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The Journal of Pediatrics Oct 2016To determine whether a nonintervention approach for treating hemodynamically significant patent ductus arteriosus (PDA) is associated with decreased mortality and/or...
OBJECTIVE
To determine whether a nonintervention approach for treating hemodynamically significant patent ductus arteriosus (PDA) is associated with decreased mortality and/or morbidity compared with a mandatory closure approach in extremely low birth weight infants.
STUDY DESIGN
We reviewed the medical records of 178 infants of 23-26 weeks' gestational age with PDA, requiring ventilator treatment, and with hemodynamically significant PDA ≥2 mm in size. Mandatory closure was used during period I (July 2009 to December 2011, n = 81), and nonintervention was used during period II (January 2012 to June 2014, n = 97).
RESULTS
During period I, 64% of infants were first treated with indomethacin, and 82% were ultimately ligated surgically. During period II, no infant was treated with indomethacin and/or ligation. The average postnatal day of PDA closure was day 13 and day 44 during periods I and II, respectively. There was significantly more use of diuretics and fluid restriction during period II compared with period I. There was no difference in mortality or morbidities such as necrotizing enterocolitis or intraventricular hemorrhage. The incidence of bronchopulmonary dysplasia (BPD) and the propensity score adjusted OR of BPD were significantly lower during period II compared with period I.
CONCLUSIONS
Despite longer PDA exposure, nonintervention was associated with significantly less BPD compared with mandatory closure. Additional study is warranted to determine the benefits and risks of non-intervention for the hemodynamically significant PDA in extremely low birth weight infants.
Topics: Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Female; Gestational Age; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Propensity Score; Plastic Surgery Procedures; Retrospective Studies
PubMed: 27453374
DOI: 10.1016/j.jpeds.2016.06.046 -
The Journal of Pediatrics Aug 2013To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic"... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic" (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus.
STUDY DESIGN
Infants were eligible for the study if they were 23(1/7)-30(6/7) weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes ≤60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized "feeding advance regimen" and guidelines for managing feeding intolerance were followed at each site (N = 13).
RESULTS
Infants (N = 177, 26.3 ± 1.9 weeks' mean ± SD gestation) were randomized at 6.5 ± 3.9 days to receive "trophic" feeds ("feeding" group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds ("fasting [nil per os]" group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 ± 15 mL/kg/d. After drug treatment, infants randomized to the "feeding" arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities.
CONCLUSION
Infants required less time to reach the feeding volume end point if they were given "trophic" enteral feedings when they received indomethacin or ibuprofen treatments.
Topics: Combined Modality Therapy; Ductus Arteriosus, Patent; Enteral Nutrition; Female; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Male; Prospective Studies; Time Factors
PubMed: 23472765
DOI: 10.1016/j.jpeds.2013.01.057 -
Anales de Pediatria (Barcelona, Spain :... Nov 2008To report the process and results of the first neonatal clinical consensus of the Ibero-American region.
OBJECTIVE
To report the process and results of the first neonatal clinical consensus of the Ibero-American region.
DESIGN AND METHODS
Two recognized experts in the field (Clyman and Van Overmeire) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We developed 46 questions of clinical-physiological relevance in all aspects of patent ductus arteriosus (PDA). Guidelines for consensus process, literature search and future preparation of educational material and authorship were developed, reviewed and agreed by all. Participants from different countries were distributed in groups, and assigned to interact and work together to answer 3-5 questions, reviewing all global literature and local factors. Answers and summaries were received, collated and reviewed by 2 coordinators and the 2 experts. Participants and experts met in Granada, Spain for 4.5 h (lectures by experts, presentations by groups, discussion, all literature available).
RESULTS
31 neonatologists from 16 countries agreed to participate. Presentations by each group and general discussion were used to develop a consensus regarding: general management, availability of drugs (indomethacin vs. ibuprofen), costs, indications for echo/surgery, etc. Many steps were learnt by all present in a collaborative forum.
CONCLUSIONS
This first consensus group of Ibero-American neonatologists SIBEN led to active and collaborative participation of neonatologists of 16 countries, improved education of all participants and ended with consensus development on clinical approaches to PDA. Furthermore, it provides recommendations for clinical care reached by consensus. Additionally, it will serve as a useful foundation for future SIBEN Consensus on other topics and it could become valuable as a model to decrease disparity in care and improve outcomes in this and other regions.
