Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants

Borràs‐Novell, Cristina; Riverola, A; Aldecoa‐Bilbao, Victoria; Izquierdo, M.; Domingo, Monica

doi:10.1016/j.jped.2018.10.004

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…Our study shows that approximately 26% of neonates <26 wks’ gestation experience a spontaneous PDA closure, consistent with findings in the previous literature [ 8 , 29 ]. About half of the enrolled infants with evidence of PDA on US received medical treatment: consistently with findings from previous studies, the success rate was about 70% [ 11 , 12 , 30 – 32 ]. By monitoring neonates during their entire hospitalization, we observed that about 4% had persistent PDA at the time of discharge.…”

Section: Discussionsupporting

confidence: 84%

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Chesi,

Rossi,

Ancora

et al. 2024

PLoS ONE

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Objectives To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). Study design A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present. Results 218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA. Conclusions The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.

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Section: Discussionsupporting

confidence: 84%

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Chesi,

Rossi,

Ancora

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Considering that studies on PDA treatment in the preterm population were not able to demonstrate meaningful short or long-term bene ts of neonatal outcomes (35), many institutions have opted to progressively adopt a more conservative approach (9,39,47). However, most studies have underrepresented the most immature population of preterm infants, which are those born at < 26 weeks and even those born at < 24 weeks.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants

Cervera,

Saeed,

Luu

et al. 2024

J Perinatol

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Assess if unit-level PDA management correlates with neurodevelopmental impairment (NDI) at 18-24 months corrected gestational age (cGA) in extremely preterm infants. Study design:Retrospective analysis of infants born at < 29 weeks (2014-2017) across two units having distinct PDA strategies. Site 1 utilized an echocardiography-based treatment strategy aiming accelerated closure (control). Site 2 followed a conservative approach. Primary endpoint: NDI, characterized by cerebral palsy, any Bayley-III composite score < 85, sensorineural/mixed hearing loss, or at least unilateral visual impairment. Results377 infants were evaluated. PDA treatment rates remained unchanged in Site 1 but eventually reached 0% in Site 2. Comparable rates of any/signi cant NDI were seen across both sites (any NDI: 38% vs 36%; signi cant NDI: 13% vs 10% for Site 1 and 2, respectively). After adjustments, NDI rates remained similar. ConclusionPDA management strategies in extremely preterm newborns showed no signi cant impact on neurodevelopment outcomes at 18-24 months cGA. **Adjusted for bronchopulmonary dysplasia, chorioamnionitis, gestational age at birth and signi cant intraventricular hemorrhage (grade 3 or 4, or presence of periventricular leukomalacia).Abbreviations: Gross Motor Function Classi cation System (GMFCS).

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“…The conservative management includes PDA non-treatment, 4,5 targeted ventilation strategies, fluid restriction, and diuretic therapy to counteract the effect of PDA shunt. 6,7 However, the hemodynamic instability caused by the left to right shunt and associated run off may cause renal or gastrointestinal effects including spontaneous perforation, necrotising enterocolitis (NEC), and bronchopulmonary dysplasia (BPD). 8,9 Pharmacological intervention in PDA relies on different agents.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of rectal dexibuprofen versus oral ibuprofen for closure of patent ductus arteriosus in preterm infants with gestational age<34 weeks: A pilot study

Pan

Yang

Cui

et al. 2023

Int J Immunopathol Pharmacol

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This pilot study aimed to explore the effectiveness and safety of dexibuprofen suppository in the treatment of PDA in preterm infants. Preterm infants with gestational age <34 weeks and color Doppler echocardiographic evidence of hemodynamically significant PDA (hs PDA) with systemic hypoperfusion was intended to be included into this study since January 2020. As of January 1, 2021, this trial had recruited 87 preterm infants who met the inclusion criteria. Neonates were admitted into hospital within 1 hour after birth and were randomly assigned into two groups. Group one included 44 preterm newborns administered with oral ibuprofen. Group two included 43 preterm newborns administered with dexibuprofen suppository. This preliminary study showed that rectal dexibuprofen and oral ibuprofen were both effective for the closure of PDA, and the closure rate of dexibuprofen suppository was comparable to that of oral ibuprofen after the 1st and 2nd courses of treatment. In addition, rectal dexibuprofen did not increase the incidence of adverse outcomes, including bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, and necrotising enterocolitis. This pilot study showed dexibuprofen suppository is as effective and safe as oral ibuprofen; yet, better designed, muticenter controlled studies are still needed.

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Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants

Cited by 11 publications

References 28 publications

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants

Effectiveness and safety of rectal dexibuprofen versus oral ibuprofen for closure of patent ductus arteriosus in preterm infants with gestational age<34 weeks: A pilot study

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