Predictors of successful closure of patent ductus arteriosus with indomethacin

Ahamed, Mohamed Farooq; Verma, Prasoon; Lee, Simon; Vega, Mario; Wang, D; Kim, M; Fuloria, Mamta

doi:10.1038/jp.2015.33

Cited by 34 publications

(36 citation statements)

References 25 publications

(34 reference statements)

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“…Gestational age [5,6,21,22], birth weight [5,23], and postnatal age at first treatment [20,23,24] have been examined previously as factors associated with medication failure. Similar to previous studies, at the bivariate level we found that several neonatal variables were significantly associated with successful pharmacologic treatment including male sex [25], higher GA [22,24] and higher birth weight [26], and we confirmed earlier work showing that infection seems to reduce the chance of successful pharmacologic closure [27]. Contrary to other studies, however, lack of antenatal corticosteroid exposure [22] and chorioamnionitis [28] did not seem to affect the success of pharmacologic treatment.…”

Section: Discussionsupporting

confidence: 89%

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

Boghossian

Tiddi

Bell

et al. 2017

Early Human Development

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Background Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. Aim We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. Study design, subjects, and outcome measures We studied infants 23–28 weeks’ gestation born 2006–2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<−2, −2 to −0.5, and >−0.5) and PDA surgery following pharmacologic treatment. Results 5,606 infants were diagnosed with PDA; 3,587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score >−0.5, PDA surgery was increased among infants with z-score −2 to −0.5 (OR=1.23; 95% CI 1.02–1.47) but not among infants with z-score <−2. Conclusion Infants with birth weight z-score −2 to −0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.

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Section: Discussionsupporting

confidence: 89%

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

Boghossian

Tiddi

Bell

et al. 2017

Early Human Development

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“…Similar to our study, all of these reports have focused on the platelet counts during the first few days of life. However, the study of Ahamed et al [30] differs from others in that they have also investigated the platelet count at the time of initiation of indomethacin therapy, over the first week of life, as a possible predictor of the success of medical management. Our results reveal that none of the platelet parameters, including the platelet count, influence the course of PDA or its response to medical treatment.…”

Section: Discussionmentioning

confidence: 96%

“…Ahamed et al could not find an association between thrombocytopenia at the time of treatment of PDA and failure of medical treatment in achieving ductal closure. However, in infants with HSDA, they demonstrated that a higher platelet count at the time of indomethacin treatment was a predictor of successful ductal closure [30].…”

Section: Discussionmentioning

confidence: 97%

Is there a relationship between platelet parameters and patency of ductus arteriosus in preterm infants?

Olukman

Özdemir²,

Karadeniz³

et al. 2017

Blood Coagulation &Amp; Fibrinolysis

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Postnatal closure of the ductus arteriosus is a complicated two-phase process involving functional and structural changes. So far, the precise mechanisms regulating this process are not fully understood. A growing body of evidence from recent studies suggests that platelets play a key role in inflammatory processes including ductal closure via interaction with endothelial cells. The aim of this study is to assess whether a relationship exists between the occurrence and/or closure of hemodynamically significant ductus arteriosus (HSDA) and platelet parameters (platelet count, circulating platelet mass, mean platelet volume, platelet distribution width) in preterm newborns. This single-center, retrospective study included 824 premature infants between 24 and 34 gestational weeks, evaluated by echocardiography at postnatal 72-96 h. Infants with and without HSDA (n = 208 vs. n = 616) were compared in terms of platelet parameters recorded within the first 3 days of life. Oral or intravenous ibuprofen was commenced for medical treatment, and echocardiography was repeated 24 h thereafter to determine ductal closure. No statistically significant difference could be demonstrated between the groups in terms of baseline platelet parameters. HSDA was independently associated with early-onset neonatal sepsis. Thrombocytopenia, low circulating platelet mass, high platelet distribution width, or high mean platelet volume could not be demonstrated as a risk factor for HSDA. None of the platelet parameters had an influence on ductal closure after medical treatment. Unlike most reports in the literature, presence of HSDA was not associated with any platelet parameter in our study. We could not demonstrate an association between any platelet parameter and either persistence or closure after medical treatment.

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“…Paradoxically, despite their known inhibitory effects on platelet activation in vitro [7] , both indomethacin and ibuprofen are effective at inducing PDA closure. Interestingly, Boo et al [37] and - very recently - Ahamed et al [38] reported an association between low platelet counts before starting indomethacin treatment and lack of response to the therapy. Nevertheless, this finding has not been confirmed in other studies [12,15].…”

Section: Discussionmentioning

confidence: 99%

Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

et al. 2015

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Background: Several cohort studies have shown an association between low platelet counts in the first day(s) of life and patent ductus arteriosus (PDA) in preterm infants. However, these results have not been confirmed by other studies. Objective: To perform a meta-analysis of all the studies addressing the relationship between platelet counts in the first day(s) of life and PDA in preterm infants. Methods: PubMed/MEDLINE and EMBASE were searched from their inception until December 2014. Results from 11 cohort studies involving 3,479 preterm infants (gestational age <32 weeks) were pooled using random-effects modeling. Results: Meta-analysis showed a significant positive association between PDA and platelet counts <150 × 10⁹/l [6 studies, risk ratio (RR) = 1.215, 95% CI: 1.027-1.436], between PDA and platelet counts <100 × 10⁹/l (5 studies, RR = 1.255, 95% CI: 1.034-1.525), and between significant PDA (SPDA) and platelet counts <100 × 10⁹/l (5 studies, RR = 1.254, 95% CI: 1.021-1.540). The association between SPDA and platelet counts <150 × 10⁹/l was not statistically significant (6 studies, RR = 1.289, 95% CI: 0.925-1.795). Pooled standard differences in mean platelet counts between infants with and without PDA/SPDA were not statistically different. Conclusion: This meta-analysis reveals a marginal but significant association between low platelet counts in the first day(s) of life and PDA/SPDA in very preterm infants. This association needs to be confirmed in prospective studies.

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Predictors of successful closure of patent ductus arteriosus with indomethacin

Abstract: Older GA, male gender and higher platelet count at time of treatment of hemodynamically significant PDA are predictors of successful ductal closure with indomethacin.

Cited by 34 publications

References 25 publications

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

Is there a relationship between platelet parameters and patency of ductus arteriosus in preterm infants?

Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

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