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Cardiology in the Young May 2017A number of case reports show various outcomes of premature closure of the ductus arteriosus in utero, including persistent pulmonary hypertension of the newborn and... (Review)
Review
BACKGROUND
A number of case reports show various outcomes of premature closure of the ductus arteriosus in utero, including persistent pulmonary hypertension of the newborn and fetal or neonatal death; however, no study clarifies the clinical observations that are related to their prognoses. We aimed to clarify the prognostic factors of intrauterine ductal closure by a systematic literature review. Data sources We searched PubMed database (1975-2014) to identify case reports and studies on intrauterine closure of the ductus arteriosus, including maternal, fetal, and neonatal clinical information and their prognoses.
RESULTS
We analysed the data of 116 patients from 39 articles. Of these, 12 (10.3%) died after birth or in utero. Fetal or neonatal death was significantly correlated with fetal hydrops (odds ratio=39.6, 95% confidence interval=4.6-47.8) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.2-15.1). Persistent pulmonary hypertension was observed in 33 cases (28.4%), and was also correlated with fetal hydrops (odds ratio=4.2, 95% confidence interval=1.3-4.6) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.6-6.0). Interestingly, maternal drug administration was not correlated with the risk of death and persistent pulmonary hypertension.
CONCLUSIONS
Fetal hydrops and complete ductal closure are significant risk factors for both death and persistent pulmonary hypertension. Cardiac or neurological prognoses could be favourable if the patients overcome right heart failure during the perinatal period.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Ductus Arteriosus, Patent; Female; Fetal Mortality; Heart; Humans; Hydrops Fetalis; Hypertension, Pulmonary; Infant; Infant Mortality; Infant, Newborn; Pregnancy; Prognosis; Risk Factors; Ultrasonography, Prenatal
PubMed: 27322829
DOI: 10.1017/S1047951116000871 -
Journal of Pediatric Nursing 2023Mothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is...
BACKGROUND
Mothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is essential for providing optimal care and health opportunities for infants, consequently improving developmental outcomes.
METHODS
In this study, we aimed to understand how mothers experienced prematurity within four processes retrospectively: (a) the mother's hospitalization after birth, (b) the infant's hospitalization in the Neonatal Intensive Care Unit (NICU), (c) after discharge, and (d) in early childhood. We adopted Max van Manen's phenomenology of practice and interviewed nine mothers whose children were born premature and reached early childhood.
FINDINGS
The themes were as follows: (a) incomplete mother; (b) facing prematurity, uncertainty, natural touch barrier, facing reductive social response, and NICU friendship; (c) being on the alert, a period of complete closure, and fighting with the reductive social response; (d) association to prematurity and (cannot) overcome the difficulties. We expressed the mothers' overall experiences through the metaphor "living with a birthmark." This metaphor represents the longitudinal effects of prematurity. As much as it is apparent and painful at first, it fades over time, and the pain lessens, but the effects of the birthmark remain in early childhood. The birthmark becomes a part of the mother-baby relationship.
CONCLUSIONS AND PRACTICE IMPLICATIONS
Our study contributes to premature infant care and health literature by highlighting the longitudinal experiences of mothers on prematurity.
Topics: Child, Preschool; Infant, Newborn; Female; Infant; Child; Humans; Mothers; Turkey; Retrospective Studies; Mother-Child Relations; Infant, Premature; Intensive Care Units, Neonatal
PubMed: 36682260
DOI: 10.1016/j.pedn.2023.01.002 -
Frontiers in Pediatrics 2020The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the... (Review)
Review
The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.
PubMed: 33643964
DOI: 10.3389/fped.2020.590578 -
Minerva Pediatrics Oct 2023Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study...
BACKGROUND
Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study was to assess and compare the neonatal morbidity and mortality of multiple versus single very preterm infants.
METHODS
Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 at 11 level III perinatal centers after a surveilled pregnancy, were analyzed and compared. Statistical analysis was performed using IBM SPSS statistics 25 and a p-value < 0.05 was considered statistically significant.
