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Current Problems in Cardiology Sep 2023This was a first-time evaluation that sought to analyze the cost-effectiveness of oral paracetamol and intravenous (IV) indomethacin as alternatives to ibuprofen for PDA...
This was a first-time evaluation that sought to analyze the cost-effectiveness of oral paracetamol and intravenous (IV) indomethacin as alternatives to ibuprofen for PDA in neonates. Decision-analytic, literature-based, economic simulation models were constructed, to follow up the use and consequences of oral/IV ibuprofen versus IV indomethacin, and oral/IV ibuprofen versus oral paracetamol, as first-line therapies for PDA closure. Model outcomes of interest were "success", defined as PDA closure with/without adverse events, or "failure" due to no response to the first course of treatment, death or premature discontinuation of therapy due to adverse events. Oral ibuprofen is dominant/cost-effective over IV indomethacin in 97.9% of simulated cases, but oral paracetamol was 75.2% dominant/cost-effective over oral ibuprofen. Against IV ibuprofen, IV indomethacin was 55.3% dominant/cost-effective, whereas oral paracetamol was dominant/cost-effective in 98.5% of the cases. Sensitivity analyses confirmed the robustness of the study results. For PDA closure, while IV indomethacin was cost-effective against IV ibuprofen, oral paracetamol was cost-effective against both oral and IV ibuprofen.
Topics: Infant, Newborn; Humans; Indomethacin; Ibuprofen; Ductus Arteriosus, Patent; Acetaminophen; Infant, Premature; Cyclooxygenase Inhibitors; Infant, Low Birth Weight; Cost-Effectiveness Analysis
PubMed: 37088173
DOI: 10.1016/j.cpcardiol.2023.101751 -
BMC Cardiovascular Disorders Mar 2024Takotsubo syndrome (TTS), commonly referred to as "broken heart syndrome," is a distinctive form of acute and reversible heart failure that primarily affects young to...
Takotsubo syndrome (TTS), commonly referred to as "broken heart syndrome," is a distinctive form of acute and reversible heart failure that primarily affects young to middle-aged individuals, particularly women. While emotional or physical stressors often trigger TTS, rare cases have been linked to interventional procedures for congenital heart disease (CHD). Despite its recognition, the exact causes of TTS remain elusive. Research indicates that dysregulation in autonomic nerve function, involving sympathetic and parasympathetic activities, plays a pivotal role. Genetic factors, hormonal influences like estrogen, and inflammatory processes also contribute, unveiling potential gender-specific differences in its occurrence. Understanding these multifaceted aspects of TTS is crucial for refining clinical approaches and therapies. Continued research efforts will not only deepen our understanding of this syndrome but also pave the way for more targeted and effective diagnostic and treatment strategies. In this report, we conduct an in-depth analysis of a case involving a TTS patient, examining the illness progression and treatment procedures. The aim of this analysis is to enhance the understanding of TTS among primary care physicians. By delving into this case, we aspire to prevent misdiagnosis of typical TTS cases that patients may present, thereby ensuring a more accurate diagnosis and appropriate treatment.
Topics: Middle Aged; Humans; Female; Takotsubo Cardiomyopathy; Ductus Arteriosus, Patent; Heart Failure; Emotions; Syndrome
PubMed: 38431545
DOI: 10.1186/s12872-024-03788-0 -
European Journal of Medical Research Nov 2023Trauma is the leading cause of death in the pediatric population. Although vascular trauma has an incidence of 6% in civilian population, iatrogenic injuries are the... (Review)
Review
Trauma is the leading cause of death in the pediatric population. Although vascular trauma has an incidence of 6% in civilian population, iatrogenic injuries are the leading cause, and the most frequent injured vessel is the iliofemoral sector. However, little information is available and there are no guidelines about its treatment. Therefore, this review aimed to describe the information available concerning pediatric iatrogenic arterial trauma, focusing on the iliofemoral segment and present 3 cases. We described 11 articles with 171 patients, of whom 61% underwent surgery to treat iatrogenic trauma. Mean age was 3.28 years (standard deviation of 3.5 years), and 54% were female. Most iliofemoral injuries occurred after arterial catheterization for hemodynamic monitorization and therapeutic or diagnostic cardiac catheterization (due to congenital heart diseases, including septal defects, tetralogy of Fallot, aortic coarctation, and patent ductus arteriosus). For acute complications, arterial thrombosis was the leading injury, followed by pseudoaneurysm, hematoma, dissection, transection, avulsion, eversion, and combined lesions.
Topics: Child; Humans; Female; Child, Preschool; Male; Heart Defects, Congenital; Heart; Arteries; Cardiac Catheterization; Iatrogenic Disease
PubMed: 37968770
DOI: 10.1186/s40001-023-01510-y -
BMC Pediatrics Aug 2023To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge.
BACKGROUND
To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge.
METHODS
The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28.
