Transcatheter Closure of Secundum Atrial Septal Defect in Infants Less than 12 Months of Age Improves Symptoms of Chronic Lung Disease

Thomas, Vincent C.; Vincent, Robert; Raviele, A; Diehl, Helen J.; Qian, Holly; Kim, Dennis

doi:10.1111/j.1747-0803.2010.00442.x

Cited by 30 publications

(30 citation statements)

References 28 publications

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“…Plausibly one could speculate that ASDs might offer a survival benefit in very/extremely premature infants with pulmonary hypertension. However this hypothesis is contrary to several prior reports suggesting that larger ASDs actually exacerbate underlying chronic lung disease of prematurity 22,23 . It is unclear why isolated pulmonary stenosis may confer an improvement in survival.…”

Section: Discussioncontrasting

confidence: 99%

Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age

Chu

Kosinski

et al. 2017

The Journal of Pediatrics

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Objective To determine the birth prevalence of congenital heart defects (CHDs) across the spectrum of common defects in very/extremely premature infants and to compare mortality rates between premature infants with and without CHDs. Study design The Kids' Inpatient Databases (2003-2012) were used to estimate the birth prevalence of CHDs (excluding patent ductus arteriosus) in very/extremely premature infants born between 25 and 32 weeks gestational age (GA). Birth prevalence was compared with term infants for a subset of “severe” defects expected to be near universally diagnosed in the neonatal period. Weighted multivariable logistic regression was used to calculate adjusted odds ratios of mortality comparing very and extremely premature infants with versus without CHDs. Results We identified 249,011 very/extremely premature infants, including 28,806 with CHDs. The overall birth prevalence of CHDs was 116 per 1000 very/extremely premature births. Severe CHDs had significantly higher birth prevalence in very/extremely premature infants when compared with term infants (7.4 per 1000 very/premature births versus 1.5 per 1000 term births, p<0.001). Very/extremely premature infants with severe CHDs had an overall 26.3% in-hospital mortality and a 7.5-fold increased adjusted odds of death compared with those without CHDs. Mortality varied widely by defect in very/extremely premature infants, ranging from 12% for interrupted aortic arch to 67% for truncus arteriosus. Conclusion Given the increased birth prevalence of severe CHDs in very/extremely premature infants, and significantly higher mortality, there is justification for intensive interventions aimed at decreasing the likelihood of premature delivery for patients where CHD is diagnosed in utero.

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Section: Discussioncontrasting

confidence: 99%

Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age

Chu

Kosinski

et al. 2017

The Journal of Pediatrics

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“…Epidemiologically, ASDs account for 8–10% of congenital heart defects, though the majority of these close spontaneously in the first year of life [26]. For those with persistent defects, small studies have suggested that infants with BPD may have improved respiratory outcome following transcatheter closure of left-to-right shunts at approximately 6 months of age [27, 28]. Unfortunately, our finding that ASDs were associated with PH development is difficult to interpret causally.…”

Section: Discussionmentioning

confidence: 98%

Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

et al. 2017

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BackgroundApproximately 8–23% of premature infants develop pulmonary hypertension (PH), and this diagnosis confers a higher possibility of mortality. As a result, professional societies recommend PH screening in premature infants. However, the risk factors for and the outcomes of PH may differ depending on the timing of its diagnosis, and little evidence is available to determine at-risk infants in the referral neonatal population. The objective of this study was to define clinical and echocardiographic characteristics of infants with pulmonary hypertension during the neonatal hospital course and at or near-term.MethodsInfants who had the following billing codes: < 32 weeks, birth weight < 1500 g, neonatal unit, and echocardiograph had records abstracted from a data warehouse at Children’s Healthcare of Atlanta. The outcome was defined as late PH on the final echocardiogram for all patients, and, separately, for patients with multiple studies. Descriptive statistics, univariable, and multivariable models were evaluated, and odds ratios and 95% confidence intervals are expressed below as (OR, CI).Results556 infants were included in the overall study, 59 had PH on their final echocardiogram (11%). In multivariable analyses, atrial septal defect (2.9, 1.4–6.1), and intrauterine growth restriction (2.7, 1.2–6.3) increased the odds of late PH, whereas caffeine therapy decreased PH (0.4, 0.2–0.8). When the analyses were restricted to 32 infants who had multiple echocardiograms during their hospitalization, the association between atrial septal defect (5.9, 2.0–16.5) and growth restriction (3.7, 1.3–10.7) and late PH was strengthened, but the effect of caffeine therapy was no longer significant. In this smaller subgroup, infants with late PH had their final echocardiogram at a median of 116 days of life, and 42–74% of them had right ventricular pathology.ConclusionsEarly clinical variables are associated with PH persistence in a referral neonatal population. Identification of early clinical factors may help guide the ascertainment of infant risk for late PH, and may aid in targeting sub-groups that are most likely to benefit from PH screening.

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“…In cases of PDA with high PVR and right to left shunting initial treatment with PH drugs followed by a second hemodynamic evaluation is advised. In the case of ASD, although the percutaneous closure of ASD has been published in BPD infants with good results the high rate of spontaneous closure or decrease in the size of the defect in the first months of life should be considered.…”

Section: Discussionmentioning

confidence: 99%