Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus

Canpolat, Fuat Emre; Şimşek, Gülsüm Kadıoğlu; Webbe, James; Büyüktiryaki, Mehmet; Karaçağlar, Nazmiye Bengü; Kutman, Hayriye Gözde Kanmaz

doi:10.3389/fped.2020.00130

Cited by 13 publications

(14 citation statements)

References 16 publications

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“…Surfactant administration was performed in a lower number of subjects in ≤30 w no-hsPDA group vs. ≤30 w hsPDA (p < 0.05). Such a result seems in agreement with some recent literature results (22,25,26), especially sustaining the association between late surfactant administration (after 2 h of life) and hsPDA, due to the rapid reduction in pulmonary pressure that favors blood flow through PDA (left-to-right shunt), lung hyperflow and ductal persistence (29). Further studies are needed to clarify whether surfactant administration could increase the risk of hsPDA or PDA could have more possibilities to evolve in hsPDA in those preterm neonates with a higher early respiratory impairment at birth, lung hypoxia and alveolar damage, evidenced by an increased need for surfactant and a more severe RDS.…”

Section: Clinical Discussionsupporting

confidence: 92%

“…Several predisposing factors have been associated to PDA condition, sometimes with contrasting results, such as genetic factors (19)(20)(21), maternal pregnancy induced hypertension (PIH) (22), chorioamnionitis (23,24), maternal antepartum hemorrhage, respiratory distress syndrome (RDS), lower birth weight (BW), Apgar score and GA, female gender (22,25), dopamine administration and eccessive intravenous fluid administration (26), neonatal sepsis (27,28), need for surfactant (22,25,26,29), maternal and neonatal drug assumption (2,(30)(31)(32)(33)(34)(35)(36)(37)(38), platelet number, function and other platelet-related parameters (4,5,(39)(40)(41)(42)(43)(44)(45)(46)(47).…”

Section: Introductionmentioning

confidence: 99%

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Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

et al. 2020

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Introduction: In premature neonates, the persistence of hemodynamically significant ductus arteriosus (hsPDA) can be associated with short- and long-term consequences, impairing their outcome. The correct strategy of management for such condition is under debate, especially regarding contraindications and/or side effects. In recent years, metabolomics was applied to several perinatal, pediatric, and adult conditions to investigate potential biomarkers of disease, which have become useful for early diagnosis and/or therapeutic management.Aim of the Study: The main purpose of our exploratory study was to asses, through 1H-NMR metabolomics analysis of urinary samples at birth, possible metabolic pathways differentiating, with a significant predictive power, those preterm neonates who will subsequently develop hsPDA and neonates of comparable gestational age (GA) who will undergo spontaneous ductal closure or the persistence of an irrelevant PDA (no-hsPDA). Moreover, we investigated potential prenatal or perinatal clinical factors potentially influencing the development of hsPDA.Materials and Methods: We enrolled n = 35 preterm neonates with GA between 24 and 32 weeks; urinary samples were collected within the first 12 h of life. Patients were closely monitored regarding intensive care, respiratory support, fluid balance and administered drugs; an echocardiogram was performed at 48–72 h.Results: Our results reported a significant correlation between lower GA at birth and the development of hsPDA. Moreover, neonates with GA ≤ 30w developing hsPDA were characterized by lower Apgar scores at 1′ and 5′, higher rates of perinatal asphyxia, higher need of delivery room resuscitation and subsequent surfactant administration. Interestingly, metabolomics analysis at birth detected a clear separation between the 1H-NMR urinary spectra of subjects GA ≤ 30w not developing hsPDA (n = 19) and those of subjects born at GA ≤ 30w in which hsPDA was confirmed at 48–72 h of life (n = 5).Conclusions: This is the first study applying metabolomics to investigate the PDA condition. Although preliminary and conducted on a limited sample, our results reveal that metabolomics could be a promising tool in the early identification of hsPDA, potentially superior to the clinical or laboratory predictive tools explored to date and even to the clinical observations and correlations in our sample, through the detection of specific urinary metabolites.

