Echocardiography-Guided Management of Preterms With Patent Ductus Arteriosus Influences the Outcome: A Cohort Study

Abstract

Introduction: Echocardiography (ECHO) with color flow Doppler is considered as the gold standard to identify a hemodynamic patent ductus arteriosus (hs-PDA). However, the optimal diagnostic and therapeutic management for newborns with hs-PDA is still controversial. We aimed to investigate two clinical strategies: (1) targeted treatment based on ECHO criteria and (2) treatment based on ECHO criteria in addition to clinical signs and symptoms.Materials and Methods: This is a cohort study including all neonates consecutively admitted in the Neonatal Intensive Care Unit of University La Sapienza in Rome, with gestational age <32 weeks or body birth weight <1,500 g and with a diagnosis of hs-PDA as confirmed by ECHO evaluation performed within 72 h of life. We classified the babies in two cohorts: (A) pharmacological treatment immediately after ECHO screening and (B) pharmacological therapy for PDA was administered when the relevance of a hs-PDA was associated with clinical signs of hemodynamic instability.Results: We considered as primary outcome newborns who survived without any morbidities (A: 48.1% vs. B: 22.2%, p = 0.022). In particular, we found that the rate of intraventricular hemorrhage stage ≥2 was increased in cohort B (A: 3.7% vs. B 24.4%, p = 0.020). A multivariate analysis showed that assignment to cohort A independently influences the primary outcome.Conclusions: Adopting an hs-PDA management option based on ECHO-directed therapy regardless of symptoms may reduce the morbidity and improve the survival of very low birth weight infants.

Size of Patent Ductus Arteriosus and Echocardiographic Markers of Shunt Volume in Preterm Infants Based on Postnatal Age

“…Recent evidence suggests that mortality may depend on the management of PDA, and a moderate approach is associated with optimal outcomes (19). While in some infants a careful "wait and watchful" strategy may be the best option, other infants may need treatment to minimize the comorbidities in the early postnatal period (20). Also, for extremely preterm infants in the transitional period, echocardiographic assessment for hsPDA is very important for the conservative management of hemodynamically unstable infants.…”

Atopic Manifestations in Children Born Preterm: A Long-Term Observational Study

“…Medical staff caring for the enrolled children was blinded to the study aims. Clinical data were collected by researchers not involved in clinical practice in a specific data form, deidentified and codified [18,19]. A statistician, blinded to the study design and aims, received a codified database and performed data analysis.…”

Neonatal Hyperglycemia Related to Parenteral Nutrition Affects Long-Term Neurodevelopment in Preterm Newborn: A Prospective Cohort Study

“…As previously described [5], we defined morbidity the presence of at least one of the major prematurity-related complications, including necrotizing enterocolitis (NEC) Bell-Stage ≥ II, periventricular leukomalacia (PVL), late-onset culture proven sepsis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD). Diagnosis of prematurityrelated morbidities was performed according to standard criteria [22][23][24][25][26]. We considered EUGR, with longitudinal definition, as the loss of 1 standard deviation (SD) from birth to 36 weeks of PMA [27].…”