Topics: Age Factors; Brain Diseases; Cost-Benefit Analysis; Cyclooxygenase Inhibitors; Diuretics; Ductus Arteriosus, Patent; Enteral Nutrition; Fluid Therapy; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ultrasonography; Water-Electrolyte Balance
PubMed: 19128748
DOI: 10.1157/13128003 -
The Pan African Medical Journal 2023Patent ductus arteriosus beyond the early neonatal period presents with failure to thrive, congestive cardiac failure, and recurrent pneumonia which is similar to the...
Patent ductus arteriosus beyond the early neonatal period presents with failure to thrive, congestive cardiac failure, and recurrent pneumonia which is similar to the presentation of pulmonary tuberculosis. Both clinical conditions can coexist with significant adverse outcomes if not properly treated. This is a case of a 9-month-old female who had a hemodynamically significant patent ductus arteriosus (PDA). She had a surgical ligation of the PDA, and postoperative recovery was stalled by pulmonary tuberculosis which was initially missed as her post-operative symptoms were thought to have been from a post-op complication. She however progressively worsened till the diagnosis of pulmonary tuberculosis (PTB) was mading a suggestive chest X-ray finding. She was treated for PTB and made remarkable improvement with the resolution of the respiratory symptoms and adequate weight gain. A child with a symptomatic congenital cardiac defect in a TB endemic area can still have pulmonary tuberculosis which should not be missed. Also, the diagnosis of TB in children can be challenging due to laboratory tests that could have relatively poor yield when compared to adults. Hence, to avoid missing the diagnosis, a combination of clinical, laboratory, and regional epidemiology correlation is essential.
Topics: Humans; Infant, Newborn; Child; Adult; Female; Infant; Ductus Arteriosus, Patent; Heart Failure; Ligation
PubMed: 37250675
DOI: 10.11604/pamj.2023.44.104.39062 -
JAMA Pediatrics May 2017Observational studies have associated patent ductus arteriosus (PDA) ligation among preterm infants with adverse neonatal outcomes and neurodevelopmental impairment in...
IMPORTANCE
Observational studies have associated patent ductus arteriosus (PDA) ligation among preterm infants with adverse neonatal outcomes and neurodevelopmental impairment in early childhood, with a resultant secular trend away from surgical treatment. However, to our knowledge, studies have inadequately addressed sources of residual bias, including survival bias and major neonatal morbidities arising before exposure to ligation.
OBJECTIVE
Evaluate the association between PDA ligation vs medical management and neonatal and neurodevelopmental outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study of preterm infants younger than 28 weeks gestational age born between January 1, 2006, and December 31, 2012, with clinical and echocardiography diagnoses of hemodynamically significant PDA was conducted at 3 tertiary neonatal intensive care units and affiliated follow-up programs.
EXPOSURE
Surgical ligation vs medical management.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 18 to 24 months corrected age. Secondary outcomes included death before discharge, NDI, moderate-severe chronic lung disease, and severe retinopathy of prematurity. Multivariable logistic regression analysis was used to adjust for perinatal and postnatal confounders.
RESULTS
Of 754 infants with hemodynamically significant PDA (mean [standard deviation] gestational age 25.7 [1.2] weeks and birth weight 813 [183] grams), 184 (24%) underwent ligation. Infants who underwent ligation had a higher frequency of morbidities before PDA closure, including sepsis, necrotizing enterocolitis, and a dependence on mechanical ventilation. After adjusting for perinatal characteristics and preligation morbidities, there was no difference in the odds of death or NDI (adjusted odds ratio (aOR), 0.83; 95% CI, 0.52-1.32), NDI (aOR, 1.27; 95% CI, 0.78-2.06), chronic lung disease (aOR, 1.36; 95% CI, 0.78-2.39) or severe retinopathy of prematurity (aOR, 1.61; 95% CI, 0.85-3.06). Ligation was associated with lower odds of mortality (aOR, 0.09; 95% CI, 0.04-0.21).
CONCLUSIONS AND RELEVANCE
Patent ductus arteriosus ligation among preterm neonates younger than 28 weeks gestational age was not associated with the composite outcome of death or NDI, and there were no differences in chronic lung disease, retinopathy of prematurity, or NDI among survivors. Mortality was lower among infants who underwent ligation, though residual survival bias could not be excluded. Previously reported associations of ligation with increased morbidity may be because of bias from confounding by indication.
