 vs. 54.2%, p = 0.014. The platelet count in infants with successful closure of hsPDA after ibuprofen treatment was significantly higher compared to those with failed closure of hsPDA, 212 vs. 183 (in a unit of 109/L), respectively (p = 0.024). Multivariate logistic regression analysis showed that a higher platelet count (≥181 × 109/L) before ibuprofen treatment was independently associated with successful closure of hsPDA [odds ratio 2.556, 95% confidence interval (1.101–5.932), p = 0.029].Conclusion: The findings in this study suggest that a higher platelet count before oral ibuprofen treatment may predict the probability of successful closure of hsPDA in VLBW infants.

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