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Pediatrics Nov 2021Patent ductus arteriosus (PDA) treatment is common among very low birth weight (VLBW) infants. Given limitations in evidence, controversy exists regarding treatment...
BACKGROUND
Patent ductus arteriosus (PDA) treatment is common among very low birth weight (VLBW) infants. Given limitations in evidence, controversy exists regarding treatment risks and benefits. In this study, we describe PDA treatment trends and variation in a large, US, multicenter VLBW infant cohort.
METHODS
Data were collected through Vermont Oxford Network on 291 292 VLBW infants born 2012-2019 at 806 US NICUs. PDA diagnosis and treatment rates, further categorized as pharmacologic, invasive, or combined, were determined. NICUs were classified as capable versus noncapable of invasive PDA treatment. Infant and hospital characteristics were examined by NICU type and treatment quartile. Geographic NICU distribution and treatment rates were described in 9 US census divisions.
RESULTS
Of all infants, 24.6% were diagnosed with and 20.5% were treated for PDA. Diagnosis and treatment rates decreased over the study period. Treatment was predominantly pharmacologic. Treatment rates varied widely among NICUs (0% to 67%) despite similar infant characteristics. The median treatment rate was higher at NICUs capable of pharmacologic and invasive treatment (20.3%, interquartile range 13.3-28.6) than at NICUs capable of only pharmacologic treatment (8.9%, interquartile range 2.9-14.8). Treatment rates were highest in the northeast and lowest in the west. Invasive treatment was more common in the west.
CONCLUSIONS
PDA diagnosis and treatment rates are trending downward. Wide variation exists in PDA treatment despite a largely uniform VLBW infant population. This variation correlates with differences in hospital treatment capabilities and geography. Further understanding of the effects of treatment disparity could aid in guiding clinical management.
Topics: Ductus Arteriosus, Patent; Female; Humans; Infant, Newborn; Infant, Small for Gestational Age; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Respiration, Artificial; United States
PubMed: 34675131
DOI: 10.1542/peds.2021-052874 -
Journal of Pediatric Health Care :... 2002
Review
Topics: Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Neonatal Nursing
PubMed: 12436101
DOI: No ID Found -
Kardiologia Polska 2024
Topics: Adult; Humans; Ductus Arteriosus, Patent
PubMed: 38493465
DOI: 10.33963/v.phj.99551 -
NeoReviews Jul 2020In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful,... (Meta-Analysis)
Meta-Analysis
In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful, health care practitioners have sought new approaches to achieve definitive ductal closure. Interest in percutaneous (catheter-based) PDA closure has emerged within the neonatal community as a viable treatment option, because it has been fueled by recent procedural and device modifications, as well as mounting feasibility and safety data. Herein, we provide a contemporary review of percutaneous PDA closure among infants at the crux of the medical debate-very-low-weight infants (≤1,500 g), including: 1) characterization of traditional PDA treatments (drug therapy, open surgical ligation) and conservative (nonintervention) management options; 2) a general overview of the major procedural steps of percutaneous ductal closure, including efforts to reduce thrombotic complications and the emergence of a novel US Food and Drug Administration-approved device; 3) a systematic review and meta-analysis to better understand risk profiles of percutaneous PDA closure in this population; and 4) discussion of current gaps in our understanding of optimal PDA care, including the critical need for well-designed, randomized, controlled clinical trials.
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Very Low Birth Weight
PubMed: 32611564
DOI: 10.1542/neo.21-7-e469 -
Clinical Pharmacy Jan 1989The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is... (Review)
Review
The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is discussed. Spontaneous closure of the ductus arteriosus (DA) usually occurs within four days after birth in most premature and full-term infants. The incidence of PDA is related to birth weight in premature infants and has been shown to decrease with an increase in birth weight. Clinical findings are reviewed. Prophylactic treatment in the first few hours after birth may not be needed in most premature infants. Treatment should be considered only if the ductus becomes symptomatic. Medical management consists of respiratory support, fluid restriction, diuretics, digoxin, and indomethacin. Respiratory support, fluid restriction, and diuretics are used as first-line treatment of symptomatic PDA. Digoxin cannot be recommended as part of first-line therapy, since its risks seem to outweigh the benefits in preterm infants. Indomethacin should be used only if other standard measures including fluid restriction and diuretic treatment fail. The mechanism of action, pharmacokinetics, adverse effects, and drug interactions of indomethacin are discussed. Symptomatic PDA can increase morbidity and mortality, especially in very low birth weight infants. Treatment of symptomatic PDA may decrease the morbidity associated with this condition.
