Article

Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less

Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
PEDIATRICS (Impact Factor: 5.3). 05/2006; 117(4):1113-21. DOI: 10.1542/peds.2005-1528
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ABSTRACT Ductus arteriosus (DA) closure occurs within 96 hours in >95% of neonates >1500 g in birth weight (BW). The prevalence and postnatal age of spontaneous ductal closure in neonates < or =1000 g in BW (extremely low birth weight [ELBW] neonates) remain unclear, as does the incidence of failure to close with indomethacin. Therefore, we prospectively examined the prevalence, postnatal age, and clinical variables associated with spontaneous DA closure, occurrence of persistent patent DA, and indomethacin failure in ELBW neonates.
Neonates delivered at Parkland Memorial Hospital from February 2001 through December 2003 were studied. Those with congenital heart defects or death <10 days postnatally were excluded. Echocardiograms were performed 48 to 72 hours postnatal and every 48 hours until 10 days postnatally.
We studied 122 neonates with BW of 794 +/- 118 (SD) g and estimated gestational age (EGA) of 26 +/- 2 weeks. Spontaneous permanent DA closure occurred in 42 (34%) neonates at 4.3 +/- 2 days postnatally, with 100% closure by 8 days. These neonates were more mature, less likely to have received antenatal steroids or have hyaline membrane disease (HMD; 52% vs 79%), and more likely to be growth restricted (31% vs 5%) and delivered of hypertensive women. Using regression analysis, EGA and absence of antenatal steroids and HMD predicted ductal closure. Ten (8%) neonates with early DA closure reopened and required medical/surgical closure. Eighty neonates had persistent patent DA; 7 were surgically ligated, and 5 remained asymptomatic, with 4 of 5 closing after 10 days postnatally. Sixty-eight (85%) received indomethacin at 6.2 +/- 4 days postnatally; 41% failed therapy and had no distinguishing characteristics.
Spontaneous permanent DA closure occurs in >34% of ELBW neonates and is predicted by variables related to maturation, for example, EGA and an absence of HMD, whereas indomethacin failure could not be predicated.

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Available from: Charles Richard Rosenfeld, Jul 14, 2014
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    • "However, controversy regarding the treatment of PDA still exists. Of greatest concern is the treatment of PDA in extremely preterm infants "born at the limits of viability" because 1) the rate of spontaneous ductal closure is extremely low (1); 2) the response rate to pharmacologic treatment is very low as well (1, 2); and 3) they are prone to develop hemodynamically significant PDA with cardiopulmonary compromise (3). For these reasons, surgical ligation is frequently performed despite the surgical risk and complications. "
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    ABSTRACT: The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17±12 vs 11±8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation. Graphical Abstract
    Journal of Korean medical science 04/2014; 29(4):581-6. DOI:10.3346/jkms.2014.29.4.581 · 1.25 Impact Factor
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    • "In the case series reported by Roofthooft et al., paracetamol was ineffective in 8 out of 10 neonates [20]; however, these patients had a lower GA and BW [20] and started paracetamol treatment later [19,20] than the patients in our case series. All these data suggest that lower GA and BW associated with previous courses of ibuprofen or later ductal treatment may negatively influence the response to paracetamol [24-26]. Accordingly, we observed a failure of paracetamol treatment in 2 subjects with very low GA. "
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    ABSTRACT: Inhibitors of the cyclo-oxygenase component of prostaglandin-H2 synthetase, namely indomethacin and ibuprofen, are commonly used in the treatment of hemodynamically significant patent ductus arteriosus. These drugs are associated with serious adverse events, including gastrointestinal perforation, renal failure and bleeding. The role of paracetamol, an inhibitor of the peroxidase component of prostaglandin-H2 synthetase, has been proposed for the treatment of patent ductus arteriosus. We report a series of 8 neonates (birth weight: 724 +/- 173 g; gestational age: 26 +/- 2 weeks) treated with paracetamol for a hemodynamically significant patent ductus arteriosus, because of contraindications to ibuprofen or indomethacin. Successful closure was achieved in 6 out of 8 babies (75%). Median ductal diameter was significantly reduced after treatment (from 1.2 mm, range 1.0-2.5 mm to 0.6 mm, range 0.0-2.5 mm, p = 0.038). No adverse or side effects were observed during treatment. On the basis of these results, paracetamol could be considered a promising and safe therapy for the treatment of patent ductus arteriosus in neonates.
    Italian Journal of Pediatrics 02/2014; 40(1):21. DOI:10.1186/1824-7288-40-21 · 1.52 Impact Factor
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    • "A prospective study demonstrated a spontaneous closure of the PDA in the first 10 days of life in at least 35% of extremely low-birth-weight (ELBW) infants and up to 70% in neonates of >28 weeks' gestation. There was a direct relationship between gestational age and spontaneous closure and for each additional week above 23 weeks, the odds of spontaneous closure increased by a ratio of 1.5 [28]. Among infants of <27 weeks' gestation with a persistent PDA at the time of hospital discharge, 75% of the infants will spontaneously close their PDA by the end of the first year [32]. "
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    ABSTRACT: Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.
    12/2013; 2013:676192. DOI:10.1155/2013/676192
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