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Pediatrics and Neonatology Jul 2021Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA...
BACKGROUND
Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA status during the first week of life for very low birthweight (VLBW, <1500 g) preterm infants and to develop a scoring system to predict spontaneous PDA closure.
METHODS
We enrolled VLBW infants admitted between January 2016 and January 2017 and performed daily echocardiographic screening for PDA existence. Oxygen index (OI, mean airway pressure × fraction of inspired oxygen/partial pressure of arterial oxygen) was applied to represent the respiratory condition.
RESULTS
A total of 215 VLBW infants were enrolled, and the accumulative incidence of spontaneous PDA closure by age 1 week was 80%, 70%, and 34% for infants born of gestational age (GA) ≥30, 28-29, and ≤27 weeks, respectively. Of these 215 infants, 184 infants entered the second phase to establish the scoring system. Infants with spontaneous PDA closure were more mature (GA 29.2 ± 2.3 vs. 26.9 ± 2.3 weeks, p < 0.001), had lower OI (2.8 ± 2.2 vs. 5.6 ± 5.3, p < 0.001) and were less likely to need endotracheal intubation (23% vs. 68%, p < 0.001). Using the receiver operating characteristics curve, OI <2.5 was determined favoring higher PDA closure incidence. The score was calculated based on the odds ratio generated in multiple regression: 4, 3 and 1 points for GA ≥30, 28-29 and ≤27 weeks, 2 and 1 points for OI <2.5 and ≥2.5, and 3 and 1 points for without and with endotracheal intubation. Using score ≥6 to predict PDA closure, the sensitivity and specificity were 0.77 and 0.72.
CONCLUSION
A score made up of GA, OI and need for intubation was proposed to predict spontaneous PDA closure by age 1 week, which could be helpful to clinicians in the management of PDA in preterm infants.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Persistent Fetal Circulation Syndrome; Protective Factors
PubMed: 33931344
DOI: 10.1016/j.pedneo.2021.03.014 -
PeerJ 2024This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse... (Meta-Analysis)
Meta-Analysis
The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis.
BACKGROUND
This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse events when administering medications to premature infants with patent ductus arteriosus (PDA).
METHOD
The protocol for this review has been registered with PROSPERO (CRD 42022324598). We searched relevant studies in PubMed, Embase, Cochrane, and the Web of Science databases from March 26, 1996, to January 31, 2022.
RESULTS
A total of six randomized controlled trials (RCTs) and five observational studies were included for analysis, involving 630 premature neonates in total. Among these infants, 480 were in the ibuprofen group (oral intravenous routes), 78 in the paracetamol group (oral intravenous routes), and 72 in the ibuprofen group (rectal oral routes). Our meta-analysis revealed a significant difference in the rate of PDA closure between the the initial course of oral ibuprofen and intravenous ibuprofen groups (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.13-1.44]; < 0.0001, = 0%). In contrast, the meta-analysis of paracetamol administration via oral versus intravenous routes showed no significant difference in PDA closure rates (RR = 0.86, 95% CI [0.38-1.91]; = 0.71, = 76%). However, there was no statistically significant difference in the risk of adverse events or the need for surgical intervention among various drug administration methods after the complete course of drug therapy.
CONCLUSION
This meta-analysis evaluated the safety and effectiveness of different medication routes for treating PDA in premature infants. Our analysis results revealed that compared with intravenous administration, oral ibuprofen may offer certain advantages in closing PDA without increasing the risk of adverse events. Conversely, the use of paracetamol demonstrated no significant difference in PDA closure and the risk of adverse events between oral and intravenous administration.
Topics: Infant, Newborn; Humans; Ductus Arteriosus, Patent; Ibuprofen; Indomethacin; Cyclooxygenase Inhibitors; Infant, Low Birth Weight; Acetaminophen; Infant, Premature
PubMed: 38304184
DOI: 10.7717/peerj.16591 -
Turkish Neurosurgery 2022To compare, and to analyze the effects of cranial suture reconstruction and frontal bone reconstruction in the operation of premature closure of the sagittal suture in...
