Regarding platelets and ductus: Is it platelet function rather than number that matters for ductal closure?

Engür, Defne

doi:10.1016/j.pedneo.2018.08.006

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…However, several investigations have consistently identified sepsis/inflammation, lower gestational age, and feto-maternal conditions such as preeclampsia as risk factors for failure of DA closure in preterm infants. Since all these factors are associated with altered platelet function, it has been speculated that platelet function, rather than platelet number, is the key determinant of PDA closure in neonates (36,37). A significant association between lower platelet count, higher CRP level and incidence of PDA has been demonstrated, with CRP being the only independent predictive factor for PDA in a regression model (38).…”

Section: Platelet Function and Pda Closure In Preterm Infantsmentioning

confidence: 99%

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

et al. 2021

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Platelets are critically involved in murine patent ductus arteriosus (PDA) closure. To date, the clinical significance of these findings in human preterm infants with PDA is still controversial. We discuss the available study data on the role of platelets for PDA closure in preterm infants: Several mostly retrospective studies have yielded conflicting results on whether thrombocytopenia contributes to failed spontaneous ductal closure. The same applies to investigations on the role of thrombocytopenia as a risk factor for unsuccessful ductus arteriosus closure by pharmacological treatment with cyclooxygenase inhibitors. Nonetheless, recent meta-analyses have concluded that thrombocytopenia constitutes an independent risk factor for both failed spontaneous and pharmacological PDA closure in preterm infants. However, the available investigations differ in regard to patient characteristics, diagnostic strategies, and treatment protocols. Several studies suggest that impaired platelet function rather than platelet number is critically involved in failure of ductus arteriosus closure in the preterm infant. A recent randomized-controlled trial on platelet transfusions in preterm infants with PDA failed to show any benefit for liberal vs. restrictive transfusion thresholds on PDA closure rates. Importantly, liberal transfusions were associated with an increased rate of intraventricular hemorrhage, and thus should be avoided. In conclusion, the available evidence suggests that thrombocytopenia and platelet dysfunction contribute to failure of spontaneous and pharmacological PDA closure in preterm infants. However, these platelet effects on PDA seem to be of only moderate clinical significance. Furthermore, platelet transfusions in thrombocytopenic preterm infants in order to facilitate PDA closure appear to cause more harm than good.

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Section: Platelet Function and Pda Closure In Preterm Infantsmentioning

confidence: 99%

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

et al. 2021

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“…Ductus arteriosus (DA) or ductus Botalli, one of the fetal shunts allowing oxygenation during intrauterine life (1,2), physiologically undergoes spontaneous functional closure within the first 72 h of postnatal life, through molecular mechanisms that have been extensively discussed (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…Several predisposing factors have been associated to PDA condition, sometimes with contrasting results, such as genetic factors (19)(20)(21), maternal pregnancy induced hypertension (PIH) (22), chorioamnionitis (23,24), maternal antepartum hemorrhage, respiratory distress syndrome (RDS), lower birth weight (BW), Apgar score and GA, female gender (22,25), dopamine administration and eccessive intravenous fluid administration (26), neonatal sepsis (27,28), need for surfactant (22,25,26,29), maternal and neonatal drug assumption (2,(30)(31)(32)(33)(34)(35)(36)(37)(38), platelet number, function and other platelet-related parameters (4,5,(39)(40)(41)(42)(43)(44)(45)(46)(47).…”

Section: Introductionmentioning

confidence: 99%

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

et al. 2020

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Introduction: In premature neonates, the persistence of hemodynamically significant ductus arteriosus (hsPDA) can be associated with short- and long-term consequences, impairing their outcome. The correct strategy of management for such condition is under debate, especially regarding contraindications and/or side effects. In recent years, metabolomics was applied to several perinatal, pediatric, and adult conditions to investigate potential biomarkers of disease, which have become useful for early diagnosis and/or therapeutic management.Aim of the Study: The main purpose of our exploratory study was to asses, through 1H-NMR metabolomics analysis of urinary samples at birth, possible metabolic pathways differentiating, with a significant predictive power, those preterm neonates who will subsequently develop hsPDA and neonates of comparable gestational age (GA) who will undergo spontaneous ductal closure or the persistence of an irrelevant PDA (no-hsPDA). Moreover, we investigated potential prenatal or perinatal clinical factors potentially influencing the development of hsPDA.Materials and Methods: We enrolled n = 35 preterm neonates with GA between 24 and 32 weeks; urinary samples were collected within the first 12 h of life. Patients were closely monitored regarding intensive care, respiratory support, fluid balance and administered drugs; an echocardiogram was performed at 48–72 h.Results: Our results reported a significant correlation between lower GA at birth and the development of hsPDA. Moreover, neonates with GA ≤ 30w developing hsPDA were characterized by lower Apgar scores at 1′ and 5′, higher rates of perinatal asphyxia, higher need of delivery room resuscitation and subsequent surfactant administration. Interestingly, metabolomics analysis at birth detected a clear separation between the 1H-NMR urinary spectra of subjects GA ≤ 30w not developing hsPDA (n = 19) and those of subjects born at GA ≤ 30w in which hsPDA was confirmed at 48–72 h of life (n = 5).Conclusions: This is the first study applying metabolomics to investigate the PDA condition. Although preliminary and conducted on a limited sample, our results reveal that metabolomics could be a promising tool in the early identification of hsPDA, potentially superior to the clinical or laboratory predictive tools explored to date and even to the clinical observations and correlations in our sample, through the detection of specific urinary metabolites.

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Platelets and ductus arteriosus closure in neonates

Sallmon¹,

Delaney²

2023

Seminars in Perinatology

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Regarding platelets and ductus: Is it platelet function rather than number that matters for ductal closure?

Cited by 3 publications

References 4 publications

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

Platelets and ductus arteriosus closure in neonates

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