Patent ductus arteriosus: to treat or not to treat?

Benitz, William Ε.

doi:10.1136/archdischild-2011-300381

Cited by 93 publications

(65 citation statements)

References 34 publications

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“…As in other studies the current data showed a significant association between PDA and BPD (p=0.002) (Table 4) [6,9,15,20,21,25,41,42,47,[66][67][68][69]. An almost similar risk was reported by Marshall et al in VLBW infants (BW <1500 g) [69].…”

Section: Respiratory Distress Syndrome and Patent Ductus Arteriosus Isupporting

confidence: 76%

“…An almost similar risk was reported by Marshall et al in VLBW infants (BW <1500 g) [69]. In preterm infants with RDS, PDA induces an interstitial and alveolar pulmonary edema, decreases pulmonary compliance, increases the need and length of mechanical ventilation and oxygen needs, thus increasing the risk for BPD [5,42].…”

Section: Respiratory Distress Syndrome and Patent Ductus Arteriosus Isupporting

confidence: 55%

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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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Section: Respiratory Distress Syndrome and Patent Ductus Arteriosus Isupporting

confidence: 76%

Section: Respiratory Distress Syndrome and Patent Ductus Arteriosus Isupporting

confidence: 55%

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Ognean

Boantă

Kovacs

et al. 2016

The Journal of Critical Care Medicine

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“…Por lo tanto, la asociación entre el DAP y morbilidades graves que se registran con mayor frecuencia a menor EG como hemorragia intraventricular, hemorragia pulmonar, NEC, DBP y (22) muerte son difíciles de interpretar . A su vez dichas morbilidades pueden ser condicionadas por el (2) manejo clínico .…”

Section: Discussionunclassified

Persistent ductus arteriosus and in-hospital morbidities in newborns of very low birth weight

Genes¹,

Rodas²,

Mir³

et al. 2016

Pediatr. (Asunción)

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RESUMEN Introducción:Objetivo: Materiales y Métodos: Resultados:El ductus arterioso persistente (DAP) es el defecto cardiocirculatorio más frecuente en prematuros, está inversamente relacionado con la edad gestacional y el peso al nacimiento; y se asocia a diversas complicaciones.Evaluar la morbilidad asociada a la presencia de ductus arterioso persistente (DAP) en Recién Nacidos de muy bajo peso al nacer (RMBPN). Estudio retrospectivo de casos y controles anidado en una cohorte de RMBPN admitidos en la UCIN, de enero de 2013 a diciembre de 2015. Excluidos RN con malformaciones congénitas, fallecidos en sala de parto, fallecidos el primer día de vida asociados a asfixia perinatal severa y trasladados a otras instituciones. Las características basales fueron: peso, edad gestacional, sexo, control prenatal, hipertensión materna, embarazo múltiple, restricción del crecimiento, corticoide prenatal, ruptura prolongada de membranas, tipo de parto, Apgar. Las morbilidades analizadas fueron: distres respiratorio (SDR), hemorragia pulmonar, enterocolitis necrozante (ECN), hemorragia intraventricular (HIV), sepsis, soporte respiratorio, broncodisplasia pulmonar (DBP), ruptura alveolar, retinopatía del prematuro (ROP), días de internación y muerte. Se consignaron los datos en SSPS 17 y Epi info 7.2, se aplicó la prueba X² o Fischer, t de Student o la prueba de Mann Whitney. Significancia p< 0,05 con intervalo de confianza 95%.Se incluyeron 131 RN, con DAP 62 y sin DAP 69, cuyas características basales fueron similares, salvo el uso de corticoides prenatales para el grupo sin DAP (p 0.035) RR 0,7 (0,5-0,9). Los RN con DAP tuvieron SDR (p 0,0003) RR 1,5 (1,1-1,9), hemorragia pulmonar (p 0,024) RR 8,9 (1,1-69), ventilación mecánica (p ABSTRACT Introduction:

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“…6 There are pharmacokinetic data regarding the use of indomethacin and ibuprofen to close ductus arteriosus in preterm infants. Several studies have shown the effectiveness of these agents and, beyond current controversies, 7 their use is still frequent especially when there is hemodynamic compromise. Both drugs cause adverse events, 8,9 such as renal function disorders, decrease in the mesenteric and cerebral blood flow velocities, and increase of platelet aggregation; likewise, ibuprofen interferes with bilirubin-albumin binding in plasma.…”

Section: Discussionmentioning

confidence: 99%

Medication error in an extremely low birth weight newborn: paracetamol overdose

Brener¹

2013

Arch Argent Pediat

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Errors are part of human nature and are usually present in our actions. Medical errors occur quite often and can be serious. Medication errors are among the most frequent, especially in newborn infants because of the multiple steps that occur during the process of prescribing and administering drugs and because most drugs are not licensed for being used in newborn infants (off-label). The aim of this report is to describe a medication error in prescribing paracetamol for closing a patent ductus arteriosus in a preterm infant and to analyze its causes. A preterm female infant born at 27 weeks of gestational age with a birth weight of 750 g received paracetamol at 9 days old at a dose 20 times greater than required. The initial plasma level was 480 µg/mL. N-acetylcysteine was administered and her clinical outcome was satisfactory. Parents were notified of the event, which was recorded in the medical record and in the electronic error reporting system of the Hospital Italiano de Buenos Aires. We consider this report as an example that we are exposed to making mistakes and should maximize precautions to improve patient safety in neonatal units.

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Patent ductus arteriosus: to treat or not to treat?

Cited by 93 publications

References 34 publications

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Persistent ductus arteriosus and in-hospital morbidities in newborns of very low birth weight

Medication error in an extremely low birth weight newborn: paracetamol overdose

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