Effectiveness and Side Effects of an Escalating, Stepwise Approach to Indomethacin Treatment for Symptomatic Patent Ductus Arteriosus in Premature Infants Below 33 Weeks of Gestation

Sperandio, Markus; Beedgen, B.; Feneberg, Reinhard; Huppertz, C.; Brüssau, Jürgen; Pöschl, Johannes; Linderkamp, Otwin

doi:10.1542/peds.2005-0293

Cited by 57 publications

(29 citation statements)

References 20 publications

(22 reference statements)

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“…Sperandio et al [8] listed four criteria for diagnosing a clinically significant PDA in ventilated preterm infants: (1) unexplained worsening of ventilator settings; (2) a systolic or continuous murmur; (3) widening of the blood pressure amplitude or low blood pressure, and (4) cardiac enlargement, increased pulmonary vascularity or pulmonary edema on chest radiography. Echocardiography was performed to validate the diagnosis when these criteria were met.…”

Section: Discussionmentioning

confidence: 99%

“…Preterm infants (i.e., born before 32 weeks of gestation) and very-low-birth-weight infants may have delayed ductal closure [1][2][3][4][5][6] . Persistent DA causes a left-toright shunt which may create left-side volume overload leading to enlargement of the left heart and the left atrium (LA) [7,8] . Common early symptoms which usually appear on the third to fourth day of life are systolic murmur, increased pericardial impulse and a wide pulse pressure.…”

Section: Introductionmentioning

confidence: 99%

“…Common early symptoms which usually appear on the third to fourth day of life are systolic murmur, increased pericardial impulse and a wide pulse pressure. Later signs may include cardiopulmonary deterioration, failure of being weaned from respiratory support and congestive heart failure [3,[8][9][10] . In premature infants, potential complications of a symptomatic patent DA (PDA) include pulmonary hemorrhage, bronchopulmonary dysplasia, intracranial hemorrhage, periventricular leukomalacia, necrotizing enterocolitis and renal insufficiency [1,3,[11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Carina Angle Measurements for Diagnosis of Patent Ductus Arteriosus in Preterm Infants

Strauss

Pessach²,

Jacoby³

et al. 2010

Neonatology

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Background: Bedside diagnosis of patent ductus arteriosus (PDA) continues to be important, especially when echocardiography is not readily available. Objective: The aim of our study was to evaluate whether measurement of left main bronchus displacement portrayed on a chest X-ray as a widened carina angle (CA) may support the presumptive diagnosis of PDA. Methods: Displacement of the left bronchus was assessed by measuring the angle between the two main bronchi at the level of the carina in 47 infants with PDA and 73 with no evidence of ductus, all born before 32 weeks of gestation. Results: The PDA group had a significantly wider CA (99.9 ± 12.1°) compared to the no-ductus group (72.9 ±15.7°; p < 0.001). Resolution of the PDA resulted in closure of the CA (62.3 ± 10.8°). We observed a significant and positive association between an increased CA measurement and PDA occurrence (OR = 1.7, 95% CI = 1.4–2.1). A CA cutoff point of 90° had the highest sensitivity (85%) and specificity (85%) for indicating the presence of PDA. Conclusions: Measurement of the CA is an easily accessible and reliable tool that may assist in establishing the diagnosis of PDA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Carina Angle Measurements for Diagnosis of Patent Ductus Arteriosus in Preterm Infants

Strauss

Pessach²,

Jacoby³

et al. 2010

Neonatology

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“…The criteria for the treatment of PDA included an increased left atrial diameter compared with the aortic root ([1.2), visualization of the ductus ([1 mm), and evidence of left-to-right blood flow through the open duct [25]. If a PDA was present, echocardiography was performed again on day 7 after medical treatment using ibuprofen [13].…”

Section: Methodsmentioning

confidence: 99%

Improved Closure of Patent Ductus Arteriosus With High Doses of Ibuprofen

et al. 2012

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The patent ductus arteriosus (PDA) is associated with various complications of prematurity. Cyclooxygenase-inhibitors are the first-line intervention for closure of the PDA. However, the rates of PDA closure still are unsatisfactory. Therefore, an individual trial was performed by changing the strategy for treating neonates with ibuprofen to induce the closure of PDA. In a retrospective study, patients receiving 20, 10, and 10 mg/kg bodyweight ibuprofen (group 1) were compared by chart review with those receiving 10, 5, 5 mg/kg (group 2). The rate of PDA closure, the incidence of side effects related to the use of ibuprofen, and the need for surgical intervention for closure of the PDA were analyzed. A higher rate of closure after three doses in group 1 could be observed (60.9 vs 52.6%; p = 0.75), which was not significant but indicated a clear positive trend. If closure of the PDA was unsuccessful, intravenous ibuprofen was continued for an additional 2 days. After 5 days, 91.3% of PDA in group 1 was closed compared with 68.4% PDA in group 2. In summary, only 8.7% of the group 1 neonates needed surgical closure of PDA after insufficient medicamentous closure compared with 31.6% in group 2 (p = 0.25). Although not statistically significant, a clear positive trend for using the higher-dose medication can be seen. More work dealing with the limitations of a retrospective study must be done. Based on the data from this study, high-dose ibuprofen seems able to increase the rate of effective medicamentous PDA closure without any further unwanted side effects.

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“…The optimal dosing of indomethacin for a PDA remains controversial, and some investigations have brought into question both the dosage and timing of PDA treatment 6 7. Other investigators have raised the question of whether asymptomatic PDA should be treated in these infants 8.…”

mentioning

confidence: 99%

B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus

Attridge¹,

Kaufman

Lim

2008

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Effectiveness and Side Effects of an Escalating, Stepwise Approach to Indomethacin Treatment for Symptomatic Patent Ductus Arteriosus in Premature Infants Below 33 Weeks of Gestation

Abstract: High-dose indomethacin after intermediate-dose therapy resulted in an overall closure rate of 98.5% (127 of 129). Although single indomethacin doses of up to 1 mg/kg were given, high-dose indomethacin was safe.

Cited by 57 publications

References 20 publications

Carina Angle Measurements for Diagnosis of Patent Ductus Arteriosus in Preterm Infants

Carina Angle Measurements for Diagnosis of Patent Ductus Arteriosus in Preterm Infants

Improved Closure of Patent Ductus Arteriosus With High Doses of Ibuprofen

B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus

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