Topics: Digoxin; Diuretics; Ductus Arteriosus, Patent; Fluid Therapy; Humans; Indomethacin; Infant, Newborn
PubMed: 2643499
DOI: No ID Found -
Brazilian Journal of Cardiovascular... Dec 2020We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active...
We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active aortic valve endocarditis successfully treated by surgery. The correct diagnosis was missed despite preoperative diagnostics because the small patent ductus arteriosus was located at the distal part of common pulmonary trunk and a huge regurgitant signal overlapped its Doppler signal. Thorough evaluation of every patient, regardless of age, is necessary to recognize and treat this congenital anomaly.
Topics: Aged; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography; Humans; Male; Middle Aged; Pulmonary Artery
PubMed: 33306329
DOI: 10.21470/1678-9741-2019-0124 -
Seminars in Neonatology : SN Feb 2001Patent ductus arteriosus (PDA) is a common problem in very preterm infants. It results in a significant left-to-right shunt and an increase in left ventricular output.... (Review)
Review
Patent ductus arteriosus (PDA) is a common problem in very preterm infants. It results in a significant left-to-right shunt and an increase in left ventricular output. Pulmonary compliance can be reduced. Systemic effects result from the diastolic steal and retrograde diastolic blood flow. Randomized controlled trials of PDA closure fall into three groups: (i) prophylactic treatment in the first 24 h, (ii) pre-symptomatic treatment on ultrasound evidence of a PDA or the first clinical signs and (iii) treatment when it becomes haemodynamically significant. Prophylactic treatment with indomethacin reduces the incidence of intraventricular haemorrhage. All the trials have a decreased need to treat a subsequent PDA in the treatment group. There are no other improvements in outcome, without any change in mortality, bronchopulmonary dysplasia, necrotizing enterocolitis or retinopathy of prematurity. Clinical decisions on the treatment of the ductus should be individualized and based on the gestation of the baby, the respiratory condition and the size of the ductal shunt.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Randomized Controlled Trials as Topic
PubMed: 11162286
DOI: 10.1053/siny.2000.0036 -
International Journal of Technology... 1991
Review
Topics: Animals; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn
PubMed: 2037442
DOI: 10.1017/s026646230001254x -
Journal of Veterinary Cardiology : the... Dec 2021A five-month-old, intact female domestic shorthair cat was presented to a specialty referral hospital for evaluation of a patent ductus arteriosus. Transvenous...
A five-month-old, intact female domestic shorthair cat was presented to a specialty referral hospital for evaluation of a patent ductus arteriosus. Transvenous embolization of the defect was achieved with a commercially available peripheral vascular plug. The use of vascular plugs for the closure of patent ductus arteriosus has been validated in dogs, yet literature for its use in cats is lacking. The product and procedural details of the device are described.
Topics: Animals; Cardiac Catheterization; Cat Diseases; Cats; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Embolization, Therapeutic; Female; Treatment Outcome
PubMed: 34757249
DOI: 10.1016/j.jvc.2021.09.006 -
JPMA. the Journal of the Pakistan... Mar 2018Patent ductus arteriosus is a common congenital cardiac defect comprising 5-10% of all these defects in term neonates. Although open chest and video-assisted...
Patent ductus arteriosus is a common congenital cardiac defect comprising 5-10% of all these defects in term neonates. Although open chest and video-assisted interruption are still in use, transcatheter occlusion has rapidly become the first choice for patent ductus arteriosus closure in the appropriate patient. Percutaneous closure of patent ductus arteriosus is widely done by transvenous approach guided by aortic access. We present the case of a 2 year old girl who underwent patent ductus arteriosus device occlusion with transvenous access only.
Topics: Angiography; Cardiac Catheterization; Child, Preschool; Ductus Arteriosus, Patent; Echocardiography; Female; Humans; Septal Occluder Device
PubMed: 29540889
DOI: No ID Found