Topics: Child, Preschool; Cohort Studies; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant Mortality; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Neonatal; Ligation; Logistic Models; Male; Neurodevelopmental Disorders; Retrospective Studies; Treatment Outcome
PubMed: 28264088
DOI: 10.1001/jamapediatrics.2016.5143 -
BMC Veterinary Research Sep 2011Diagnosis of extracardiac intrathoracic vascular anomalies is of clinical importance, but remains challenging. Traditional imaging modalities, such as radiography,...
BACKGROUND
Diagnosis of extracardiac intrathoracic vascular anomalies is of clinical importance, but remains challenging. Traditional imaging modalities, such as radiography, echocardiography, and angiography, are inherently limited by the difficulties of a 2-dimensional approach to a 3-dimensional object. We postulated that accurate characterization of malformations of the aorta would benefit from 3-dimensional assessment. Therefore, multidetector-row computed tomography (MDCT) was chosen as a 3-dimensional, new, and noninvasive imaging technique. The purpose of this study was to evaluate patients with 2 common diseases of the intrathoracic aorta, either patent ductus arteriosus or vascular ring anomaly, by contrast-enhanced 64-row computed tomography.
RESULTS
Electrocardiography (ECG)-gated and thoracic nongated MDCT images were reviewed in identified cases of either a patent ductus arteriosus or vascular ring anomaly. Ductal size and morphology were determined in 6 dogs that underwent ECG-gated MDCT. Vascular ring anomalies were characterized in 7 dogs and 3 cats by ECG-gated MDCT or by a nongated thoracic standard protocol. Cardiac ECG-gated MDCT clearly displayed the morphology, length, and caliber of the patent ductus arteriosus in 6 affected dogs. Persistent right aortic arch was identified in 10 animals, 8 of which showed a coexisting aberrant left subclavian artery. A mild dilation of the proximal portion of the aberrant subclavian artery near its origin of the aorta was present in 4 dogs, and a diverticulum analogous to the human Kommerell's diverticulum was present in 2 cats.
CONCLUSIONS
Contrast-enhanced MDCT imaging of thoracic anomalies gives valuable information about the exact aortic arch configuration. Furthermore, MDCT was able to characterize the vascular branching patterns in dogs and cats with a persistent right aortic arch and the morphology and size of the patent ductus arteriosus in affected dogs. This additional information can be of help with regard to improved diagnoses of thoracic anomalies and the planning of surgical interventions.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Multidetector Computed Tomography; Vascular Malformations
PubMed: 21943366
DOI: 10.1186/1746-6148-7-57 -
Indian Pediatrics Aug 2012
Topics: Ductus Arteriosus, Patent; Female; Humans; Infant, Premature, Diseases; Male
PubMed: 22962235
DOI: 10.1007/s13312-012-0125-2 -
Italian Journal of Pediatrics May 2020Patent ductus arteriosus (PDA) is a congenital heart defect with an unclear etiology that occurs commonly among newborns. Adequately understanding the molecular...
OBJECTIVE
Patent ductus arteriosus (PDA) is a congenital heart defect with an unclear etiology that occurs commonly among newborns. Adequately understanding the molecular pathogenesis of PDA can contribute to improved treatment and prevention. Plasma proteins may provide evidence to explore the molecular mechanisms of abnormal cardiac development.
METHODS
Isobaric tags for relative and absolute quantitation (iTRAQ) proteomics technology was used to measure different plasma proteins in PDA patients (n = 4) and controls (n = 4). The candidate protein was validated by ELISA and Western blot (WB) assays in a larger sample. Validation of the location and expression of this protein was performed in mouse heart sections.
RESULTS
There were three downregulated proteins and eight upregulated proteins identified in the iTRAQ proteomics data. Among these, protein disulfide-isomerase A6 (PDIA6) was further analyzed for validation. The plasma PDIA6 concentrations (3.2 ± 0.7 ng/ml) in PDA patients were significantly lower than those in normal controls (5.8 ± 1.2 ng/ml). In addition, a WB assay also supported these results. PDIA6 was widely expressed in mouse heart outflow tract on embryonic day 14.5.
