Changes in Myocardial Function and Hemodynamics after Ligation of the Ductus Arteriosus in Preterm Infants

Noori, Shahab; Friedlich, Philippe; Seri, István; Wong, Pierre C.

doi:10.1016/j.jpeds.2007.01.035

Cited by 131 publications

(123 citation statements)

References 31 publications

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“…Left ventricular failure could lead to pulmonary edema and result in difficulty with oxygenation. 4,13 A study in the preterm baboon showed ligated animals had more severe left ventricular dysfunction, required more cardiovascular support and higher mean airway pressures at 24 h of age compared with animals with persistent PDA that is consistent with what we often see in this population. 14 This acute decompensation experienced by infants post ligation is important because it may place them at higher likelihood for poor long-term outcomes.…”

Section: Discussionsupporting

confidence: 69%

“…A subset of infants may have an inadequate cortisol response during acute illness that results in changes in vasomotor tone, hypotension and increased dependence on vasopressor support. 13,15 We postulate that relative adrenal insufficiency may have a role in the postoperative decompensation of some premature infants and, providing HC before the stressful event may aid the infants in producing an appropriate response and possibly prevent poor long-term outcomes. Identifying infants with relative adrenal insufficiency is difficult; measuring cortisol levels may be useful, however, studies have shown that low cortisol levels are not helpful in defining a population who would benefit from HC therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Seri et al 12 described the cardiovascular effects of administering physiological doses of HC to preterm infant with refractory hypotension to imitate a stress response. Noori et al 13 has shown HC improves blood pressure without compromising cardiac function, systemic perfusion or endorgan blood flow in human neonates. The impact of HC on improved blood pressure in our study may be explained by these physiological responses to HC.…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone

2011

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Objective: Following patent ductus arteriosus (PDA) ligation, preterm infants may develop profound hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, postulating these infants do not synthesize steroids because of an immature hypothalamic-pituitary-adrenal axis. The purpose of this study was to compare outcomes in infants who received stress HC before their PDA ligations to those who did not.Study Design: A retrospective chart review was performed of infants who underwent PDA ligations at our institution's neonatal intensive care unit. Data were collected on treatment with HC, and respiratory and cardiovascular support.Result: Gestational age (GA) and birth weight were lower in the HC group (24 vs 25 weeks, 632 vs 790 g), but age at time of surgery was similar (26 vs 21 days). Cardiorespiratory support was comparable between the groups pre-and post-operatively. In regression models that adjusted for GA, HC treatment was not independently related to respiratory support postoperatively, but was associated with a decrease in postoperative dopamine (2.2 mcg kg À1 min À1 ; P ¼ 0.03). Respiratory support postoperatively was predicted by preoperative respiratory support. GA and age at surgery were not independently associated with outcome.Conclusion: Preoperative stress HC was not associated with improved cardiorespiratory stability, regardless of GA. Further investigation is needed to identify infants who may benefit from this therapy.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone

2011

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“…In about 30% of preterm infants undergoing PDA ligation, there is some degree of cardiovascular compromise as evidenced by the need for initiation or escalation of vasopressorinotrope or inotrope treatment. [52][53][54] The reason for this deterioration is not known. In one study, lower gestational age, and higher respiratory support and, interestingly, exposure to antenatal steroids were associated with post-ligation hypotension.…”

Section: Surgical Closurementioning

confidence: 99%

“…52 Age at ligation might be another factor having a role in the development of postoperative morbidities, although the studies show conflicting results. [52][53][54] The sudden change in the preload and systemic vascular resistance at the time of surgical ligation is also thought to result in subtle myocardial dysfunction. 53 This transient deterioration in myocardial function in turn contributes to an exaggerated drop in left ventricular output.…”

Section: Surgical Closurementioning

confidence: 99%

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Noori

2010

J Perinatol

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Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA) in the very preterm infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, the factors that have fueled the controversy of the approach to the management of PDA and the gap in our knowledge are reviewed in detail. In addition, the pros and cons of the different treatment strategies applied in clinical care are evaluated with a focus on discussing the available evidence in the literature.

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Kent¹

2015

Keeling’s Fetal and Neonatal Pathology

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Preterm birth is defi ned as delivery less than 37 weeks' gestational age. The rate of preterm birth varies around the world and differs between developed and developing countries. It is 12-13 % in the United States of America (USA), 5-9 % in Europe, 9 % in Australia, and as high as 18 % in some countries in Africa. In developed countries the increased rate of preterm birth has been attributed to the changing demographics of childbearing. The mean age of childbearing has increased over the years with the average age of primiparous women in Australia now 28.3 years of age and the percentage of fi rst-time mothers over 35 years of age in the USA now 4 %. Delayed childbearing is associated with a number of risk factors including preeclampsia and gestational diabetes. Infertility with the resultant use of in vitro fertilization methods and consequent twins/triplets are also signifi cant issues. Another major risk factor for preterm birth is maternal obesity, which is increasing in both developed and developing countries. Complications of maternal obesity include maternal and fetal death, preeclampsia, gestational diabetes, and congenital abnormalities. Preterm BirthPreterm birth is defi ned as delivery less than 37 weeks' gestational age. The rate of preterm birth varies around the world and differs between developed and developing countries. It is 12-13 % in the USA, 5-9 % in Europe, 9 % in Australia, and as high as 18 % in some countries in Africa [ 1 -3 ]. In 2010 more than 60 % of preterm births occurred in south Asia and sub-Saharan Africa [ 2 ]. In developed countries the increased rate of preterm birth has been attributed to the changing demographics of childbearing. The mean age of childbearing has increased over the years with the average age of primiparous women in Australia now 28.3 years of age [ 3 ] and the percentage of fi rsttime mothers over 35 years of age in the USA now 4 % [ 4 ]. Delayed childbearing is associated with a number of risk factors including preeclampsia and gestational diabetes. Infertility

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Changes in Myocardial Function and Hemodynamics after Ligation of the Ductus Arteriosus in Preterm Infants

Cited by 131 publications

References 31 publications

Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone

Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

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