Early Hemodynamic Consequences of Patent Ductus Arteriosus in Preterm Infants with Intrauterine Growth Restriction

Rakza, Thameur; Magnenant, Eric; Klosowski, S; Tourneux, P.; Bachiri, A.; Storme, Laurent

doi:10.1016/j.jpeds.2007.04.058

Cited by 63 publications

(49 citation statements)

References 26 publications

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“…However, oxygen saturations in the range of 83 to 89% do not appear to impact the response of the DA to pharmacological closure as the rate of surgical ligation remained unchanged. Several factors affect the incidence of PDA in preterm neonates including GA, 1 intrauterine growth restriction, 18 antenatal steroids, 19,20 low Apgar scores 21 and the presence of respiratory distress syndrome. 22 When adjusted for these factors using univariate and multivariate logistic regression, the odds of having an hsPDA remained higher with the low oxygen saturation limits.…”

Section: Discussionmentioning

confidence: 99%

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

et al. 2009

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Objective: Postnatal increase in oxygen promotes constriction of the patent ductus arteriosus (PDA). According to the findings of prospective observational studies, the clinical practice of targeting lower fractional oxygen saturation between 70 and 90% has been associated with a reduced incidence of severe retinopathy of prematurity (ROP) without affecting survival or neurodevelopmental disability at 1 year of age. Our objective was to investigate the impact of the use of a lower oxygen saturation target range on the incidence of early hemodynamically significant PDA (hsPDA) and the need for ductal ligation in extremely low birth weight (ELBW, <1000 g) infants.Study Design: In this retrospective study, we analyzed data from 263 ELBW infants managed 4 years before (episode I: target oxygen saturation 89 to 94%) and after (episode II: target oxygen saturation 83 to 89%) implementation of the use of lower oxygen saturation limits in two neonatal intensive care units. Infants with a birth weight of 1000 to 1500 g were managed with the same oxygen saturation target range (89 to 94%) during both episodes, and they served as controls. Parametric and nonparametric tests were used as appropriate and multivariate logistic regression models were used to correct for confounders.Results: There was an increase in the incidence of hsPDA (63.2 vs 74.8%, P ¼ 0.043), without an increase in the need for surgical ligation (24.2 vs 29.9%, P ¼ 0.3) after implementation of the lower oxygen saturation target range policy. After adjusting for confounders, there was an increase in the odds of having an hsPDA (odds ratio (OR) 1.77, 95% confidence interval (CI) (1.03 to 3.06), P ¼ 0.04) but the odds for ductal ligation did not change in episode II (OR 1.25, 95% CI (0.70 to 2.25), P ¼ 0.4). The incidence of ROPXstage III (50.7 vs 15.7%; P<0.0001) and the need for laser ablation (33.8% vs 8.7%; P<0.0001) were significantly reduced. There was no change in the incidence of hsPDA or ductal ligation in the control group. Conclusion:Targeting lower oxygen saturation limits to minimize periods of hyperoxemia in ELBW infants reduced the incidence of severe ROP and the need for laser ablation. The incidence of early hsPDA was increased; however, final closure rate and the incidence of surgical ligation of the ductus arteriosus were not affected.

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Section: Discussionmentioning

confidence: 99%

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

et al. 2009

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“…[ [14,16]. Nor was any difference found between infants with and without PDA when comparing the mean ponderal index and the proportions of SGA infants even though SGA was reported in other studies as a risk factor for PDA [27,49].…”

Section: Patent Ductus Arteriosus Associated Risk Factors and Clinicmentioning

confidence: 97%

“…Multiple risk factors have been described in association with PDA such as lower GA and BW [14][15][16]21,22], chorioamnionitis and neonatal sepsis, [3,15,[22][23][24][25], maternal diabetes mellitus, [14,26] antepartum hemorrhage, multiple pregnancy, male gender [14], small for gestational age (SGA), [27] lower Apgar scores, need for resuscitation at birth, asphyxia [16], severe respiratory distress syndrome (RDS) [16,22,28,29], excessive fluid administration during the first days of life [30], Furosemide administration [31], decreased platelets number during the first day of life [22,32], oxygen administration [16], lower oxygen saturation targets [33,34], surfactant administration [16,28,35,36], increased duration of mechanical ventilation and respiratory support [22], metabolic acidosis [16], phototherapy [37], and high altitude [6].…”