CONCLUSION
Plasma proteomics profiles suggested novel candidate molecular markers for PDA. The findings may allow development of a new strategy to investigate the mechanism and etiology of PDA.
Topics: Animals; Blood Proteins; Case-Control Studies; Child, Preschool; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Male; Mice; Protein Disulfide-Isomerases; Proteomics; Reproducibility of Results
PubMed: 32430045
DOI: 10.1186/s13052-020-00831-6 -
Pediatric Radiology Aug 2016Little is known about cerebral artery resistive index values in infants born extremely preterm.
BACKGROUND
Little is known about cerebral artery resistive index values in infants born extremely preterm.
OBJECTIVE
To report resistive index values in various cerebral arteries in a prospective cohort of preterm infants born at <29 weeks' gestation, and to compare resistive index in these arteries and assess the relationship between resistive index and hemodynamically significant patent ductus arteriosus.
MATERIALS AND METHODS
Using Doppler imaging, we obtained resistive index values of internal carotid arteries, basilar artery, anterior cerebral artery, and pial and striatal arteries in the first 3 days of age and weekly thereafter until discharge or death. We analyzed paired observations using the Wilcoxon signed-rank test, between-group comparisons with the Mann-Whitney test.
RESULTS
We performed 771 examinations in 235 infants. Resistive indices differed among arteries: vessels with larger diameters showed significantly higher resistive indices. Resistive index in infants without patent ductus arteriosus was lower than that in infants with hemodynamically significant patent ductus arteriosus (median in anterior cerebral artery: 0.75 and 0.82, respectively; P<0.001), though this was not statistically significant in all arteries. There was no difference in pre- and post-ligation resistive indices in infants who underwent patent ductus arteriosus ligation.
CONCLUSION
For accurate follow-up and comparison of cerebral artery resistive index, the same artery should be examined on each occasion.
Topics: Cerebral Arteries; Ductus Arteriosus, Patent; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Male; Prospective Studies; Ultrasonography, Doppler, Duplex; Vascular Resistance
PubMed: 27259991
DOI: 10.1007/s00247-016-3615-x -
Journal of Veterinary Internal Medicine May 2016Patent ductus arteriosus (PDA) is one of the most common congenital heart defects in dogs. Advanced echocardiographic techniques such as speckle-tracking...
BACKGROUND
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects in dogs. Advanced echocardiographic techniques such as speckle-tracking echocardiography (STE) have not been extensively used to evaluate cardiac function in affected dogs.
HYPOTHESIS
Advanced echocardiographic techniques are more sensitive than standard echocardiographic techniques in analyzing systolic function in dogs with PDA.
ANIMALS
Forty-four client-owned dogs: 34 dogs with PDA (preoperative evaluation) and 10 healthy sex- and weight-matched controls.
METHODS
Prospective study. Dogs were recruited over a 2-year period. Complete echocardiographic evaluation was performed, including conventional (end-diastolic volumes indexed to body surface area in B and M-mode [EDVIB /M ], end-systolic volumes indexed to body surface area in B and M-mode [ESVIB /M ], allometric scaling in diastole and systole [AlloD/S], pulmonary flow to systemic flow [Qp/Qs], ejection fraction [EF] and fractional shortening [FS]) and speckle-tracking echocardiography ([STE]: global longitudinal, radial and circumferential strain [S] and strain rate [SR]).
RESULTS
Dogs with PDA had significantly different EDVIB /M , ESVIB /M , AlloD/S, Qp/Qs and all STE-derived parameters (global longitudinal S and SR, global circumferential S and SR, global radial S and SR)compared to healthy dogs. No correlation was found between standard techniques (EDVIB /M , ESVIB /M , AlloD/S, Qp/Qs) and STE-derived parameters (global longitudinal, circumferential and radial S and SR).
CONCLUSION AND CLINICAL IMPORTANCE
Conventional parameters routinely used to assess systolic function (EF and FS) were not different between the groups; STE-derived parameters identified subtle changes in cardiac systolic function and contractility between the 2 groups of dogs. Based on these findings, STE may be a more appropriate tool to assess cardiac contractility in dogs with PDA.
Topics: Animals; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Echocardiography; Female; Male; Prospective Studies; Systole
PubMed: 27177624
DOI: 10.1111/jvim.13938