What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study

Toyoshima, Katsuaki; Isayama, Tetsuya; Kobayashi, Toshimitsu; Su, Chemin; Mikami, Masashi; Yokoyama, Takashi; Iwami, Hiroko; Nagasawa, Hiroyuki; Kawasaki, Hidenori; Amari, Shoichiro; Nakayama, Atsushi; Ikeda, Toshifumi; Okada, Naoko; Yamamoto, Yutaka; Masutani, Satoshi

doi:10.1016/j.jjcc.2019.05.004

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…In contrast, infants in multiple other studies were reported with either a small or moderate‐sized PDA, 16,17 presumably resulting in favourable outcomes. It has been shown that cases with a larger PDA size are more prone to require assisted closure, either pharmacological or surgical, whereas minor PDAs are more likely to close spontaneously 22 . Despite differences in both PDA sizes and follow‐up period, our cohort of infants was in agreement with other studies that report similar median GA and birth weight, hence making our findings comparable 7,16–18 …”

Section: Discussionsupporting

confidence: 89%

“…It has been shown that cases with a larger PDA size are more prone to require assisted closure, either pharmacological or surgical, whereas minor PDAs are more likely to close spontaneously. 22 Despite differences in both PDA sizes and follow-up period, our cohort of infants was in agreement with other studies that report similar median GA and birth weight, hence making our findings comparable. 7,[16][17][18] The incidence of NEC in our study was 10% which is high compared to 2-8% in other premature infants.…”

Section: Bold Indicates Significant P-valuessupporting

confidence: 92%

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The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

et al. 2022

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Aim: The primary aim was to estimate premature infants' spontaneous patent ductus arteriosus closure rate. Secondly, to identify criteria associated with the chance of spontaneous closure. Methods:We performed a retrospective cohort study of 167 infants born before 32 weeks of gestation and diagnosed with a patent ductus arteriosus between 1 January 2008 and 31 December 2017. The spontaneous patent ductus arteriosus closure event rate was evaluated using the Kaplan-Meier estimator. Results:The spontaneous closure rate within the first year of life was 66% (95% CI 58%-73%), increasing to 80% (95% CI 72%-86%) five years after birth. When including both spontaneous closure and closure following treatment, 96% (95% CI 86%-100%) closed within 5 years after birth. The chance of spontaneous closure was reduced in the case of a large patent ductus arteriosus: OR 0.16 (95% CI 0.05-0.52), left atrial enlargement: OR 0.16 (95% CI 0.05-0.51), and pulmonary hypertension: OR 0.23 (95% CI 0.07-0.74). Conclusion:The chance of spontaneous closure in premature infants born between 23 and 32 weeks of gestation was high, and the incidence continued increasing until 5 years of follow-up.

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Section: Discussionsupporting

confidence: 89%

Section: Bold Indicates Significant P-valuessupporting

confidence: 92%

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

et al. 2022

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“…According to national surveys in Japan, the use of echocardiography and cardiovascular agents, including catecholamines and vasodilators, are part of the current practices for the circulatory management of ELBWIs. 38,39 This concept consists of tailored circulatory management based on the stress-velocity relationship in preterm infants. 40 That study showed that serious complications of intraventricular and/or pulmonary hemorrhages in ELBWIs were higher in infants with an excessive afterload, which resulted in a decrease in the function of the LV.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Reference Ranges of Non-Invasive Myocardial Work Indices in Newborns

