Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates

Jain, Amish; Shah, Prakesh S.

doi:10.1001/jamapediatrics.2015.0987

Cited by 241 publications

(116 citation statements)

References 79 publications

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“…29 However, infants with moderate to large PDA, based on its size relationship to the left pulmonary artery (LPA), have a 15 times greater likelihood of requiring treatment for clinically and hemodynamically significant PDA than those with small PDA. 29,30 We, therefore, excluded any infant with a moderate to large hemodynamically significant PDA (hsPDA) in the first week of age, and any size PDA from 32 weeks and beyond, but a separate sub-analysis was performed for this cohort. For this study a hsPDA was defined as a PDA diameter of > 1.5 mm with the presence of flow reversal in the descending aorta and a left atrial to aortic root ratio (LA:Ao) of > 1.5.…”

Section: Methodsmentioning

confidence: 99%

Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age

Levy

El-Khuffash

Patel

et al. 2017

Journal of the American Society of Echocardiography

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144

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Background We aimed to determine the maturational changes in systolic ventricular strain mechanics by two-dimensional speckle tracking echocardiography in extreme preterm neonates from birth to one year of age, and discern the impact of common cardiopulmonary abnormalities on the deformation measures. Methods In a prospective multi-center study of 239 extreme preterm infants (< 29 weeks gestation at birth), left ventricle (LV) global longitudinal strain and systolic strain rate (GLS, GLSRs), interventricular septal wall (IVS) GLS and GLSRs, right ventricle free wall longitudinal S and SR (RV FWLS, FWLSRs), and segmental LS (SLS) in the RVFW, LVFW and IVS were serially measured at Days 1, 2, 5–7, 32 weeks and 36 weeks post-menstrual age (PMA), and one year corrected age (CA). Premature infants who developed bronchopulmonary dysplasia (BPD) or had echocardiographic findings of pulmonary hypertension (PH) were analyzed separately. Results In uncomplicated preterm infants (n=103, 48%), LV GLS and GLSRs remained unchanged from Day 5–7 to one year CA (p=0.60 and 0.59). RV FWLS, FWLSRs and IVS GLS and GLSR significantly increased over the same time period (p < 0.01 for all measures). A significant base-to-apex (highest to lowest) SLS gradient (p < 0.01) in the RVFW and a reverse apex-to-base gradient (p < 0.01) existed in the LVFW. In infants with BPD and/or PH (n=119, 51%), RV FWLS and IVS GLS were significantly lower (p < 0.01), LV GLS and GLSRs were similar (p=0.56), and IVS SLS persisted as an RV dominant base-to-apex gradient from 32 weeks PMA to one year CA. Conclusions This study tracks the maturational patterns of global and regional deformation by 2DSTE in extreme preterm infants from birth to one year CA. The maturational patterns are ventricular specific. BPD and PH leave a negative impact on RV and IVS strain, while LV strain remains stable.

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Section: Methodsmentioning

confidence: 99%

Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age

Levy

El-Khuffash

Patel

et al. 2017

Journal of the American Society of Echocardiography

Self Cite

144

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“…Additionally, there is an important risk for adverse neurodevelopmental outcome in infants who eventually need surgical closure. [4][5][6][7][8] Moreover, Kabra et al 9 reported neurosensory impairment after surgical closure, and others have suggested that surgical closure is related to increased risk for poor short-and long-term outcomes. 10 Additionally, Jhaveri et al 11 found that a conservative approach toward ductal closure decreased rates of ductal ligation without increasing rates of complications such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity, and neurologic injury.…”

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confidence: 99%

Patent Ductus Arteriosus and Brain Volume

et al. 2016

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“…There are several studies on significant echocardiographic parameters as an early marker of hsPDA because echocardiographic signs usually have been shown to precede clinical symptoms by 1.8 days (27). Some researchers have suggested that a transductal diameter exceeding 1.5 mm combined with diastolic flow reversal in the descending aorta may be the best echocardiographic criterion (28). Others have stated that a substantial ductal shunt is associated with the following: an increased ratio of left atrial to aortic root dimensions ≥ 1.5:1, a ductal diameter ≥ 1.5 mm, a measured LVDD ratio by the normal LVDD ratio of more than 115% (29), left ventricular volume and pressure overloading, and reversal of diastolic flow in the descending aorta or in the cerebral or renal arteries (1230).…”

Section: Discussionmentioning

confidence: 99%

“…There is a high chance of spontaneous closure of preterm PDA, especially in infants with higher GA (2128). Moreover, there is some evidence that preterm infants with mild symptoms from PDA do not necessarily benefit from early pharmacologic treatment compared with conservative treatment (1531).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

Yoo

Lee

et al. 2017

J Korean Med Sci

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The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23–27] vs. 26 [23–27] weeks; P = 0.012) and lighter (655 [500–930] vs. 880 [370–1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ≤ 2 postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

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Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates

Cited by 241 publications

References 79 publications

Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age

Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age

Patent Ductus Arteriosus and Brain Volume

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

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