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The Journal of Pediatrics Jun 1993A series of investigations has been performed to assess the timing of physiologic closure of the ductus arteriosus in premature infants with and without respiratory... (Review)
Review
A series of investigations has been performed to assess the timing of physiologic closure of the ductus arteriosus in premature infants with and without respiratory distress syndrome. The data from these studies emphasize the concept of physiologic ductal patency and give normative data for expected closure rates through the fourth day of life. On the basis of these data, patency on or beyond the fourth day of life is abnormal irrespective of gestational age, and prematurity, in the absence of respiratory distress syndrome, is not a risk factor for persistent patent ductus arteriosus. We also found that persistent patent ductus arteriosus in larger premature infants (> or = 30 weeks of gestation) with respiratory distress syndrome is relatively uncommon. Last, ductal patency was evaluated in a group of low birth weight infants with severe respiratory distress syndrome in a randomized, double-blind trial of exogenous surfactant administration. We concluded that the beneficial effects of exogenous surfactant are not associated with either a greater clinical need for indomethacin or any increased risk of delayed closure of the ductus arteriosus.
Topics: Ductus Arteriosus, Patent; Gestational Age; Humans; Infant, Newborn; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Risk Factors
PubMed: 8501549
DOI: 10.1016/s0022-3476(09)90044-0 -
Medicine Sep 2018The aim of this study was to investigate the effects of prophylactic oral ibuprofen on the closure rate of patent ductus arteriosus (PDA).This was a retrospective study... (Observational Study)
Observational Study
The aim of this study was to investigate the effects of prophylactic oral ibuprofen on the closure rate of patent ductus arteriosus (PDA).This was a retrospective study and data on infants born before 36 weeks were collected. The prophylactic group was treated with ibuprofen (10, 5, and 5 mg/kg) from days 1 to 3 after birth, respectively. The conventional group was treated with the same dose of ibuprofen from days 4 to 6 once they were echocardiographically confirmed with PDA on day 3 after birth. The placebo group was treated with 5% glucose.The closure rate of PDA in the prophylactic group significantly increased on day 7 compared with the placebo group (P = .02), but showed no difference compared with the conventional group (P = .12). Serum NT-proBNP in the prophylactic and conventional groups decreased compared with the placebo group (P = .03 vs P = .07).Prophylactic oral ibuprofen can increase the closure rate of PDA in premature infants; however, it showed no significant advantages compared with conventional treatment. Serum NT-proBNP can be used to observe PDA treatment responses in premature infants.
Topics: Dinoprostone; Ductus Arteriosus, Patent; Echocardiography; Electrocardiography; Female; Gestational Age; Humans; Ibuprofen; Infant, Premature; Male; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies
PubMed: 30212951
DOI: 10.1097/MD.0000000000012206 -
Cardiology in the Young Dec 2019Patent ductus arteriosus is the most common cardiovascular abnormality in premature infants. With newly available percutaneous devices, centres are reporting high rates...
Patent ductus arteriosus is the most common cardiovascular abnormality in premature infants. With newly available percutaneous devices, centres are reporting high rates of success and favourable safety profiles with percutaneous closure of haemodynamically significant ductus arteriosi in infants under 1000 g. We report the case of a 5-week-old, previous 25-week gestation, 1200-g infant who underwent successful percutaneous closure of a ductus arteriosus with a Medtronic Microvascular Plug but who developed late-term coarctation from the device. This case should prompt practitioners to consider the need and timing of follow-up echocardiograms in this population and sheds light on a newly reported long-term complication of device closure in premature infants.
Topics: Aortic Coarctation; Cardiac Catheterization; Ductus Arteriosus, Patent; Echocardiography, Doppler, Color; Gestational Age; Hemodynamics; Humans; Imaging, Three-Dimensional; Infant; Infant, Low Birth Weight; Infant, Premature; Male; Septal Occluder Device; Tomography, X-Ray Computed
PubMed: 31760959
DOI: 10.1017/S1047951119002555 -
The Journal of Pediatrics Nov 2003To determine whether postnatal vitamin A therapy increased ductal closure rate in premature infants. (Clinical Trial)
Clinical Trial Randomized Controlled Trial
OBJECTIVE
To determine whether postnatal vitamin A therapy increased ductal closure rate in premature infants.