Section: Introductionmentioning

confidence: 99%

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Ognean

Boantă

Kovacs

et al. 2016

The Journal of Critical Care Medicine

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Introduction: Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates. Aim: To evaluate the association between the presence of PDA and the severity of clinical condition at birth in critically ill preterm infants, with gestational ages (GA) ≤ 32 weeks and severe respiratory distress. Methods: All preterm infants with GA ≤ 32 weeks admitted to the neonatal intensive care unit (NICU) of the Clinical County Emergency Hospital, Sibiu between 1 January 2010 and 31 December 2015 were included in the study. These were categorized as Group 1 [Preterm infants with PDA; n=154] and Group 2 [Preterm infants without PDA; n=186]. Epidemiological and clinical data were collected in the National Registry for Respiratory Distress Syndrome for all children, and data related to prenatal period, clinical characteristics at birth i.e GA, weight, gender, Apgar scores, and clinical features such as resuscitation at birth, surfactant administration, need and duration of respiratory support, neonatal sepsis, complications associated with prematurity, and death, were analyzed. Results: Group 1 infants had significantly lower GA and birth weights, were more often out born (p=0.049, HR 1.69), and had significantly lower Apgar scores at 1 and 10 minutes (p=0.022, p=0.000). They presented a significantly higher need for surfactant administration (42.9% vs 24.7%, p<0.0001) and respiratory support (96.8% vs 90.3%, HR 3.19, p=0.019 for need of CPAP and 22.1% vs 10.8%, HR 2.35, p=0.004 for mechanical ventilation). Duration of respiratory support was also significantly higher in the Group 1 (7.6%±7.5 vs. 5.1±3.8 days, p<0.0001 for CPAP and 20.1±22.5 vs. 12.0±15.7 days, p<0.0001 for mechanical ventilation). Conclusion:In very preterm infants, PDA may be associated with a critical clinical condition leading to serious complications. The presence of PDA after the seventh day of life was associated with an increased need for respiratory support, both CPAP and mechanical ventilation, increased severity of the respiratory distress syndrome, requiring a longer duration of respiratory support, and increased the hospitalization length. In very preterm infants, PDA presence was also associated with a higher rate of severe complications and death, indicating the need for a careful and proper management of these critical cases in neonatal intensive care units.

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“…Incidence of patent ductus arteriosus is higher in small for GA infants. 43 Indeed, in our study the average BW of the group of infants requiring ligation was 625 g, but the mechanisms underlying this observation and more specifically in a donor of TTTS is unknown.…”

Section: Discussionmentioning

confidence: 67%

Blood pressures in newborns with twin–twin transfusion syndrome

Mercanti

Boivin

et al. 2011

J Perinatol

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Objective: In addition to unbalanced flow through placental anastomoses, evidence suggests that transfer of circulating vasoactive elements from the donor to the recipient contribute to the pathological process of twin-twin transfusion syndrome (TTTS). The objective of this study was to test the hypothesis that TTTS recipients have higher blood pressure (BP) at birth than donors.Study Design: Chart review of all TTTS infants born from 1996 to 2007 with both twins alive X24 h (51 pairs; average gestational age 30 ± 3 weeks).Results: Both systolic and diastolic neonatal BPs were significantly higher in recipients. When expressed relative to predicted BP for birth weight (BW), BP were lower than expected in donors and higher in recipients.Conclusions: Data indicate that TTTS recipients have BP significantly higher than donors and than BP expected for BW. The long-term impact of these early hemodynamic perturbations remains to be determined.

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Early Hemodynamic Consequences of Patent Ductus Arteriosus in Preterm Infants with Intrauterine Growth Restriction

Cited by 63 publications

References 26 publications

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Blood pressures in newborns with twin–twin transfusion syndrome

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