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Section: Clinical Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

et al. 2020

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“…It also decreases the risk of pneumothorax, pulmonary interstitial emphysema, neonatal mortality and chronic lung disease in comparison to later rescue surfactant [9]. Additionally, late surfactant administration may also increase the risk of patent ductus arteriosus [10]. An increasing risk of bacterial catheter contamination as shown here adds another argument why early identification of infants requiring exogenous surfactant is important.…”

Section: Discussionmentioning

confidence: 72%

Microbiological analyses of nasally guided catheters after less invasive surfactant administration – a pilot study

et al. 2020

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Background: Respiratory distress syndrome (RDS) is a frequent complication of premature birth. Treating RDS by continuous positive airway pressure and less invasive surfactant administration (LISA) may reduce bronchopulmonary dysplasia. Surfactant, however, can be inactivated by bacterial infection. Therefore, potential routes of microbe transmission into the airway are of interest. The aim of this study was to evaluate microbiological contamination of catheters used for LISA procedures and its association with postnatal age. Methods: Catheter tips used for LISA procedures via the nasal route (LISA-n) in infants with RDS were placed into a sterile eSwab container directly after the procedure, cultured and examined for microbiological contamination.Results: Interpretable results could be collected from 20 catheter tips. Four showed positive culture results (20%) with microbes potentially associated with the development of early onset neonatal sepsis. Risk of positive microbe detection increased with postnatal age (< 4 h: 10%; 4-18 h: 20%; > 18 h: 40%).Conclusions: In this pilot study, the risk of tracheal microbe transmission following the LISA-n procedure increased with postnatal age. Although the clinical relevance of this finding is unclear, earlier surfactant administration might reduce the risk of catheter contamination.

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“…Hastalara ait anne yaşı, annede preeklampsi, gestasyonel diyabet, antenatal steroid, gebelik haftası (GH), doğum ağırlığı (DA), doğum şekli (sezaryen/normal vajinal yol), Apgar skorları (1. ve 5. dakika), cinsiyeti, mekanik ventilasyon, non invaziv solunum destek ve oksijen destek süresi, erken neonatal sepsis (ENS, ≤72 saat), geç neonatal sepsis (GNS, >72saat) (7), RDS (8), intraventiküler kanama (İVK, evre ≥3) (9), hemodinamik anlamlı olup tedavi gerektiren patent duktus arteriozus (PDA) (10), tedavi gerektiren prematüre retinopatisi (ROP) (11), orta/ciddi BPD (12), kanıtlanmış ya da ciddi nekrotizan enterokolit (NEK; >2 evre) (13) varlığı, tam enteral beslenmeye geçiş zamanı, YDYBÜ yatış süresi ve mortalite verileri kayıt edildi. Prematüre bebeğin Fenton eğrilerine göre doğum ağırlığı gebelik haftasına göre 10 persentilin altında ise SGA, 10-90 persentil arasında olması durumunda AGA olarak tanımlandı (14).…”

Section: Demografik Ve Klinik öZelliklerunclassified

Effects of being small for gestational age on morbidities of prematurity

Yildiz

Ceran

Çakır

et al. 2022

Anadolu Kliniği Tıp Bilimleri Dergisi

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Amaç: Gebelik yaşına göre düşük doğum ağırlığı (small for gestational age: SGA) olan prematüre bebeklerin prematüreliğe ek olarak hangi morbiditeler açısından daha riskli olduğu konusundaki kanıtlar yetersizdir. Çalışmamızda gebelik haftası <32 hafta olan SGA prematüre bebeklerin morbidite ve mortalite açısından risklerinin değerlendirilmesi amaçlanmıştır.Yöntemler: Gebelik haftası <32 hafta olup SGA olan bebeklerin morbiditeleri ve mortalite verileri, <32 gebelik haftasında doğan gebelik haftasına uygun doğum ağırlığı ile doğan (appropriate for gestational age: AGA) bebekler ile karşılaştırıldı.Bulgular: Çalışmaya 122 (%24,6) SGA ve 372 (%75,4) AGA bebek olmak üzere toplam 494 prematüre bebek dâhil edildi. Doğumda SGA olan bebeklerde AGA olanlara göre annede preeklampsi, nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), intraventiküler kanama (İVK) oranı daha yüksekti. Ayrıca SGA olanlarda AGA olanlara göre tam enteral beslenmeye geçiş zamanı, yoğun bakımda yatış süresi anlamlı olarak daha yüksekti (p<0,05).Sonuç: Gebelik haftaları benzer olsa da SGA ve prematüre olan bebeklerde, AGA olan bebeklere göre İVK, ROP ve NEK gibi prematüre morbiditeleri daha yüksekti.

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Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus

Cited by 13 publications

References 16 publications

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

Microbiological analyses of nasally guided catheters after less invasive surfactant administration – a pilot study

Effects of being small for gestational age on morbidities of prematurity

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