The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: Size matters

Tschuppert, Scott; Doell, Carsten; Arlettaz-Mieth, Romaine; Baenziger, Oskar; Rousson, Valentin; Balmer, Christian; Prêtre, René; Dodge‐Khatami, Ali

doi:10.1016/j.jtcvs.2007.07.027

Cited by 29 publications

(21 citation statements)

References 14 publications

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“…We 10 previously were unable to show a relationship between EGA, postnatal age, BW or clinical variables with the success of indomethacin administration. Unlike Tshuppert et al, 19 we did not identify a significant relationship between PDA size and the response to indomethacin. Whereas the study was not powered to examine this, it is notable that there was an association between an initially small PDA or closed DA and subsequent successful closure with indomethacin.…”

Section: Discussioncontrasting

confidence: 99%

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

et al. 2010

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Objective: Identify echocardiographic parameters at p4 day postnatal that predict the subsequent need for closure of a clinically significant patent ductus arteriosus (sPDA) in extremely-low-birth-weight neonates (ELBW).Study Design: Serial echocardiograms obtained in 115 ELBW at p10 day postnatal were examined to estimate PDA size using the PDA:left pulmonary artery (LPA) diameter ratio: X1 indicated a large PDA, <1 but X0.5 moderate, and <0.5 small. Sensitivity, specificity, and positive predictive values (PPV) were determined for ELBW <27 weeks and X27 weeks gestational age.Result: Neonates with moderate to large PDA at p4 day had 15-times greater likelihood of requiring treatment for sPDA than those with a small PDA (95% confidence interval (CI): 5.6-41). Sensitivity, specificity and PPV of the PDA:LPA at <27 weeks was 80, 86 and 92%, respectively. Conclusion:A moderate to large PDA determined from the PDA:LPA ratio at p4 day postnatal identifies neonates <27 week gestation who subsequently require closure of a PDA.

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Section: Discussioncontrasting

confidence: 99%

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

et al. 2010

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“…The ductal diameter measured on the first day of life has a high sensitivity and specificity in predicting the development of hsPDA (2). Further authors also describe the association between ductal size and the need for further medicamentous or surgical closure (13). Measuring flow velocities from the suprasternal view gives information about the direction of the shunt and allows pulmonary pressures to be assessed.…”

Section: Echocardiographic Evaluation Of Pdamentioning

confidence: 99%

Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants

Arlettaz

2017

Front. Pediatr.

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Patent ductus arteriosus (PDA) is part of the typical morbidity profile of the preterm infant, with a high incidence of 80–90% in extremely low birth weight infants born before 26 weeks of gestation. Whereas spontaneous closure of the ductus arteriosus (DA) is likely in term infants, it is less so in preterm ones. PDA is associated with increased mortality and various comorbidities including cardiac failure, need for respiratory support, bronchopulmonary dysplasia, pulmonary or intracranial hemorrhage, and necrotizing enterocolitis; however, there is no proven causality between these morbidities and the presence of DA. Thus, the indication to close PDA remains highly controversial. This paper focuses on echocardiographic evaluation of PDA in the preterm infant and particularly on the echocardiographic signs of hemodynamic significance.

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“…Both drugs have similar adverse effect profile. Treatment failure is about 25-30 % and is more common among a) extremely low birth weight infants, b) infants not exposed to antenatal steroids, c) inf ants exposed t o antenatal i ndomethacin and chorioamnionitis, d) infants with severe respiratory distress, e) infants with thrombocytopenia <100,000, and f) large ductus arteriosus index >9 mm 2 /kg (ductal diameter squared/ birth weight) [35].…”

Section: Indications For Rescue Therapymentioning

confidence: 99%

Management of Patent Ductus Arteriosus in Premature Infants

Bhat

Das

2014

Indian J Pediatr

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Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

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The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: Size matters

Cited by 29 publications

References 14 publications

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants

Management of Patent Ductus Arteriosus in Premature Infants

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