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Preterm PDA

Se In Sung, Yun Sil Chang, Jisook Kim, Jin Hwa Choi, So Yoon Ahn, Won Soon Park
This study aimed to determine the natural course of patent ductus arteriosus (PDA) with noninterventional conservative management and whether the presence and/or prolonged duration of hemodynamically significant (HS) PDA increased the risk of mortality and morbidities in extremely preterm (EPT) infants. We retrospectively reviewed the medical records of EPT infants born at 23-28 weeks of gestation (n = 195) from January 2011 to June 2014, when PDA was managed with noninterventional conservative treatment. We stratified infants into three subgroups of 23-24, 25-26, and 27-28 weeks and analyzed the prevalence and natural evolution of HS PDA, defined as ventilator dependency and PDA size ≥2 mm...
2019: PloS One
Karl Wilhelm Olsson, Anders Jonzon, Richard Sindelar
AIM: We assessed whether early haemodynamically significant patent ductus arteriosus (hsPDA) predicted persistent PDA in extremely preterm infants. METHODS: This prospective observational study of 60 infants born at 22-27 weeks of gestational age without any major congenital anomalies or heart defects was conducted at Uppsala University Children's Hospital from November 2012 to May 2015. Respiratory and systemic circulatory parameters were continuously recorded and echocardiographic examinations performed daily during the first three days of life...
February 12, 2019: Acta Paediatrica
Batoule Majed, David A Bateman, Natalie Uy, Fangming Lin
BACKGROUND: This study aimed to test the hypothesis that a patent ductus arteriosus (PDA) is independently associated with acute kidney injury (AKI) in neonates ≤ 28 weeks gestation. METHODS: Preterm infants with echocardiographic diagnosis of moderate-large PDA at age ≤ 30 days were studied retrospectively. AKI, the primary outcome, was defined and staged according to serum creatinine using Kidney Disease Improving Global Outcomes (KDIGO) neonatal criteria...
January 31, 2019: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Maarja Hallik, Mari-Liis Ilmoja, Tõnis Tasa, Joseph F Standing, Kalev Takkis, Rūta Veigure, Karin Kipper, Tiiu Jalas, Maila Raidmäe, Karin Uibo, Joel Starkopf, Tuuli Metsvaht
OBJECTIVES: The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10-45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature neonates at risk of postligation cardiac syndrome and give dosing recommendations. DESIGN: A prospective single group open-label pharmacokinetics study...
January 18, 2019: Pediatric Critical Care Medicine
Alona Bin-Nun, Yair Kasirer, Francis Mimouni, Irina Schorrs, Daniel Fink, Cathy Hammerman
BACKGROUND AND OBJECTIVES:  Widened pulse pressure is generally associated with patent ductus arteriosus (PDA). Surprisingly, this is often not true for preterm infants during the first week of life when systolic and diastolic pressures are both reduced and pulse pressure may remain unchanged. METHODS:  This is a retrospective, observational review of individual blood pressure (BP) parameters preterm neonates <30 weeks' gestational age during the first week of life as correlated with ductal patency and severity...
January 15, 2019: American Journal of Perinatology
Sonia El-Saiedi, Antoine Fakhry AbdelMassih, Yasser Sedky, Amr Malash, Nouran Hussain, Monica Alfons, Rana Essam
Background: Hemodynamically significant (HS) patent ductus arteriosus (PDA) is a significant cause of mortality in preterm neonates. Early detection of HS PDA and pre-symptomatic closure may help in avoiding complications. For this to happen, easily performed predictors must be available; the aim of this paper is to test the reliability and repeatability of tissue Doppler-derived parameters for prediction of HS PDA. Methods: Preterm neonates <32 weeks were screened with echocardiography at Day 3 of life; 80 neonates with PDA were classified into HS group and hemodynamically insignificant (HIS) group based on benchmark parameter namely left ventricular outflow to superior vena caval flow ratio (LVO/SVC), and a ratio ≥4 was considered predictive of HS PDA...
April 2019: Journal of the Saudi Heart Association
J M Toye, J Yang, K Sankaran
BACKGROUND: Mechanical ventilation (MV) causes discomfort but whether it causes pain remains controversial. Around the world neonatal intensive care units (NICU) often utilize narcotics and/or sedatives during MV of vulnerable infants yet the association with adverse neonatal outcomes has not been adequately addressed. OBJECTIVE: Test for associations between the use of narcotics/sedatives during MV and mortality/morbidity in preterm infants in a large infant cohort in Canada...
December 31, 2018: Journal of Neonatal-perinatal Medicine
Ruben Vaidya, Donna Wilson, Yvonne Paris, Laura Madore, Rachana Singh
PURPOSE: Patent ductus arteriosus (PDA) continues to be one of the most common complications associated with preterm birth. Up to 70% of infants born before 28 weeks gestational age may require some form of medical or surgical treatment for PDA closure. Recent studies have suggested acetaminophen to be a promising new alternative to indomethacin and ibuprofen for closure of PDA with potentially fewer adverse effects. Our aim for the study was to report our experience regarding the efficacy of acetaminophen compared to indomethacin for treatment of hemodynamically significant PDA (hs-PDA) in infants born in our institution...
January 28, 2019: Journal of Maternal-fetal & Neonatal Medicine
Jennifer L Shepherd, Shahab Noori
OBJECTIVE: There is no consensus on the definition of a hemodynamically significant patent ductus arteriosus (hsPDA). In this review article, our objective is to discuss the main variables that one should consider when determining the hemodynamic significance of a PDA. RESULTS: We describe the various approaches that have been utilized over time to define an hsPDA and discuss the strengths and weaknesses of each echocardiographic index. Finally, we propose a comprehensive and individualized approach in determining the hemodynamic significance of the PDA...