Yanase¹,

Iwashima

Takahashi

2022

Circ Rep

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Background: Myocardial work (MCW), estimated using non-invasive pressure-strain loops, is a novel approach for assessing left ventricular function. MCW offers potential advantages over left ventricular ejection fraction and global longitudinal strain (GLS). This study aimed to establish a reference range for MCW in newborns. Methods and Results:Overall, 113 healthy newborns (mean [±SD] birth weight 3,120±378 g) were included in the study. After entering peripheral systolic and diastolic blood pressure (BP) values, global constructive work (GCW), global work index (GWI), global work efficiency (GWE), and global wasted work (GWW) were calculated using EchoPAC software (version 204). Considering a mean [±SD] GLS of −16.3±2.8%, the mean [±SD] GWI, GCW, GWW, and GWE was 698.7±147.9 mmHg%, 1,008.5±200.1 mmHg%, 58.1±28.1 mmHg%, and 93.1±2.9%, respectively. All MCW parameters in newborns were lower than those previously reported in children and adults. However, GWI and GCW were more closely correlated with BP and GLS, as in adulthood and children. Estimation of the correlation between MCW and the frame rate index revealed no significant correlations among MCW parameters.Conclusions: Cardiac function in newborns was evaluated by assessing MCW. With the establishment of reference ranges and normative MCW data for newborns, routine clinical use and rotational mechanics are likely to become increasingly common. Future studies are needed to determine whether MCW is useful in screening for cardiac illness among newborns.

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“…An increase in preload of right ventricle leads to elevated central venous pressure and elevated cerebral venous pressure. As a consequence, the fragile vein around the germinal matrix is not able to tolerate the increased cerebral venous pressure, which causes IVH (3,(31)(32)(33)(34)(35). In addition, the left ventricle of the pre-term infant has low distensibility (15,31), which results in increased pulmonary venous pressure and pulmonary congestion during elevation of preload of the left ventricle, ultimately leading to pulmonary hemorrhage (36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

Decreased Incidence of Intraventricular Hemorrhage in Extremely Low Birth Weight Infants Using Customized Circulatory Management to Evaluate the Hemodynamic Change of Patent Ductus Arteriosus

et al. 2021

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Background: In extremely low birth weight (ELBW) infants, the patent ductus arteriosus (PDA) with left-to-right shunt and an increase in systemic artery resistance may cause increasing preload and afterload of the left ventricle. The immature myocardium in ELBW infants has a limited ability to respond to the change, which leads to hemorrhagic complications. In this study, we detected the hemodynamic change of cardiac performance and applied a clinical strategy to prevent PDA-associated hemorrhagic complications in ELBW infants.Methods: We enrolled ELBW infants at a single medical center in Taiwan. The customized circulatory management was performed by echocardiography after birth until the PDA closed. Inotropic agents were administrated according to the requirements of hemodynamic parameters or clinical conditions. The primary outcomes were hemorrhagic complications including pulmonary hemorrhage and intraventricular hemorrhage (IVH) greater than grade II. The secondary outcomes were the rate of surgical ligation of PDA, mortality, necrotizing enterocolitis, and bronchopulmonary dysplasia.Results: A total of 20 ELBW infants were evaluated by customized circulatory management from 2019 to 2020. We reviewed 35 ELBW infants born between 2017 and 2018 in our hospital, who served as the non-management group. The management group had a significantly lower incidence rate of IVH greater than grade 2 (p = 0.02). Other outcomes showed no significant differences. Dobutamine was prescribed in 8 cases in the management group, and end-systolic wall stress (ESWS) was significantly decreased after Dobutamine administration (p = 0.017).Conclusion: The incidence rate of IVH greater than grade II in ELBW infants decreased after use of customized circulatory management in our study. The strategy of customized circulatory management might be an effective “early target therapy” for hemodynamically significant PDA in high-risk ELBW infants. Inotropic therapy with Dobutamine could be a useful medical choice for improving cardiac function to prevent hemorrhagic complications.

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What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study

Cited by 16 publications

References 34 publications

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

Echocardiographic Reference Ranges of Non-Invasive Myocardial Work Indices in Newborns

Decreased Incidence of Intraventricular Hemorrhage in Extremely Low Birth Weight Infants Using Customized Circulatory Management to Evaluate the Hemodynamic Change of Patent Ductus Arteriosus

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