RESULTS
This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors.
CONCLUSION
SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR.
TRIAL REGISTRATION
CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn .
Topics: Female; Infant; Male; Infant, Newborn; Humans; Birth Weight; Gestational Age; Infant, Newborn, Diseases; Infant, Premature, Diseases; China; Milk, Human; Infant, Premature
PubMed: 37653371
DOI: 10.1186/s12887-023-04245-1 -
Interdisciplinary Cardiovascular and... Oct 2023The dislodgement of device during transcatheter procedure is a rare complication and the device can be retrieved by transcatheter techniques in most cases. In case of...
The dislodgement of device during transcatheter procedure is a rare complication and the device can be retrieved by transcatheter techniques in most cases. In case of failed attempts, the surgery may be required and in haemodynamically unstable patients cardiopulmonary bypass (CPB) may be unavoidable. A case of surgical retrieving of patent ductus arteriosus (PDA) occlusion device (OD) from the right pulmonary artery (PA) in a 1050 g baby on CPB was presented. In literature, CPB use in babies weighing under 1 kg has been rarely reported. CPB support was performed securely in our case who is one of the tiniest patients operated on. CPB can be safe enough in the surgical approach of a complication of very low birth weight patient.
PubMed: 37740326
DOI: 10.1093/icvts/ivad162 -
American Journal of Physiology. Heart... Oct 2023The ductus arteriosus (DA) is a vascular shunt that allows oxygenated blood to bypass the developing lungs in utero. Fetal DA patency requires vasodilatory signaling via...
The ductus arteriosus (DA) is a vascular shunt that allows oxygenated blood to bypass the developing lungs in utero. Fetal DA patency requires vasodilatory signaling via the prostaglandin E (PGE) receptor EP. However, in humans and mice, disrupted PGE-EP signaling in utero causes unexpected patency of the DA (PDA) after birth, suggesting another role for EP during development. We used EP-knockout (KO) mice and acute versus chronic pharmacological approaches to investigate EP signaling in DA development and function. Expression analyses identified EP as the primary EP receptor in the DA from midgestation to term; inhibitor studies verified EP as the primary dilator during this period. Chronic antagonism recapitulated the EP KO phenotype and revealed a narrow developmental window when EP stimulation is required for postnatal DA closure. Myography studies indicate that despite reduced contractile properties, the EP KO DA maintains an intact oxygen response. In newborns, hyperoxia constricted the EP KO DA but survival was not improved, and permanent remodeling was disrupted. Vasomotion and increased nitric oxide (NO) sensitivity in the EP KO DA suggest incomplete DA development. Analysis of DA maturity markers confirmed a partially immature EP KO DA phenotype. Together, our data suggest that EP signaling in late gestation plays a key developmental role in establishing a functional term DA. When disrupted in EP KO mice, the postnatal DA exhibits signaling and contractile properties characteristic of an immature DA, including impairments in the first, muscular phase of DA closure, in addition to known abnormalities in the second permanent remodeling phase. EP is the primary EP receptor in the ductus arteriosus (DA) and is critical during late gestation for its development and eventual closure. The "paradoxical" patent DA (PDA) phenotype of EP-knockout mice arises from a combination of impaired contractile potential, altered signaling properties, and a failure to remodel associated with an underdeveloped immature vessel. These findings provide new mechanistic insights into women who receive NSAIDs to treat preterm labor, whose infants have unexplained PDA.
Topics: Mice; Animals; Infant, Newborn; Female; Pregnancy; Humans; Ductus Arteriosus; Dinoprostone; Receptors, Prostaglandin E, EP4 Subtype; Ductus Arteriosus, Patent; Mice, Knockout
PubMed: 37566109
DOI: 10.1152/ajpheart.00294.2023 -
Turkish Archives of Pediatrics Nov 2023Congenital heart disease (CHD) is one of the common diseases of childhood, which is classified into non-cyanotic and cyanotic types. It can affect thyroid function and...
OBJECTIVE
Congenital heart disease (CHD) is one of the common diseases of childhood, which is classified into non-cyanotic and cyanotic types. It can affect thyroid function and lead to disruptions in thyroid hormone secretion and hypofunction. This study aimed to evaluate thyroid function in patients younger than 2 years old with cyanotic and non-cyanotic CHD.
MATERIALS AND METHODS
In our study, 101 patients (female/male: 50/51) were included. The thyroid-stimulating hormone and thyroid hormones such as thyroxine (T4) and triiodothyronine (T3) were measured using the electrochemiluminescence method, and thyroid peroxidase antibodies were measured by an enzyme-linked immunosorbent assay. Subclinical hypothyroidism referred to normal levels of T4, with elevated levels of thyroid-stimulating hormone in the serum.
