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Journal of Clinical Neonatology Apr 2014Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity,... (Review)
Review
Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.
PubMed: 25024972
DOI: 10.4103/2249-4847.134670 -
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 -
Tidsskrift For Den Norske Laegeforening... May 2004Complex craniofacial synostosis is a group of rare genetic disorders characterized by premature closure of the sutures in the craniofacial skeleton and which to varying... (Review)
Review
BACKGROUND
Complex craniofacial synostosis is a group of rare genetic disorders characterized by premature closure of the sutures in the craniofacial skeleton and which to varying degrees affects the extremities.
MATERIAL AND METHODS
On the basis of relevant literature, we present a review of syndromal craniofacial synostosis.
RESULTS
Phenotypically, the complex craniofacial syndromes have many similarities. Synostosis of the sutures of the cranial vault can result in a variety of skull deformations, depending on the sutures involved, the sequence of premature closure, and the time of closure. Synostosis of the sutures in the skull base and facial skeleton leads to shallow orbits, exophthalmus, hypertelorism, midface retrusion, and prognathia.
INTERPRETATION
Precise diagnosis of complex craniofacial syndromes may be difficult solely on the basis of a clinical examination. However, several of the most common syndromes are caused by mutations in genes that code for fibroblast growth-factor receptors. Children with a suspected complex craniofacial syndrome should be referred to genetic testing.
Topics: Acrocephalosyndactylia; Craniosynostoses; Humans; Infant; Infant, Newborn; Mutation; Phenotype; Receptors, Fibroblast Growth Factor
PubMed: 15131704
DOI: No ID Found -
World Psychiatry : Official Journal of... Jun 2011
PubMed: 21633682
DOI: 10.1002/j.2051-5545.2011.tb00027.x -
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 -
Children (Basel, Switzerland) Sep 2020There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a... (Review)
Review
There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a difference in long-term benefits remains. This article intends to review the pulmonary vasculature changes that can occur with a chronic hemodynamically significant PDA in a preterm infant. It also explains the rationale and decision-making involved in a diagnostic cardiac catheterization and transcatheter PDA closure in these preterm infants.
PubMed: 32947808
DOI: 10.3390/children7090139 -
Diagnosis (Berlin, Germany) Jan 2014The Operating Room does not leave time for scholarly reflection before action. Old ways of managing the risk of Premature Closure under stress need re-appraisal and...
The Operating Room does not leave time for scholarly reflection before action. Old ways of managing the risk of Premature Closure under stress need re-appraisal and perhaps a new paradigm. Is it time to say farewell to the autonomous surgeon?
PubMed: 29539975
DOI: 10.1515/dx-2013-0025 -
BMJ Open Apr 2023Premature trial discontinuation and non-publication of trial results are still major issues negatively affecting reliable evidence generation.
BACKGROUND
Premature trial discontinuation and non-publication of trial results are still major issues negatively affecting reliable evidence generation.
OBJECTIVES
To investigate trial completion and publication rate of cancer trials conducted within the Swiss Group for Clinical Cancer Research (SAKK).
DESIGN
Cohort study of clinical trials.
SETTING
Cohort of interventional cancer trials conducted in Switzerland with accrual closure between 1986 and 2021 identified from the SAKK trial management system.
OUTCOMES
Premature trial discontinuation and publication in peer-reviewed journal.
RESULTS
We included 261 trials; median number of recruited patients was 150.5 (range 1-8028). Most trials (67.0%) were randomised. Overall, 76 of 261 (29.1%) trials were prematurely closed for accrual. The three main reasons for premature closure were insufficient accrual in 28 trials, followed by stopping for futility in 17 or efficacy in 8 trials. We included 240 trials for the publication status (21 excluded, because 8 still in follow-up, for 10 the primary completion date was less than a year ago and for 3 the manuscript was submitted, but to accepted yet). 216 of 240 (90.0%) were published as a full article, 14 were published in other formats, leading to an overall publication rate of 95.8%. The rate of premature discontinuation declined over time, with 34.2%, 27.8% and 23.5% in trials activated before 2000, between 2000 and 2009, and since 2010, respectively. We observed an increasing publication rate in peer-reviewed journals over time: 79.2% (closed before 2000), 95.7% (closed between 2000 and 2009) and 93.2% (closed after 2010).
CONCLUSION
Insufficient patient recruitment is still the major reason for premature trial discontinuation. SAKK has continuously improved its quality management of trial conduct over time leading to increased successful trial completion and publication. However, there is still room for improvement to increase the number of trials reaching their target sample size.
Topics: Humans; Cohort Studies; Neoplasms; Research Design; Patient Selection; Ethnicity
PubMed: 37072360
DOI: 10.1136/bmjopen-2022-068490 -
Italian Journal of Pediatrics Nov 2023Ductal patency of preterm infants is potentially associated with long term morbidities related to either pulmonary overflow or systemic steal. When an interventional... (Review)
Review
Ductal patency of preterm infants is potentially associated with long term morbidities related to either pulmonary overflow or systemic steal. When an interventional closure is needed, it can be achieved with either surgical ligation or a catheter-based approach.Transcatheter PDA closure is among the safest of interventional cardiac procedures and it is the first choice for ductal closure in adults, children, and infants weighing more than 6 kg. In preterm and very low birth weight infants, it is increasingly becoming a valid and safe alternative to ligation, especially for the high success rate and the minor invasiveness and side effects. Nevertheless, being it performed at increasingly lower weights and gestational ages, hemodynamic complications are possible events to be foreseen.Procedural steps, timing, results, possible complications and available monitoring systems, as well as future outlooks are here discussed.
Topics: Infant; Child; Infant, Newborn; Humans; Infant, Premature; Ductus Arteriosus, Patent; Hemodynamic Monitoring; Feasibility Studies; Gestational Age; Treatment Outcome
PubMed: 37932790
DOI: 10.1186/s13052-023-01552-2