Ductus arteriosus and the preterm brain

Chock, Valerie Y.; Bhombal, Shazia; Variane, Gabriel Fernando Todeschi; Meurs, Krisa P. Van; Benitz, William Ε.

doi:10.1136/archdischild-2022-324111

Cited by 4 publications

(1 citation statement)

References 44 publications

(58 reference statements)

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“…PDA is diagnosed in 39% of very-low-birth-weight infants (VLBW, <1500 g birth weight), and up to 70% of infants born before 28 wk gestation, and there have been many cases of long-term patent ductus arteriosus in preterm infants [4]. PDA is associated with neonatal mortality and morbidity, including conditions such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) [5][6][7][8]. In addition, there are many unclear points regarding its impact on long-term neurodevelopment.…”

Section: Introductionmentioning

confidence: 99%

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Kikuchi,

Goto,

Katsumata

et al. 2024

JCDD

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In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011–2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson’s correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the “posture/motor” sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.

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Section: Introductionmentioning

confidence: 99%

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Kikuchi,

Goto,

Katsumata

et al. 2024

JCDD

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Severe brain injury and trends of gestational‐age‐related neurodevelopmental outcomes in infants born very preterm: A population cohort study

Wang,

Chu,

Lin

et al. 2024

Develop Med Child Neuro

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AimTo investigate the impact of severe neonatal brain injury (SNBI) on gestational age‐related trends in neurodevelopmental impairment (NDI) outcome in infants born very preterm.MethodA population‐based cohort study recruited 1091 infants born at a gestational age of less than 31 weeks between 2011 and 2020. The trends in neonatal morbidities, mortality, and 24‐month NDI severity (no/mild, moderate, severe) by epoch (2011–2015, 2016–2020) and gestational age (22–25 weeks, 26–28 weeks, 29–30 weeks) were determined in infants with and without SNBI inclusion.ResultsThere was increased antenatal steroid use and higher maternal education and socioeconomic status over time. The rates of neonatal morbidities and mortality had no temporal changes. Among 825 infants with follow‐up, those in the 22 to 25 weeks gestational age group had declining trends in cerebral palsy and severe cognitive impairment, with decreased rates of severe NDI from 19% to 8% across epochs, particularly in those without SNBI (from 16% to 2%). Relative to its occurrence in epoch 2011 to 2015, risk of severe NDI was significantly reduced in epoch 2016 to 2020 (adjusted relative risk 0.39, 95% confidence interval 0.16–0.96) for infants born at 22 to 25 weeks gestational age, and the risk dropped even lower in these infants without SNBI (0.12, 0.02–0.84).InterpretationInfants born at 22 to 25 weeks gestational age had decreased rates of severe NDI in the decade between 2011 and 2020, particularly those without SNBI. The improvement might be attributed to better perinatal/neonatal and after‐discharge care.

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TREOCAPA: Prophylactic Treatment of the Ductus Arteriosus in Preterm Infants by Acetaminophen. Statistical analysis plan for the randomized phase III group sequential trial

Ursino,

Alberti,

Cambonie

et al. 2024

Preprint

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Background Persistent patency of the ductus arteriosus (PDA) has challenged neonatologists for more than 40 years. Controversies persist about the management of PDA in extremely preterm infants. PDA is associated with morbidities but no therapeutic strategy has resulted in an improved neonatal outcome. Acetaminophen appears to be a promising alternative with possibly fewer adverse effects. The primary objective is to determine whether a prophylactic pharmacological intervention with acetaminophen, may increase the survival without severe morbidity at postmenstrual age of 36 weeks. Methods and analysis TREOCAPA Phase III is a randomized, multicenter, double-blind, stratified, placebo-controlled superiority trial, two arms in a 1:1 ratio performed in 43 NICUs of 14 European countries and evaluating whether the intervention increases the survival without severe morbidity by 10 percent until the age of 36 postmenstrual weeks. Patients eligible for inclusion are preterm infants with a gestational age between 23 and 28 weeks. In acetaminophen group, 20 mg/kg loading dose within 12 hours after birth, followed by 7.5 mg/kg quarter in die (QID) for 5 days will be administered to the 27–28 weeks gestational age group, and 25 mg/kg loading dose then 10 mg/kg QID to the 23–26 weeks gestational age group. The severe morbidities include severe bronchopulmonary dysplasia (BPD Grade 3) according to NIH consensus, necrotizing enterocolitis (NEC) of Bell's stage II or III, intraventricular hemorrhage (IVH) grade III-IV according to Papille classification or cystic leukomalacia. Discussion Whatever the results, the conclusions of this study should be informative for the neonatal scientific community: Secondary effects of aceminotophen or not? Prophylactic treatment of PDA useful or not? Ethics and dissemination Ethical approval of the trial has been performed in each of the 14 countries after approval, at the European level, by the Voluntary Harmonization Procedure committee on 04/07/2020. Results will be disseminated through articles in peer-reviewed journals. Trial registration European Clinical Trials Database: EudraCT Number: 2019-004297-26

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Ductus arteriosus and the preterm brain

Cited by 4 publications

References 44 publications

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Severe brain injury and trends of gestational‐age‐related neurodevelopmental outcomes in infants born very preterm: A population cohort study

TREOCAPA: Prophylactic Treatment of the Ductus Arteriosus in Preterm Infants by Acetaminophen. Statistical analysis plan for the randomized phase III group sequential trial

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