RESULTS
The frequency of subclinical hypothyroidism and hypothyroidism in patients with cyanotic CHD was estimated at 27.5% and 10%, respectively, and 1 patient had hyperthyroidism. The majority of cyanotic and non-cyanotic CHD cases were diagnosed with tetralogy of Fallot (30%) and patent ductus arteriosus (32.79%). There were no significant differences between cyanotic and non-cyanotic groups regarding T3, T4, free T3, free T4, and anti-thyroid peroxidase antibody levels (0.389, 0.142, 0.354, 0.248, and 0.333, respectively).
CONCLUSION
Based on the present findings, subclinical hypothyroidism is a common finding in cyanotic CHD patients during childhood, which is associated with increased levels of oxygen saturation, severity of cyanosis, and age.
PubMed: 37737230
DOI: 10.5152/TurkArchPediatr.2023.22277 -
Journal of Cardiovascular Development... Jan 2024In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of...
In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011-2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson's correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the "posture/motor" sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.
PubMed: 38248896
DOI: 10.3390/jcdd11010026 -
Journal of Clinical Medicine Dec 2023Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency with substantial morbidity and mortality risks, especially for very low-birth-weight (VLBW)... (Review)
Review
Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency with substantial morbidity and mortality risks, especially for very low-birth-weight (VLBW) infants, and unclear multifactorial pathophysiology. Whether common treatments for VLBW infants increase the NEC risk remains controversial. Indomethacin (utilized for patent ductus arteriosus) offers benefits but is concerning because of its vasoconstrictive impact on NEC susceptibility. Similarly, corticosteroids used to treat bronchopulmonary dysplasia may increase vulnerability to NEC by compromising immunity and altering the mesenteric blood flow. Histamine-2 receptor blockers (used to treat gastric bleeding) may inadvertently promote NEC by affecting bacterial colonization and translocation. Doxapram (used to treat apnea) poses a risk of gastrointestinal disturbance via gastric acid hypersecretion and circulatory changes. Glycerin enemas aid meconium evacuation but disrupt microbial equilibrium and trigger stress-related effects associated with the NEC risk. Prolonged antibiotic use may unintentionally increase the NEC risk. Blood transfusions for anemia can promote NEC via interactions between the immune response and ischemia-reperfusion injury. Probiotics for NEC prevention are associated with concerns regarding sepsis and bacteremia. Amid conflicting evidence, this review unveils NEC risk factors related to treatments for VLBW infants, offers a comprehensive overview of the current research, and guides personalized management strategies, thereby elucidating this clinical dilemma.
PubMed: 38202069
DOI: 10.3390/jcm13010062 -
Journal of the American Heart... Jul 2023Background As partial pressure of oxygen (pO) rises with the first breath, the ductus arteriosus (DA) constricts, diverting blood flow to the pulmonary circulation. The...
Background As partial pressure of oxygen (pO) rises with the first breath, the ductus arteriosus (DA) constricts, diverting blood flow to the pulmonary circulation. The DA's O sensor resides within smooth muscle cells. The DA smooth muscle cells' mitochondrial electron transport chain (ETC) produces reactive oxygen species (ROS) in proportion to oxygen tension, causing vasoconstriction by regulating redox-sensitive ion channels and enzymes. To identify which ETC complex contributes most to DA O sensing and determine whether ROS mediate O sensing independent of metabolism, we used electron leak suppressors, S1QEL (suppressor of site I electron leak) and S3QEL (suppressor of site III electron leak), which decrease ROS production by inhibiting electron leak from quinone sites I and III, respectively. Methods and Results The effects of S1QEL, S3QEL, and ETC inhibitors (rotenone and antimycin A) on DA tone, mitochondrial metabolism, O-induced changes in intracellular calcium, and ROS were studied in rabbit DA rings, and human and rabbit DA smooth muscle cells. S1QEL's effects on DA patency were assessed in rabbit kits, using micro computed tomography. In DA rings, S1QEL, but not S3QEL, reversed O-induced constriction (=0.0034) without reducing phenylephrine-induced constriction. S1QEL did not inhibit mitochondrial metabolism or ETC-I activity. In human DA smooth muscle cells, S1QEL and rotenone inhibited O-induced increases in intracellular calcium (=0.02 and 0.001, respectively), a surrogate for DA constriction. S1QEL inhibited O-induced ROS generation (=0.02). In vivo, S1QEL prevented O-induced DA closure (<0.0001). Conclusions S1QEL, but not S3QEL, inhibited O-induced rises in ROS and DA constriction ex vivo and in vivo. DA O sensing relies on pO-dependent changes in electron leak at site I in ETC-I, independent of metabolism. S1QEL offers a therapeutic means to maintain DA patency.
Topics: Animals; Humans; Rabbits; Ductus Arteriosus; Oxygen; Reactive Oxygen Species; Electron Transport; Calcium; Electrons; Rotenone; X-Ray Microtomography
PubMed: 37345832
DOI: 10.1161/JAHA.122.029131