RESULTS
A total of 494 infants delivered from 410 women were enrolled in the study; 320 (64.8%) infants resulted from single gestation and 174 (35.2%) resulted from multiple order gestation (153 double, 21 triple). Multiples were associated with a higher maternal age, a greater use of medically assisted reproduction techniques, higher C-section rates, more frequent full cycle use of antenatal corticosteroids, higher gestational age with adequate birth weight, spent less days on oxygen therapy, presented less prevalence of BPD and cPVL, needed less surgical closure of PDA and had a lower length of stay in NICU. Abruptio placenta, hypertensive disorders of pregnancy and preeclampsia were more frequent in single pregnancies. The multivariate analysis by logistic regression adjusted to gestational age and confounding variables did not show any significant difference on the outcomes of multiples compared to singles.
CONCLUSIONS
The results of our study support the scientific evidence that, with the current practices, the neonatal morbidity and mortality of very premature infants are not different between those resulting from single and multiple gestations.
PubMed: 31692310
DOI: 10.23736/S0026-4946.19.05592-0 -
Catheterization and Cardiovascular... Apr 2020First national multicenter report of interventional closure of patent ductus arteriosus in preterm infants. Results describe commendable technical and procedural success...
First national multicenter report of interventional closure of patent ductus arteriosus in preterm infants. Results describe commendable technical and procedural success of 99% with year-on-year tendency for intervention in smaller patients. Reported complications (8.9%) and outcome (1-year mortality 6.8%) are far superior to contemporary surgical intervention but indicate room for improvement.
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Surveys and Questionnaires; Treatment Outcome
PubMed: 31957974
DOI: 10.1002/ccd.28685 -
Seminars in Fetal & Neonatal Medicine Aug 2018The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in... (Review)
Review
The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in scope and become laden with uncertainty. Associations of ligation with adverse neonatal and neurodevelopmental outcomes have rendered the ligation decision more challenging for clinicians and have been associated with a decline in surgical treatment, but these findings may be due to bias from confounding by indication in observational studies rather than a causal detrimental effect of ligation. Accordingly, ligation may still be indicated for infants with large ductal shunts and moderate-severe respiratory insufficiency in whom the prospect of timely spontaneous closure appears low. Ultimately a randomized trial of surgical ligation versus conservative management is necessary to assess the efficacy of this invasive intervention in a population of extremely preterm infants with large ductal shunts. Simultaneously, the transcatheter approach to ductal closure in the very immature infant represents an exciting therapeutic alternative but which is still in its infancy. Insights into the pathophysiology of postoperative cardiorespiratory deterioration, including the importance of left ventricular afterload, may help clinicians avoid instability and mitigate a potentially injurious aspect of surgical treatment. This review examines the evidence regarding the benefits and risks of PDA surgery in preterm neonates and provides a pathophysiology-based management paradigm to guide perioperative care in high-risk infants.
Topics: Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care, Neonatal; Treatment Outcome
PubMed: 29636280
DOI: 10.1016/j.siny.2018.03.003 -
European Journal of Pediatrics Jun 2024Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of... (Observational Study)
Observational Study
Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of interventional closure in surgical ligation, its application in percutaneous transcatheter closure remains unexplored. This study aims to assess cerebral and renal hemodynamic changes using NIRS during percutaneous closure compared to surgical closure in preterm infants. A prospective observational study enrolled preterm infants born at 32 weeks of gestation or less and diagnosed with hsPDA between January 2020 and December 2022. These infants received either surgical or catheter-based closure of the PDA. Cerebral and renal oxygen saturation was monitored using the INVOS 5100 device from 12 h before the intervention until 24 h after. Linear mixed-effects models were used to analyze time-dependent variables. Twenty-two patients were enrolled, with catheter-based closure performed in 16 cases and conventional surgery in 6 cases. Following ductal closure, a significant increase in renal and cerebral oximetry was observed alongside a decrease in renal and cerebral tissue oxygen extraction. These changes were particularly pronounced in the renal territory. No differences were detected between catheterization and surgical closure. Conclusion: An improvement in cerebral and renal oximetry following hsPDA closure was observed. However, we did not identify differences in this pattern based on the type of interventional procedure for PDA, whether surgery or catheterization. What is Known: • The presence of a significant ductus is common in premature patients. Studies have shown that it affects cerebral and renal hemodynamics negatively, leading to decreased oximetry values in these areas. It has been reported that closure of the ductus, either pharmacologically or surgically, results in improved oximetry values. What is New: • This study assess the impact of percutaneous closure of ductus, revealing increased oximetry values in cerebral and renal territories without significant differences compared to surgical ligation. Notably, renal oximetry values showed a greater increase, underscoring the importance of multi-location monitoring.
