Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants

Pereira, Sujith; Kempley, Stephen; Shah, Divyen K.; Morris, Joan K.; Sinha, Ajay

doi:10.1111/apa.14361

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…Our study reported a high spontaneous closure rate in infants born at 25 gestational weeks or later, consistent with recent reports [8,26]. Due to high treatment rates, we were not able to report the actual spontaneous rate in infants born before 25 gestational weeks in our cohort, but it has been reported to be relatively high in centers with a non-interventional PDA strategy [8,9,[26][27][28]. Furthermore, there was possible overtreatment as infants having three ibuprofen doses or less had a similar closure rate as infants who closed their duct spontaneously.…”

Section: Discussionsupporting

confidence: 89%

Early N-Terminal Pro B-Type Natriuretic Peptide (NTproBNP) Plasma Values and Associations with Patent Ductus Arteriosus Closure and Treatment—An Echocardiography Study of Extremely Preterm Infants

Guðmundsdóttir

Bartocci

Picard

et al. 2022

JCM

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The aim was to investigate the association of gestational age (GA), echocardiographic markers and levels of plasma N-terminal pro-B-type natriuretic peptide (NTproBNP) with the closure rate of a haemodynamically significant patent ductus arteriosus (hsPDA). Ninety-eight Swedish extremely preterm infants, mean GA 25.7 weeks (standard deviation 1.3), born in 2012–2014, were assessed with echocardiography and for levels of NTproBNP. Thirty-three (34%) infants had spontaneous ductal closure within three weeks of age. Infants having spontaneous closure at seven days or less had significantly lower NTproBNP levels on day three, median 1810 ng/L (IQR 1760–6000 ng/L) compared with: infants closing spontaneously later, 10,900 ng/L (6120–19,200 ng/L); infants treated either with ibuprofen only, 14,600 ng/L (7740–28,100 ng/L); or surgery, 32,300 ng/L (29,100–35,000 ng/L). Infants receiving PDA surgery later had significantly higher NTproBNP values on day three than other infants. Day three NTproBNP cut-off values of 15,001–18,000 ng/L, predicted later PDA surgery, with an area under the curve in ROC analysis of 0.69 (0.54–0.83). In conclusion, the spontaneous PDA closure rate is relatively high in extremely preterm infants. Early NTproBNP levels can be used with GA in the management decisions of hsPDA.

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Section: Discussionsupporting

confidence: 89%

Early N-Terminal Pro B-Type Natriuretic Peptide (NTproBNP) Plasma Values and Associations with Patent Ductus Arteriosus Closure and Treatment—An Echocardiography Study of Extremely Preterm Infants

Guðmundsdóttir

Bartocci

Picard

et al. 2022

JCM

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“…There are few studies on surgically treated PDA in infants born before 28 weeks gestational age, and results from studies of infants born at a higher gestational age might be difficult to apply in extremely pre-term infants. Also, many studies on surgically treated PDA were conducted during an era where surfactant therapy, antenatal steroids, non-invasive positive pressure ventilation, routine echocardiography, or pharmacological treatment of PDA were not fully established (14,15). The aim of this matched case control study of PDA was to investigate the differences in peri-and post-natal characteristics, pharmacological PDA treatment, and outcomes between surgically and non-surgically treated extremely preterm infants.…”

Section: Introductionmentioning

confidence: 99%

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

et al. 2021

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Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010–2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/−1 week) and time of birth (+/−1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24+5 ± 1+3 weeks and 668 ± 170 g) and the Control group (24+5 ± 1+3 weeks and 704 ± 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.

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Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study

Masutani

Isayama

Kobayashi

et al. 2021

Journal of Cardiology

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Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants

Abstract: Echocardiographic ductal parameters on day 1 or 3 did not identify infants who received PDA treatment. Gestation was the most powerful predictor for receiving medical or surgical treatment of PDA.

Cited by 4 publications

References 26 publications

Early N-Terminal Pro B-Type Natriuretic Peptide (NTproBNP) Plasma Values and Associations with Patent Ductus Arteriosus Closure and Treatment—An Echocardiography Study of Extremely Preterm Infants

Early N-Terminal Pro B-Type Natriuretic Peptide (NTproBNP) Plasma Values and Associations with Patent Ductus Arteriosus Closure and Treatment—An Echocardiography Study of Extremely Preterm Infants

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study

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