Clinical Analysis of the Effects of Frontal Bone Reconstruction and Cranial Suture Reconstruction in the Operation of Simple Premature Closure of Frontal Suture in Infants.
AIM
To compare, and to analyze the effects of cranial suture reconstruction and frontal bone reconstruction in the operation of premature closure of the sagittal suture in infants.
MATERIAL AND METHODS
A total of 35 infants with simple premature closure of frontal suture were divided into the experimental group (n=18) and the control group (n=17). In the experimental group, the skull model was reconstructed by imaging examination and three-dimensional (3D) printing technique before operation, and the frontal bone reconstruction was used to guide the surgical treatment of cranial stenosis. In the control group, the skull model was reconstructed by imaging examination and 3D printing technique before operation, and the cranial suture reconstruction was performed by the same operator. The surgical effects of the two groups were compared.
RESULTS
During the 12-month follow-up after operation, the interfrontal angles of scaphoid malformation were 153.67 ± 12.77 and 128.67 ± 7.90 in the experimental and control groups, respectively. The difference between the two groups was statistically significant.
CONCLUSION
Frontal bone reconstruction surgery can guide the operation of cranial stenosis, significantly improve the surgical treatment effect of infants with frontal suture, and esthetically enhance the head type of infants. Moreover, its effect is better than that of traditional operation, which is worth given significant attention in clinical settings.
Topics: Constriction, Pathologic; Cranial Sutures; Craniosynostoses; Frontal Bone; Humans; Infant; Skull; Sutures
PubMed: 35023140
DOI: 10.5137/1019-5149.JTN.35711-21.1 -
Respiratory Care May 2022A persistent patent ductus arteriosus (PDA) can have significant clinical consequences in preterm infants, depending on the degree of left-to-right shunting, its impact... (Review)
Review
A persistent patent ductus arteriosus (PDA) can have significant clinical consequences in preterm infants, depending on the degree of left-to-right shunting, its impact on cardiac performance, and associated perinatal risk factors that can mitigate or exacerbate the shunt. Although the best management strategy remains contentious, PDAs that have contraindications to, or have failed medical management have historically undergone surgical ligation. Recently smaller occluder devices and delivery systems have allowed for minimally invasive closure in the catheterization laboratory even in extremely premature infants. The present review summarizes the pathophysiologic manifestations, treatment options and management of hemodynamically significant PDA in preterm infants. Additionally, we review the available literature surrounding the respiratory support and outcomes of preterm infants following definitive PDA closure.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Risk Factors
PubMed: 35473850
DOI: 10.4187/respcare.09489 -
Maternal diabetes induces senescence and neural tube defects sensitive to the senomorphic rapamycin.Science Advances Jun 2021Neural tube defects (NTDs) are the second most common structural birth defect. Senescence, a state of permanent cell cycle arrest, occurs only after neural tube closure....
Neural tube defects (NTDs) are the second most common structural birth defect. Senescence, a state of permanent cell cycle arrest, occurs only after neural tube closure. Maternal diabetes-induced NTDs are severe diabetic complications that lead to infant mortality or lifelong morbidity and may be linked to premature senescence. Here, we report that premature senescence occurs in the mouse neuroepithelium and disrupts neurulation, leading to NTDs in diabetic pregnancy. Premature senescence and NTDs were abolished by knockout of the transcription factor , the gene, and the cell cycle inhibitors and ; transgenic expression of the dominant-negative FoxO3a mutant; or the senomorphic rapamycin. Double transgenic expression of p21 and p27 mimicked maternal diabetes in inducing premature neuroepithelium senescence and NTDs. These findings integrate transcription- and epigenome-regulated miRNAs and cell cycle regulators in premature neuroepithelium senescence and provide a mechanistic basis for targeting premature senescence and NTDs using senomorphics.
