Indomethacin Impairs Coronary Perfusion in Infants with Hemodynamically Significant Ductus Arteriosus

Sehgal, Arvind; Ramsden, C. Andrew; McNamara, Patrick J.

doi:10.1159/000327844

Cited by 23 publications

(22 citation statements)

References 82 publications

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“…Because of the recent acknowledgement of the physiology of PDA and the adverse effects on various organ systems of treatment (14, 15, 16, 17), most current studies have focused on delayed treatment and a more conservative approach for preterm infants (18, 19, 20, 21). Considering the surgical complications and hemodynamic instability after ligation (22, 23, 24), we also believe that early aggressive intervention could be detrimental to these tiny infants.…”

Section: Discussionmentioning

confidence: 99%

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

et al. 2014

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The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17±12 vs 11±8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

et al. 2014

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“…increasing ventilation, oxygenation problems) and/or systemic hypoperfusion (e.g. abdominal distension, oliguria) [14]. In the absence of clear clinical signs, ascertainment of hemodynamic significance was made on the basis of any of the following echocardiographic characteristics: left atrial/aortic root ratio >1.4, mean velocity in the left pulmonary artery >0.6 m/s or diastolic backflow in the abdominal aorta [15].…”

Section: Methodsmentioning

confidence: 99%

Platelet Counts in the First Seven Days of Life and Patent Ductus Arteriosus in Preterm Very Low-Birth-Weight Infants

et al. 2014

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Background: Decreased platelet number and/or function are related to patent ductus arteriosus (PDA) in mice. Whether this is also the case in human infants remains controversial. Objectives: To investigate the association between platelet count nadir within the first 7 days of life and the rate of hemodynamically significant PDA (HSPDA), as well as the rate of response to the treatment with cyclooxygenase (COX) inhibitors. Methods: This is a retrospective study of a cohort of 194 very low-birth-weight (VLBW) infants (<1,500 g) with gestational age <30 weeks. HSPDA was assessed by echocardiography on day 3 of life. Results: HSPDA was present in 105 infants (54.1%). Of these, 101 were treated with COX inhibitors. The treatment failure rate was 21.8%. Median platelet count nadir and rate of thrombocytopenia - defined as platelet count <150 × 10⁹/l and graded as mild (100 to <150 × 10⁹/l), moderate (50 to <100 × 10⁹/l) or severe (<50 × 10⁹/l) - within the first 2 days of life were not significantly associated with the presence of HSPDA on day 3. Moreover, low platelet counts, either on days 1-2 or 3-7, were not significantly associated with the rate of response to treatment with COX inhibitors. Conclusions: Our data provide further evidence for the lack of association between platelet counts within the first days of life and either spontaneous or pharmacological closure of the ductus arteriosus in VLBW infants.

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“…Indomethacin produces significant reductions in renal [42], mesenteric [43], coronary [44], and cerebral blood flow and reduces cerebral oxygenation [45]. Treatment with COX inhibitors may be associated with transient renal impairment [46], and this effect is more pronounced with indomethacin [47].…”

Section: To Treat or Not To Treat?mentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

Abdel‐Hady

Nasef

Shabaan

et al. 2013

BioMed Research International

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Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

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Indomethacin Impairs Coronary Perfusion in Infants with Hemodynamically Significant Ductus Arteriosus

Cited by 23 publications

References 82 publications

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

Platelet Counts in the First Seven Days of Life and Patent Ductus Arteriosus in Preterm Very Low-Birth-Weight Infants

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

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