STUDY DESIGN
This was a prospective, double-blind, placebo-controlled trial. Subjects (n=40) were recruited on day of life 1. Inclusion criteria were premature neonates weighing 500 to 1500 g with an indwelling umbilical line. Vitamin A was administered intramuscularly on days 1, 3, and 7. Blood vitamin A and retinol binding protein levels were obtained on days 1 and 3. Echocardiography was performed on days 1, 3, 7, and 14. Failure of ductal closure was defined as the presence of a moderate to large patent ductus arteriosus on day 14, indomethacin therapy, or surgical ligation.
RESULTS
Comparison between the treatment and placebo groups revealed no differences in gestational age, weight, or oxygenation index. Vitamin A and retinol binding protein levels did not differ between the groups at entry but increased significantly after vitamin A treatment. Failure of ductal closure occurred in 22 of 40 babies without any difference between the groups (12/22 vs 10/18, P=NS). Four infants required surgical ligation, all in the treatment group (P=.04). Clinical outcome did not vary between groups.
CONCLUSION
Postnatal vitamin A therapy did not improve ductal closure rates in premature infants.
Topics: Birth Weight; Double-Blind Method; Ductus Arteriosus, Patent; Electrocardiography; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Prospective Studies; Severity of Illness Index; Vitamin A
PubMed: 14615738
DOI: 10.1067/S0022-3476(03)00501-8 -
Acta Paediatrica (Oslo, Norway : 1992) Dec 2022The primary aim was to estimate premature infants' spontaneous patent ductus arteriosus closure rate. Secondly, to identify criteria associated with the chance of...
The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow-up.
AIM
The primary aim was to estimate premature infants' spontaneous patent ductus arteriosus closure rate. Secondly, to identify criteria associated with the chance of spontaneous closure.
METHODS
We performed a retrospective cohort study of 167 infants born before 32 weeks of gestation and diagnosed with a patent ductus arteriosus between 1 January 2008 and 31 December 2017. The spontaneous patent ductus arteriosus closure event rate was evaluated using the Kaplan-Meier estimator.
RESULTS
The spontaneous closure rate within the first year of life was 66% (95% CI 58%-73%), increasing to 80% (95% CI 72%-86%) five years after birth. When including both spontaneous closure and closure following treatment, 96% (95% CI 86%-100%) closed within 5 years after birth. The chance of spontaneous closure was reduced in the case of a large patent ductus arteriosus: OR 0.16 (95% CI 0.05-0.52), left atrial enlargement: OR 0.16 (95% CI 0.05-0.51), and pulmonary hypertension: OR 0.23 (95% CI 0.07-0.74).
CONCLUSION
The chance of spontaneous closure in premature infants born between 23 and 32 weeks of gestation was high, and the incidence continued increasing until 5 years of follow-up.
Topics: Infant; Infant, Newborn; Humans; Pregnancy; Female; Ductus Arteriosus, Patent; Infant, Premature; Retrospective Studies; Follow-Up Studies; Infant, Premature, Diseases
PubMed: 36098710
DOI: 10.1111/apa.16541 -
Archives of Disease in Childhood. Fetal... Mar 2018Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be...
BACKGROUND
Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction.
METHODS
We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open.
HYPOTHESIS
Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung.
RESULTS
The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth.
CONCLUSION
Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.