PubMed: 34193422
DOI: 10.1126/sciadv.abf5089 -
Neonatology Jun 2010The unique differentiation program of the ductus arteriosus (DA) is essential for its specific task during fetal life and for the adapting circulation after birth.... (Review)
Review
The unique differentiation program of the ductus arteriosus (DA) is essential for its specific task during fetal life and for the adapting circulation after birth. Phenotypic changes occur in the DA during the normal maturation and definitive closure. Morphological abnormalities of the vessel wall characterize the persistent DA (PDA) in older children. Here, we give an overview of the animal models of DA regulation and remodeling. Genetic research has identified the cause of syndromic forms of PDA, such as the TFAP2B mutations in Char syndrome. Genes that interfere with the remodeling of vascular smooth muscle cells (VSMCs) of the ductal media are affected in virtually all of these anomalies. Therefore, the pivotal regulatory role of VSMCs is emphasized. A better understanding of the genetic background of this developmental process may help develop new strategies to manipulate the DA in premature infants, neonates with duct-dependent anomalies, and patients with syndromic and non-syndromic PDA.
Topics: Animals; Disease Models, Animal; Dogs; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature; Mice; Muscle, Smooth, Vascular; Mutation; Rabbits; Rats; Transcription Factor AP-2
PubMed: 19955832
DOI: 10.1159/000262481 -
Pediatric Cardiology Dec 2022We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the...
We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the Microvascular Plug, "MVP" (Medtronic, Minneapolis, MN); Micro Plug Set, "Micro Plug" (KA Medical, Minneapolis, MN); and Amplatzer Piccolo Occluder, "Piccolo" (Abbot, Santa Clara, CA). We also report trends in device selection over time. Studies examining outcomes according to device selection for PDA closure in premature infants are lacking. We performed a retrospective review of all percutaneous PDA closures in premature infants at a single center (June 2018-May 2021). Patients were grouped by initial device selected for PDA closure (intention to treat). Institutional Review Board approval was obtained. 58 premature infants [MVP (n = 25), Micro Plug (n = 25), and Piccolo (n = 8)] underwent successful transcatheter PDA closure (mean gestational age 27 weeks 2 days; mean weight at procedure 1.4 kg; mean age at procedure 28 days). Pre-procedural demographics, procedural data, and follow-up data were similar between groups. There were no significant procedural adverse events. Three devices (2 MVP, 0 Micro Plug, 1 Piccolo p = 0.27) embolized after the procedure. One other device was removed for concern for aortic obstruction. Device selection evolved with a clear trend toward the Micro Plug device over time. Demographic, procedural, and follow-up data were similar between the MVP, Micro Plug, and Piccolo groups. The Micro Plug did not require exchange for suboptimal fitting or embolize and became our preferred device in most cases.
Topics: Infant, Newborn; Infant; Humans; Ductus Arteriosus, Patent; Cardiac Catheterization; Treatment Outcome; Infant, Premature; Septal Occluder Device; Infant, Premature, Diseases; Retrospective Studies
PubMed: 35430709
DOI: 10.1007/s00246-022-02903-2 -
American Journal of Surgery May 2020In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost...
BACKGROUND
In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored.
METHODS
A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations.
RESULTS
80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01).
CONCLUSION
Delayed fascial closure was associated with significantly greater hospital costs during the index admission.
