Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants

Philip, Ranjit; Waller, B. Rush; Chilakala, Sandeep; Graham, Belinda; Stecchi, Nathan; Apalodimas, Leah; Cunningham, Jorden; Washington, Kristen; Sathanandam, Shyam

doi:10.1038/s41372-020-00772-2

Cited by 34 publications

(23 citation statements)

References 34 publications

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“…The optimal timing of interventions on these lesions is a topic of ongoing investigation. Philip et al [12] recently assessed timing of transcatheter occlusion of PDAs in premature infants born before 27 weeks gestation with the ability to wean off of respiratory support and supplemental oxygen. They found intervention within 4 weeks of life seemed to be associated with faster weaning of ventilator support and supplemental oxygen as compared to delaying the procedure beyond 8 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Recent technological advances have made transcatheter occlusion of PDAs and ASDs in small premature infants both feasible and safe, and some studies have suggested improvements in respiratory status after the procedure [10][11][12][13][14][15][16][17][18]. However, to our knowledge, there have not been any case-controlled studies assessing respiratory outcomes in premature infants with BPD who have undergone transcatheter occlusion of ASDs or PDAs.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter Occlusion of Left-To-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia

et al. 2022

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Introduction: Patent ductus arteriosus (PDA) and atrial septal defects (ASDs) cause pulmonary overcirculation, potentially worsening bronchopulmonary dysplasia (BPD) in premature infants. Transcatheter device occlusion of these defects is feasible and safe, though no case-controlled studies have assessed respiratory outcomes in infants with BPD. We hypothesized infants with BPD and ASDs or PDAs would experience improved respiratory outcomes following device occlusion of these lesions as compared to those who did not. Methods: We conducted a single-center, retrospective case-control study of premature infants diagnosed with BPD and either a small to large ASD or a small to moderate PDA from 2015 to 2021. The intervention group underwent transcatheter device occlusion of their defects and the control group did not. We compared changes in BPD severity over time between these two groups. Results: The control and intervention groups demonstrated comparable baseline demographics. Of the 15 patients in the intervention group, 9 underwent PDA device occlusion and 6 underwent ASD device occlusion at median postmenstrual age of 42 weeks (IQR 41–45 weeks). Despite having higher severity BPD at baseline, there was a more pronounced improvement in BPD severity in the intervention group as compared to the control group. Discussion: Premature infants with BPD and an ASD or PDA who underwent transcatheter occlusion of their lesion demonstrated a faster rate of improvement of their BPD severity as compared to a control cohort with similar lesions who did not undergo device occlusion of their lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcatheter Occlusion of Left-To-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia

et al. 2022

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“…We believe that clinically stable infants not receiving high respiratory support should be evaluated both clinically and echocardiographically but should not be given medical treatment (Hamrick et al, 2020; Oncel et al, 2014; Smith & El‐Khuffash, 2020). However, medical PDA closure is recommended for infants with respiratory problems requiring ventilator support and findings of increased pulmonary load (Härmä et al, 2020; Philip et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…However, medical PDA closure is recommended for infants with respiratory problems requiring ventilator support and findings of increased pulmonary load (Härmä et al, 2020;Philip et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Long‐term neurodevelopmental outcomes in very low birth weight infants with and without patent ductus arteriosus: A retrospective case control observational study

Canpolat

Işık

Büyüktiryaki

et al. 2022

Child

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Background: Patent ductus arteriosus (PDA) has been associated with early morbidities and long-term developmental problems in very preterm infants. Aims:The aim of this study is to investigate the effect of patent ductus arteriosus and medical treatment on long-term developmental outcomes in very low birth weight infants.Study design: This is a retrospective case control observational study. Subject:The study included preterm infants who were born before 30 weeks' gestation and birth weight less than 1,500 g and underwent neurodevelopmental testing at a corrected age of 24 months during follow-up in our centre. The results of neurodevelopmental assessment using the Bayley Scales of Infant Development II at 24 months of corrected age and other morbidities were recorded.

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“…This uncertainty about the clinical impact of PDA has resulted in a variety of treatment approaches. Many centres have adopted protocols incorporating a combination of expert opinion guidelines and echocardiography to diagnose and manage a haemodynamically significant (HDS) PDA 4,5 . However, these guidelines and interpretations may not be followed due to bedside clinician's discretion and lack of equipoise.…”

Section: Commentarymentioning

confidence: 99%

Changes in PDA treatment strategy and respiratory outcomes: Optimal timing of intervention … continuing the long conversation

Gowda

Patil

2021

Acta Paediatrica

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Premature newborns with respiratory failure often require mechanical ventilation. Prolonged mechanical ventilation, lower gestational age, lower birthweight, small for gestational age, resuscitation, infections, hyperoxia, genetic factors, poor nutrition and male gender predispose these patients to bronchopulmonary dysplasia (BPD). 1Patent ductus arteriosus (PDA) contributes to respiratory failure through pulmonary overcirculation. 2,3 Previous studies have shown an association between PDA and BPD but not causality. This uncertainty about the clinical impact of PDA has resulted in a variety of treatment approaches. Many centres have adopted protocols incorporating a combination of expert opinion guidelines and echocardiography to diagnose and manage a haemodynamically significant (HDS) PDA. 4,5 However, these guidelines and interpretations may not be followed due to bedside clinician's discretion and lack of equipoise. How to cite this article: Gowda SH, Patil MS. Changes in PDA treatment strategy and respiratory outcomes: Optimal timing of intervention … continuing the long conversation. Acta

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Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants

Cited by 34 publications

References 34 publications

Transcatheter Occlusion of Left-To-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia

Transcatheter Occlusion of Left-To-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia

Long‐term neurodevelopmental outcomes in very low birth weight infants with and without patent ductus arteriosus: A retrospective case control observational study

Changes in PDA treatment strategy and respiratory outcomes: Optimal timing of intervention … continuing the long conversation

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