Topics: Humans; Infant, Newborn; Prospective Studies; Female; Male; Oximetry; Infant, Premature; Spectroscopy, Near-Infrared; Ductus Arteriosus, Patent; Kidney; Cardiac Catheterization; Cerebrovascular Circulation; Brain
PubMed: 38558310
DOI: 10.1007/s00431-024-05541-3 -
Frontiers in Pediatrics 2022The present review considers some controversial management practices during extremely premature perinatal transition. We focus on perinatal prevention and treatment of... (Review)
Review
The present review considers some controversial management practices during extremely premature perinatal transition. We focus on perinatal prevention and treatment of respiratory distress syndrome (RDS) in immature infants. New concerns regarding antenatal corticosteroid management have been raised. Many fetuses are only exposed to potential adverse effects of the drug. Hence, the formulation and the dosage may need to be modified. Another challenge is to increase the fraction of the high-risk fetuses that benefit from the drug and to minimize the harmful effects of the drug. On the other hand, boosting anti-inflammatory and anti-microbial properties of surfactant requires further attention. Techniques of prophylactic surfactant administration to extremely immature infants at birth may be further refined. Also, new findings suggest that prophylactic treatment of patent ductus arteriosus (PDA) of a high-risk population rather than later selective closure of PDA may be preferred. The TREOCAPA trial (Prophylactic treatment of the ductus arteriosus in preterm infants by acetaminophen) evaluates, whether early intravenous paracetamol decreases the serious cardiorespiratory consequences following extremely premature birth. Lastly, is inhaled nitric oxide (iNO) used in excess? According to current evidence, iNO treatment of uncomplicated RDS is not indicated. Considerably less than 10% of all very premature infants are affected by early persistence of pulmonary hypertension (PPHN). According to observational studies, effective ventilation combined with early iNO treatment are effective in management of this previously fatal disease. PPHN is associated with prolonged rupture of fetal membranes and birth asphyxia. The lipopolysaccharide (LPS)-induced immunotolerance and hypoxia-reperfusion-induced oxidant stress may inactivate NO-synthetases in pulmonary arterioles and terminal airways. Prospective trials on iNO in the management of PPHN are indicated. Other pulmonary vasodilators may be considered as comparison drugs or adjunctive drugs. The multidisciplinary challenge is to understand the regulation of pregnancy duration and the factors participating the onset of extremely premature preterm deliveries and respiratory adaptation. Basic research aims to identify deficiencies in maternal and fetal tissues that predispose to very preterm births and deteriorate the respiratory adaptation of immature infants. Better understanding on causes and prevention of extremely preterm births would eventually provide effective antenatal and neonatal management practices required for the intact survival.