Topics: Fasciotomy; Female; Gastroschisis; Hospital Costs; Humans; Infant, Newborn; Length of Stay; Male; Parenteral Nutrition; Time Factors; Wound Closure Techniques
PubMed: 32199604
DOI: 10.1016/j.amjsurg.2020.03.003 -
Swiss Medical Weekly Oct 2008Preterm premature rupture of the foetal membranes (früher vorzeitiger Blasensprung) has remained a devastating complication of pregnancy with very high risk of... (Review)
Review
Preterm premature rupture of the foetal membranes (früher vorzeitiger Blasensprung) has remained a devastating complication of pregnancy with very high risk of pregnancy loss. Several methods of sealing spontaneously ruptured membranes to stop amniotic fluid leakage and prolong pregnancy have been tested, but no one of them has achieved a clinical breakthrough. Also, needle and foetoscopic puncture of membranes for diagnostic or surgical interventions in the amniotic cavity carry a significant risk of persistent membrane leakage and subsequent rupture - thus limiting the developing field of intrauterine foetal surgery. Efforts are concentrated on taking action before rupture rather than reacting after rupture: one avenue of research concerns prophylactic plugging of foetoscopic access sites in foetal membranes at the time of intervention, thus inhibiting leakage and rupture. Foetal membrane injuries, spontaneous or iatrogenic, constitute extreme challenges to repair: thinness of foetal membrane tissue, difficult localisation and accessibility of the rupture site, the need for injectable sealants, wet gluing conditions and poor wound healing in this tissue all complicate repair. The goal is to achieve immediate and at the same time long-lasting closure of the membrane leak. Here we review approaches to closure of foetal membrane defects with liquid sealants or solid biomaterial scaffolds, with the focus on prophylactic plugging of foetoscopic access sites.
Topics: Female; Fetal Membranes, Premature Rupture; Humans; Hydrogels; Pregnancy; Pregnancy Outcome; Tissue Adhesives; Tissue Engineering; Tissue Scaffolds
PubMed: 18941945
DOI: 10.4414/smw.2008.11997 -
Medicine Jun 2023The objective of this study was to evaluate the effect of maturing fetal lung on clinical efficacy of acetaminophen in the treatment of premature infants with patent... (Clinical Trial)
Clinical Trial
The objective of this study was to evaluate the effect of maturing fetal lung on clinical efficacy of acetaminophen in the treatment of premature infants with patent ductus arteriosus (PDA). A total of 441 premature infants admitted to our hospital from May 2020 to May 2021 were recruited, including 152 premature infants receiving fetal lung maturation (13 cases of PDA closure with drug use and 2 cases failed) and 289 cases without maturing fetal lung (17 cases of PDA closure and 8 cases failed). Finally, a total of 30 cases were enrolled in this clinical trial. All infants were divided into groups A and B according to whether fetal lung maturation was adopted before delivery. In group A, 13 infants received fetal lung maturation, and 17 in group B did not undergo fetal lung maturation. Infants in both groups were orally given with acetaminophen. After 3-day treatment, the second course of treatment was given immediately if PDA was not closed. The PDA closure rate and patency rate of PDA at the end of 2 treatment courses were statistically compared between 2 groups. The feeding intolerance, upper gastrointestinal bleeding, renal failure, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, the age at total enteral nutrition and the length of hospital stay were also compared between 2 groups. After the 1st and 2nd treatment courses, the PDA closure rate in group A was 84.61%, significantly higher than 52.94% in group B (P < .05), whereas there was no significant difference in the PDA patency rate between 2 groups (P > .05). No significant differences were observed regarding the feeding intolerance, renal failure, necrotizing enterocolitis, periventricular-intraventricular hemorrhage, bronchopulmonary dysplasia, the length of hospital stay and the age at total enteral nutrition between 2 groups (all P > .05). In addition, the incidence of upper gastrointestinal bleeding in group A was 7.69%, slightly lower than 5.88% in group B (P > .05). Compared with premature infants untreated with fetal lung maturation interventions before delivery, premature infants who receive fetal lung maturation interventions combined with acetaminophen for PDA are likely to obtain a higher PDA closure rate and a lower incidence rate of the upper gastrointestinal bleeding.
Topics: Humans; Infant, Newborn; Acetaminophen; Bronchopulmonary Dysplasia; Cerebral Hemorrhage; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Gastrointestinal Hemorrhage; Infant, Premature; Lung
PubMed: 37327300
DOI: 10.1097/MD.0000000000034011