Incidence and risk factors for cerebral palsy in infants with perinatal problems: A 15-year review

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

“…Search results and citation lists for prior publications identified 75 randomized-controlled trials of interventions that close a PDA in preterm infants. In 26 trials (five comparing long and short courses of indomethacin, [37][38][39][40][41] 19 comparing indomethacin and ibuprofen, [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and two that included very early crossover to treatment of nonresponders 29,61 ), rates of ductal closure did not differ between treatment assignments, precluding evaluation of effects of ductal closure on other outcomes, so these were excluded. The remaining 49 trials, 36, including 4728 subjects, were deemed potentially informative, as all but one documented substantial reduction in ductal patency after treatment.…”

“…1 Over the following two decades, the hemodynamic and pulmonary consequences of delayed ductal closure provided a compelling rationale for treatment to close the ductus. In landmark papers, patent ductus arteriosus (PDA) in infants with RDS was linked to bronchopulmonary dysplasia (BPD) by Northway et al, 2 prolonged ventilation by Siassi et al, 3 mortality by Gregory et al, 4 and worsening pulmonary disease by Kitterman et al 5 Subsequent studies confirmed the association of PDA with pulmonary hemorrhage, 6,7 severe RDS, 8,9 BPD, [10][11][12] necrotizing enterocolitis (NEC), 13,14 renal impairment, 15 intraventricular hemorrhage (IVH), 16,17 periventricular leukomalacia (PVL), 18 cerebral palsy, 19 and death. 20,21 Even now, the adjusted risk of death is increased four- 22 to eightfold 23 for very low birth weight (<1500 g) infants in whom the ductus remains patent after medical therapy.…”

Infecção sistêmica e lesão cerebral no recém-nascido pré-termo

“…This well-designed study adds supportive evidence for the role of postnatal infection in the pathogenesis of PVL. 2 While the data are provocative, it is unclear from this article how the timing of the sepsis episodes is related to the development of PVL. If the study infants all had early-onset sepsis, it is somewhat surprising that coagulase negative staphylococcus was the most common pathogen recovered.…”

Controversies in Management of Patent Ductus Arterious in the Preterm Infant

“…It also steals blood away from the systemic circulation resulting in adverse consequences of necrotizing enterocolitis [33] intraventricular hemorrhage [34] periventricular leukomalacia [35], cerebral palsy [36] and death [37]. Although observational studies have consistently shown an association with the above adverse outcomes, there is lack of evidence whether PDA is truly causal or simply an association.…”