December 12, 2018: Congenital Heart Disease
P Thakore, A E Dunbar, E B Lindsay
A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant's initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted...
December 1, 2018: Journal of Neonatal-perinatal Medicine
Maria Gillam-Krakauer, Jeff Reese
Preterm infants are at increased risk for patent ductus arteriosus (PDA). Prolonged exposure to PDA may be deleterious and has been associated with neonatal morbidity and mortality. Although the molecular mechanisms underlying regulation of postnatal ductus arteriosus closure are not fully understood, clinical experience and research trials have informed recent changes in PDA management strategies and refocused treatment strategies on smaller subsets of infants who require intervention. This review examines current diagnostic and management approaches to PDA in preterm neonates...
July 2018: NeoReviews
Chen-Hong Wang, Li-Ping Shi, Xiao-Lu Ma, Li-Zhong DU
OBJECTIVE: To study the clinical features and prognosis of bronchopulmonary dysplasia (BPD) complicated by pulmonary hypertension (PH) in preterm infants. METHODS: A retrospective analysis was performed on the clinical data of 191 preterm infants with BPD. RESULTS: In the 191 preterm infants with BPD, 37 (19.4%), all with moderate or severe BPD, developed PH beyond 36 weeks' corrected age. The incidence rates of PH in infants with moderate and severe BPD were 5...
November 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Kai-Hsiang Hsu, Pierre Wong, S Ram Kumar, Julie Evans, Shahab Noori
OBJECTIVE: To characterize preterm infants that demonstrates respiratory improvement 7 days after ligation of a patent ductus arteriosus (PDA). STUDY DESIGN: We performed a 2-phase study of preterm infants (birthweight <1500 g between 2010 and 2016). We first did a retrospective analysis using regression modeling of ligation population. We then performed a case-control study comparing a ligation group with infants matched by gestational age, postnatal age, and preligation respiratory condition (ventilator mode, mean airway pressure [MAP], and fraction of inspired oxygen [FiO2 ])...
February 2019: Journal of Pediatrics
Ronald I Clyman, Melissa Liebowitz, Joseph Kaempf, Omer Erdeve, Ali Bulbul, Stellan Håkansson, Johanna Lindqvist, Aijaz Farooqi, Anup Katheria, Jason Sauberan, Jaideep Singh, Kelly Nelson, Andrea Wickremasinghe, Lawrence Dong, Denise C Hassinger, Susan W Aucott, Madoka Hayashi, Anne Marie Heuchan, William A Carey, Matthew Derrick, Erika Fernandez, Meera Sankar, Tina Leone, Jorge Perez, Arturo Serize
OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial...
October 16, 2018: Journal of Pediatrics
Gamze Demirel, Aslan Yılmaz, Binay Vatansever, Ayhan Tastekin
AIM: To determine whether there is any association between platelet indices within the first hours of life and hemodynamically significant patent ductus arteriosus (hsPDA) in preterm newborns. PATIENT AND METHODS: A total of 100 preterm infants, gestational age < 32 weeks and birth weight < 1500 grams were analyzed in the study. Complete blood counts obtained within the first 6 hours of life were evaluated for platelet parameters and compared for patent ductus arteriosus (PDA) status...
October 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Ufuk Cakir, Cuneyt Tayman
OBJECTIVE:  Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. STUDY DESIGN:  Our study was conducted between January 2013 and December 2017. Premature infants, birth weight <1,500 g and gestational age <32 weeks were included in the study...
October 6, 2018: American Journal of Perinatology
Karl Wilhelm Olsson, Anders Larsson, Anders Jonzon, Richard Sindelar
BACKGROUND: Early identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants. METHODS: Infants born at 22-27 weeks' gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen...
September 18, 2018: Pediatric Research
R Thomas Collins, Robert E Lyle, Mallikarjuna Rettiganti, Jeffrey M Gossett, James M Robbins, Patrick H Casey
OBJECTIVE: To evaluate whether the presence of patent ductus arteriosus (PDA) in preterm infants worsens long-term neurodevelopmental outcomes. STUDY DESIGN: This was a secondary observational analysis of data from 1090 preterm low-birthweight infants in the Infant Health and Development Program (IHDP), a multicenter longitudinal cohort study of outcomes assessed from 3 to 18 years of age. Multivariable analysis was adjusted for IHDP treatment group (intervention or follow-up), birth weight, maternal race, maternal education, infant sex, maternal preconception weight, Home Observation Measurement of the Environment (HOME) total score at 12 months, neonatal health index, and gestational age...
December 2018: Journal of Pediatrics
Arne Ohlsson, Rajneesh Walia, Sachin S Shah
BACKGROUND: Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to several organs. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective as indomethacin with fewer adverse effects. OBJECTIVES: To determine the effectiveness and safety of ibuprofen compared with indomethacin, other cyclo-oxygenase inhibitor(s), placebo, or no intervention for closing a patent ductus arteriosus in preterm, low-birth-weight, or preterm and low-birth-weight infants...
September 28, 2018: Cochrane Database of Systematic Reviews
James I Hagadorn, Mihoko V Bennett, Elizabeth A Brownell, Kurlen S E Payton, William E Benitz, Henry C Lee
OBJECTIVE: To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants. STUDY DESIGN: This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs...
September 20, 2018: Journal of Pediatrics
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