Outcomes of patent ductus arteriosus ligation in very low birth weight premature infants: A retrospective cohort analysis

Ashfaq, Adeel; Rettig, R. Luke; Chong, Albert J.; Sydorak, Roman M.

doi:10.1016/j.jpedsurg.2022.02.037

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…The relevant literature reported that it could be low protein, low autoimmune function or early postoperative malnutrition, including low food intake and feeding intolerance. 28 The lower albumin level can reduce the pressure of the blood plasma, which increases the leakage of pleural fluid. We found that the preoperative albumin level was low in the case group and the postoperative protein was significantly different between the two groups; that is, the postoperative albumin level was lower in the case group and, therefore, the albumin should be supplemented as early as possible in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

Zhang,

Liu,

Yao

et al. 2024

TCRM

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Background Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood. Objective The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants. Methods This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the occurrence of chylothorax, the patients were divided into a control group (n = 88) and a case group (n = 88). Univariate and multivariate logistic regression were performed to analyse the incidence and influencing factors of chylothorax after congenital heart surgery in infants. Results Between 2016 and 2020, the annual incidence rate fluctuated between 1.55% and 3.17%, and the total incidence of chylothorax was 2.02%. Multivariate logistic regression analysis showed that postoperative albumin ( p = 0.041; odds ratio [OR] = 0.095), preoperative mechanical ventilation ( p = 0.001; OR = 1.053) and preterm birth ( p = 0.002; OR = 5.783) were risk factors for postoperative chylothorax in infants with congenital heart disease. Conclusion The total incidence of chylothorax was 2.02% and the annual incidence rate fluctuated between 1.55% and 3.17% between 2016 and 2020. Premature infants, longer preoperative mechanical ventilation and lower albumin after congenital heart surgery may be risk factors for chylothorax. In addition, infants with chylothorax are inclined to be infected, need more respiratory support, use a chest drainage tube for longer and remain longer in hospital.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

Zhang,

Liu,

Yao

et al. 2024

TCRM

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“…33 Pneumothorax and pulmonary hemorrhage have also been reported. 34,35 A relatively new therapy is transcatheter PDA closure (TCPC). This is a well-established intervention for infants greater than 5 kg, but new devices and approaches have allowed this intervention to be offered to infants as small as approximately 600 g. 36 While there are no randomized studies comparing these procedures, TCPC is currently increasing in use as it becomes available in more centers.…”

Section: Surgical Ligation and Catheter-based Closurementioning

confidence: 99%

Obstacles to the Early Diagnosis and Management of Patent Ductus Arteriosus

Gowda,

Philip,

Weems

2024

RRN

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What we know is little, and what we are ignorant of is immense"; the last words of Laplace still apply to the diagnosis and management of the patent ductus arteriosus (PDA). Despite decades of research, we are searching for the right approach to care for patients with PDA. Nuances of myocardial structural changes and cardiopulmonary interactions with prolonged exposure to excess pulmonary blood flow have played an important role in decision-making. The availability of medical treatments with poor efficacy and, historically, surgical ligation as the only available definitive therapy further widened the gap between observation and definitive closure. As more extremely low birth weight neonates born at earlier gestational ages survive, we are faced with a population whose physiological immaturity and structural alignment of the myocardium predisposes them to myocardial dysfunction and dysregulated vascular tone. Therefore, it may be time to replace historical approaches with a more precise patient-centric therapeutic model. A comprehensive serial echocardiography assessment of the heart function, hemodynamic significance, and clinical context with respect to pulmonary insufficiency and gut perfusion aids the neonatologist in making PDA management decisions. A targeted approach balances risks and benefits of therapy, avoids treatment for infants likely to have early spontaneous closure, and limits prolonged exposure to the pathologic PDA shunt in high-risk infants. There is significant variability in the diagnosis and treatment of the PDA, both within and across centers. This review highlights the clinical obstacles contributing to the variability and illustrates the need for a standardized approach to PDA diagnosis and management.

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“…PDA is a congenital heart defect characterized by the persistence of the ductus arteriosus after birth [1]. This condition predominantly affects premature infants, substantially increasing morbidity and mortality risks [2,3]. Given their clinical vulnerability, premature infants with PDA require specialized care [4].…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence-Based Diagnostic Support System for Patent Ductus Arteriosus in Premature Infants

Park,

Moon,

Eun

et al. 2024

JCM

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Background: Patent ductus arteriosus (PDA) is a prevalent congenital heart defect in premature infants, associated with significant morbidity and mortality. Accurate and timely diagnosis of PDA is crucial, given the vulnerability of this population. Methods: We introduce an artificial intelligence (AI)-based PDA diagnostic support system designed to assist medical professionals in diagnosing PDA in premature infants. This study utilized electronic health record (EHR) data from 409 premature infants spanning a decade at Severance Children’s Hospital. Our system integrates a data viewer, data analyzer, and AI-based diagnosis supporter, facilitating comprehensive data presentation, analysis, and early symptom detection. Results: The system’s performance was evaluated through diagnostic tests involving medical professionals. This early detection model achieved an accuracy rate of up to 84%, enabling detection up to 3.3 days in advance. In diagnostic tests, medical professionals using the system with the AI-based diagnosis supporter outperformed those using the system without the supporter. Conclusions: Our AI-based PDA diagnostic support system offers a comprehensive solution for medical professionals to accurately diagnose PDA in a timely manner in premature infants. The collaborative integration of medical expertise and technological innovation demonstrated in this study underscores the potential of AI-driven tools in advancing neonatal diagnosis and care.

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Outcomes of patent ductus arteriosus ligation in very low birth weight premature infants: A retrospective cohort analysis

Cited by 4 publications

References 9 publications

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

Obstacles to the Early Diagnosis and Management of Patent Ductus Arteriosus

Artificial Intelligence-Based Diagnostic Support System for Patent Ductus Arteriosus in Premature Infants

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