PubMed: 35620146
DOI: 10.3389/fped.2022.862038 -
Drugs Jun 2016The article discusses possible effects of the use of analgesics during pregnancy. It summarizes the pertinent literature and reports some previously unpublished data... (Review)
Review
The article discusses possible effects of the use of analgesics during pregnancy. It summarizes the pertinent literature and reports some previously unpublished data from the Swedish Medical Birth Register. Most likely the use of analgesics does not cause spontaneous abortion. Only small malformation risk increases are seen after the use of opioids and perhaps non-steroid anti-inflammatory drug (NSAID) use. If possible, the latter should be avoided during the first trimester. If exposure has occurred there is no reason to consider an interruption of the pregnancy. Continued use of analgesics may increase the risk of preeclampsia and of preterm birth, especially valid for opioids. Use of acetylsalicylic acid (ASA) in late pregnancy should be avoided because of the risk of bleeding and (valid also for NSAIDs) premature closure of the ductus arteriosus. A small risk for neonatal abstinence syndrome may exist after the use of opioids for chronic pain, notably during the third trimester and long-lasting effects on child development can possibly occur. For a woman with chronic pain, adequate use of pain killers during pregnancy is needed. It is prudent to avoid ASA and NSAIDs towards the end of the pregnancy, while acetaminophen is an acceptable option all through pregnancy. If continued use of opioids is necessary, the associated risks are low. Triptans can be used for migraine during pregnancy. If possible sumatriptan is preferable to other triptans as data for the latter are largely lacking. Ergots are preferably avoided as not enough data are available.
Topics: Acetaminophen; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Chronic Pain; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors; Tryptamines
PubMed: 27154242
DOI: 10.1007/s40265-016-0582-3 -
Minerva Pediatrica Jun 2018This analysis performed a review of giant-omphaloceles to determine the predictors of mortality. (Review)
Review
INTRODUCTION
This analysis performed a review of giant-omphaloceles to determine the predictors of mortality.
EVIDENCE ACQUISITION
PubMed and KoBson databases were searched for terms "giant," "omphalocele," and "mortality." Primary end points included mortality correlation with gestational age (GA), birth weight (BW), eviscerated organs, associated anomalies and management. To calculate mean and median values IBM SPSS v. 23.0 was used.
EVIDENCE SYNTHESIS
After de-duplication and review search revealed 42 articles of which 23 met the inclusion criteria with 396 giant-omphaloceles for this analysis. Median gestational age (GA) was 36 weeks for all neonates (range 21-41); 21 neonates were reported as premature with median GA 33.5 (range 21-36). Overall median birth weight (BW) was 3100 g (range 1100-4100 g). The diameter of abdominal wall defect was 4-15 cm with the average size of 7.6 cm except for non-giant giant omphaloceles (N.=7) where the defect was measuring between 2.7 and 4 cm. Amniotic sac contents beside intestines included liver (N.=154), stomach (N.=11), spleen (N.=2), pancreas (N.=1), gallbladder (N.=5), and 5 giant omphaloceles were reported to contain only liver; sac was ruptured in 22. Giant omphaloceles were associated with a variety of other anomalies, most often with cardiac anomalies (N.=93; 23.4%) and pulmonary hypoplasia and/or pulmonary hypertension (N.=39; 9.8%). Management included conservative treatment N.=264 (66.6%), primary closure (N.=17; 4.3%), staged closures (N.=98; 24.7%) primary or staged closure (N.=17; 4.3%). The most frequent complication was sepsis (N.=52). There were 90 (22.7%) lethal outcomes, 6 lethal outcomes in neonates even before final closure could be achieved and 12 in prematures. Leading cause of mortality was sepsis (N.=51; 56.6%), the cause of lethal outcome was not reported in 8 cases.
CONCLUSIONS
Giant-omphaloceles have a lethal outcome in one-fifth of neonates. Predictors of mortality included pulmonary hypoplasia and respiratory failure with prematurity and ruptured sacs implicated within this group. Sepsis was the independent iatrogenic factor in mortality.
Topics: Abnormalities, Multiple; Birth Weight; Gestational Age; Hernia, Umbilical; Humans; Infant, Newborn; Lung; Lung Diseases; Neonatal Sepsis; Respiratory Insufficiency; Risk Factors
PubMed: 29160639
DOI: 10.23736/S0026-4946.17.05109-X