Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants

Mirza, Hussnain; Garcia, Javier O.; McKinley, Genevieve; Hubbard, L.E.; Sensing, Wendla; Schneider, Jordan; Oh, William; Wadhawan, Rajan

doi:10.1038/s41372-019-0496-5

Cited by 54 publications

(39 citation statements)

References 21 publications

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“…It can result in pulmonary edema, reduced lung compliance, and ineffective gas exchange. This, in turn, leads to increased ventilator settings, which can cause parenchymal lung damage in the neonate (39). It has been suggested that PDA closure within the first 4 weeks of life may allow for faster weaning of oxygen and ventilatory support in extremely low birth weight (ELBW) infants (birth weight ≤1,000 g) (40); however, further investigation is needed.…”

Section: Pda In the Premature Neonatementioning

confidence: 99%

Management of Patent Ductus Arteriosus in Premature Infants in 2020

et al. 2021

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The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.

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Section: Pda In the Premature Neonatementioning

confidence: 99%

Management of Patent Ductus Arteriosus in Premature Infants in 2020

et al. 2021

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“…Patent ductus arteriosus is inversely related to gestational age, occurring in up to 70% of extremely premature infants beyond the postnatal transition period and has been associated with increased risk of bronchopulmonary dysplasia, hemorhagic pulmonary edema, necrotizing enterocolitis, intraventricular hemorrhage, and retinopathy of prematurity. 31 In our study, 38% of subjects underwent surgical closure of the ductus arteriosus; 8 subjects were rescued with HFJV perioperatively, whereas the remaining 12 underwent rescue HFJV within 24 h following surgery. Our study was not designed to discern the impact of ductal patency on outcomes because patent ductus arteriosus was considered a categorical variable and we did not control for clinically important factors such as the relative pressure differences between pulmonary and systemic circulations, and size or duration of significant ductus arteriosus.…”

Section: Discussionmentioning

confidence: 80%

“…Our study was not designed to discern the impact of ductal patency on outcomes because patent ductus arteriosus was considered a categorical variable and we did not control for clinically important factors such as the relative pressure differences between pulmonary and systemic circulations, and size or duration of significant ductus arteriosus. [31][32][33] Preoperatively, the progressive reduction of pulmonary vascular resistance, increased left-to-right shunt, and subsequent pulmonary overcirculation compounds underlying respiratory distress syndrome via mechanisms of pulmonary edema formation. This results in further reduction of respiratory system compliance and worsened gas exchange.…”

Section: Discussionmentioning

confidence: 99%

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

et al. 2020

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BACKGROUND: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV. METHODS: Subjects were enrolled if birthweight was^2,000 g and they were^34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney U-test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score. RESULTS: A total of 53 premature subjects (n 5 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2-19.8, P 5 .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3-39.5, P 5 .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5-28.3, P 5 .02) were independent predictors of mortality. CONCLUSIONS: We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.

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“…However, there was no difference in unadjusted risk between infants with PDA for 1-2 weeks (51%) compared with those exposed for >2 weeks (59%; P = .97). 5 Schena et al described increased rates of death or BPD with exposures to hemodynamically significant PDA (³E2, ³E3, or E4 by McNamara classification 6 ) for more than 7 days (unadjusted OR 3.85, 2.18-6.78; 3.45, 1.83-6.50; and 15.1, 1.43-156, respectively). In multivariate analysis, exposure to E2 PDA had no significant impact, but E3-E4 PDA was associated with increased risk (aOR 1.70 per week of exposure, 95% CI 1.09-2.66).…”

mentioning

confidence: 99%

“…Birth size can be increased by supplementing maternal diets with micronu-trients or more comprehensive products with micro-and macronutrients and energy. 5,6 What has been less clear is whether it is important to start the dietary supplementation before or during pregnancy and whether the possible fetal growth gains in size are preserved after birth. These 2 questions were addressed in the Women First trial, in which nonpregnant women from Democratic Republic of Congo, Guatemala, India, and Pakistan were randomized to receive no supplementation (Arm 3) or dietary supplementation starting either before pregnancy (Arm 1) or at around 11 weeks of gestation (Arm 2) and continuing until delivery.…”

mentioning

confidence: 99%