The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis

Ding, Ran; Zhang, Qianwei; Yi, Dengxia; Wang, Dai-Jing; Sun, Qi-Bin; Shan, Ruobing

doi:10.1007/s00431-020-03802-5

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…Furthermore, a higher platelet count (≥181 × 10 9 /L) before ibuprofen treatment was found to be independently associated with the closure of hsPDA in VLBW infants without concurrent infection. Since Echtler et al (16) first reported that platelets are crucial for ductus arteriosus closure in mice and premature infants, several studies also analyzed the association between low platelet and the patency of ductus arteriosus in preterm infants, yielding conflicting findings (8,(17)(18)(19)(20). Building up the complexity studies investigating whether platelet level affects the closure of PDA after pharmacotherapeutic agents also reported conflicting findings.…”

Section: Discussionmentioning

confidence: 99%

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

Zhong

Lin

et al. 2021

Front. Pediatr.

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Background: Platelet-rich thrombosis leads to the occlusion of arteries. Whether the association between platelet count and closure of hemodynamically significant patent ductus arteriosus (hsPDA) exists remains inconclusive. Given that neonatal platelet count is significantly affected by infection, this study aims to evaluate the association of platelet parameters before ibuprofen treatment with the closure of hsPDA in very low birth weight (VLBW) infants without concurrent infection.Methods: A retrospective study was conducted at the NICU of Shenzhen Maternity and Child Healthcare Hospital from January 2016 to August 2020. VLBW infants diagnosed with hsPDA, treated with oral ibuprofen and without concurrent infection were included in this study. The platelet parameters were retrieved from the whole-blood test routinely performed within 24 h before starting treatment of oral ibuprofen. A multiple regression model was built to evaluate the association between platelet parameters before ibuprofen treatment and successful closure of hsPDA.Results: A total of 129 premature infants with hsPDA were analyzed in this study. After oral ibuprofen treatment, successful closure of hsPDA was achieved in 70 (54.3%) infants. The gestational age at birth and birth weight in infants with successful or failed closure of hsPDA after ibuprofen treatment were 28.3 vs. 27.6 weeks (p = 0.016) and 1,120 vs. 960 g (p = 0.043), respectively. The rate of mechanical ventilation in infants with successful closure of hsPDA was significantly lower compared to those with failed closure of hsPDA, 31.4 vs. 54.2%, p = 0.014. The platelet count in infants with successful closure of hsPDA after ibuprofen treatment was significantly higher compared to those with failed closure of hsPDA, 212 vs. 183 (in a unit of 109/L), respectively (p = 0.024). Multivariate logistic regression analysis showed that a higher platelet count (≥181 × 109/L) before ibuprofen treatment was independently associated with successful closure of hsPDA [odds ratio 2.556, 95% confidence interval (1.101–5.932), p = 0.029].Conclusion: The findings in this study suggest that a higher platelet count before oral ibuprofen treatment may predict the probability of successful closure of hsPDA in VLBW infants.

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Section: Discussionmentioning

confidence: 99%

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

Zhong

Lin

et al. 2021

Front. Pediatr.

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“… 23 , 50 , 51 In a recent systematic review and meta-analysis, it has been concluded that platelet count, PCT, and platelet mass of the first 3 days of life are potentially helpful in identifying infants at risk for hsPDA. 20 …”

Section: Methods Other Than Echocardiographymentioning

confidence: 99%

“…Nonetheless, recent meta-analyses concluded that thrombocytopenia represents a moderate independent risk factor for both delayed spontaneous ductal closure and failed pharmacologic ductus arteriosus closure. [18][19][20] Furthermore, several studies suggest that impaired platelet function rather than platelet number is critically involved in the failure of ductus arteriosus closure in preterm infants. 12,[21][22][23][24] In addition, a randomized-controlled trial on platelet transfusions failed to show any benefit for liberal versus restrictive transfusion thresholds on patent ductus arteriosus (PDA) closure rates in preterm infants, and liberal transfusion thresholds were associated with an increased rate of intraventricular hemorrhage (IVH).…”

Section: Molecular and Mechanical Mechanisms Of Ductal Closurementioning

confidence: 99%

An Update on Patent Ductus Arteriosus and What is Coming Next

Erdeve

Okulu

Singh

et al. 2022

Turk Arch Pediatrics

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Patent ductus arteriosus is the most common cardiovascular condition in preterm infants. There is a significant uncertainty about when and how to close ductus arteriosus in preterm infants due to a high spontaneous closure rate even in very immature preterm infants. Diagnosis and management of patent ductus arteriosus remain a challenge for both neonatologists and pediatric cardiologists. Researchers have tried to define a balance between an expectant approach and active treatment in selected infants. This review aimed to focus on the pathophysiology and management of patent ductus arteriosus and to make suggestions about approaches that might eliminate the association of morbidities with patent ductus arteriosus.

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“…In summary, the aforementioned studies (and recent metaanalyses) on platelet indices and PDA have revealed inconsistent or even conflicting results, which were probably, at least in part, due to differences in study designs, treatment protocols, and the definition of hsPDA (28,34). Furthermore, hematologic indices might be affected by several conditions, such as inflammation, hypoxia and/or volume status, and thus likely represent surrogate markers of neonatal well-being rather than being specific indicators of PDA/hsPDA, e.g., higher PDW values are thought to reflect altered platelet function/activation (35).…”

Section: Platelet Indices and Pdamentioning

confidence: 99%

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

et al. 2021

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Platelets are critically involved in murine patent ductus arteriosus (PDA) closure. To date, the clinical significance of these findings in human preterm infants with PDA is still controversial. We discuss the available study data on the role of platelets for PDA closure in preterm infants: Several mostly retrospective studies have yielded conflicting results on whether thrombocytopenia contributes to failed spontaneous ductal closure. The same applies to investigations on the role of thrombocytopenia as a risk factor for unsuccessful ductus arteriosus closure by pharmacological treatment with cyclooxygenase inhibitors. Nonetheless, recent meta-analyses have concluded that thrombocytopenia constitutes an independent risk factor for both failed spontaneous and pharmacological PDA closure in preterm infants. However, the available investigations differ in regard to patient characteristics, diagnostic strategies, and treatment protocols. Several studies suggest that impaired platelet function rather than platelet number is critically involved in failure of ductus arteriosus closure in the preterm infant. A recent randomized-controlled trial on platelet transfusions in preterm infants with PDA failed to show any benefit for liberal vs. restrictive transfusion thresholds on PDA closure rates. Importantly, liberal transfusions were associated with an increased rate of intraventricular hemorrhage, and thus should be avoided. In conclusion, the available evidence suggests that thrombocytopenia and platelet dysfunction contribute to failure of spontaneous and pharmacological PDA closure in preterm infants. However, these platelet effects on PDA seem to be of only moderate clinical significance. Furthermore, platelet transfusions in thrombocytopenic preterm infants in order to facilitate PDA closure appear to cause more harm than good.

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The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis

Cited by 9 publications

References 31 publications

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus

An Update on Patent Ductus Arteriosus and What is Coming Next

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

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