Topics: Animals; Animals, Newborn; Epiglottis; Glottis; Larynx; Lung; Noninvasive Ventilation; Rabbits
PubMed: 29054974
DOI: 10.1136/archdischild-2017-312681 -
Indian Journal of Pediatrics Jan 2015Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right.... (Review)
Review
Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Surgical Procedures; Disease Management; Ductus Arteriosus, Patent; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Ligation; Treatment Outcome
PubMed: 25532746
DOI: 10.1007/s12098-014-1646-6 -
Acta Paediatrica (Oslo, Norway : 1992) Apr 2018Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birthweight infants and is often resistant to medication....
AIM
Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birthweight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants.
METHODS
Our cohort were 295 extremely preterm or extremely low birthweight infants, born at less than 28 weeks or 1000 g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002 to 2015, before and after intravenous paracetamol was introduced in June 2009. Ductal closure dates, paracetamol medication details, morbidities and mortality data were evaluated.
RESULTS
Intravenous paracetamol was given to 128 infants, starting at a median of 4.4 hours age (range: 0-169 hours), with a mean total dosage of 212 mg/kg (range: 7.5-1175 mg/kg). We also included 167 controls who were mainly treated before we used intravenous paracetamol. Ibuprofen (p < 0.001) and ligation (p = 0.002) were lower in the paracetamol group than controls. No adverse effects were detected. Paracetamol was not associated with other morbidities.
CONCLUSION
We found that early use of intravenous paracetamol decreased the incidence of ductal therapies in extremely premature or extremely low birthweight infants.
Topics: Acetaminophen; Administration, Intravenous; Analgesics, Non-Narcotic; Ductus Arteriosus, Patent; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Male; Retrospective Studies
PubMed: 29105147
DOI: 10.1111/apa.14137 -
Journal of Clinical Pharmacology Mar 2024Patent ductus arteriosus (PDA) is a blood vessel that critically supports fetal circulation. The ductus naturally closes within a few days after birth. However, it can... (Review)
Review
Pharmacokinetic and Pharmacodynamic Analysis of Acetaminophen and Ibuprofen Dual Therapy for Patent Ductus Arteriosus Closure in Preterm Neonates at Less Than 29 Weeks of Gestation.
Patent ductus arteriosus (PDA) is a blood vessel that critically supports fetal circulation. The ductus naturally closes within a few days after birth. However, it can stay open in premature neonates for an extended period of time, which is associated with increased mortality and various co-morbidities. Ibuprofen and indomethacin are currently the only 2 drugs approved for inducing PDA closure, but both have been associated with adverse renal and bleeding events. Clinical evidence suggests that combining acetaminophen (APAP) and ibuprofen treatments can decrease the need for surgical ligation. The objective of this study was to establish a disease-drug-trial model to characterize and predict PDA closure following single and combination drug therapy with ibuprofen and/or APAP in children at less than 29 weeks of gestation. The model was informed by a comprehensive literature review. The results of our analysis suggest that ibuprofen and APAP achieve therapeutic synergy. They further suggest that the younger the preterm neonates, the higher the treatment benefit. A 5-day oral dosing regimen consisting of ibuprofen (20 mg/kg Q24h on day 1, followed by 10 mg/kg Q24h on days 2-5) plus APAP (15 mg/kg Q6h) was deemed appropriate to achieve at least 90% PDA in all preterm neonates evaluated within 1 month of life. The model can now be used to design prospective pediatric trials to evaluate optimal drug combinations for PDA closure in preterm neonates and to refine optimal dosing regimens in cohorts of differing gestational age.
Topics: Infant, Newborn; Humans; Child; Pregnancy; Female; Ibuprofen; Ductus Arteriosus, Patent; Acetaminophen; Infant, Premature; Infant, Low Birth Weight; Prospective Studies
PubMed: 38015103
DOI: 10.1002/jcph.2386 -
Small and preterm infants: The shrinking frontier of transcatheter patent ductus arteriosus closure.Catheterization and Cardiovascular... May 2017
Topics: Birth Weight; Cardiac Catheterization; Ductus Arteriosus, Patent; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Prosthesis Design; Septal Occluder Device; Treatment Outcome
PubMed: 28432825
DOI: 10.1002/ccd.27076