Materiały źródłowe

• #1 Factors Predicting Spontaneous Closure of Patent Ductus Arteriosus in Very Low Birth Weight Neonates

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11439460/

  Patent ductus arteriosus (PDA) is a relatively rare condition among neonates in the United States, estimated at approximately 1 in every 2,000 births. […] Managing hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) neonates remains a challenge. […] This study aims to explore and report on the spontaneous closure of hsPDA in VLBW infants in a clinical setting. […] A total of 108 infants were included in the study; 52 experienced spontaneous PDA closure, and 56 required treatment. […] Within the adjusted model, cesarean section (CS) (OR: 0.18; 95% CI: 0.06-0.55), average pre-diagnosis partial pressure of carbon dioxide (PCO2) (OR: 0.92; 95% CI: 0.86-0.98), and pre-diagnosis daily fluid intake (OR: 0.96; 95% CI: 0.94-0.99) were associated with increased odds of spontaneous closure.

• #2 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  For infants with just an isolated PDA, the prognosis is good. In premature infants, the prognosis is dependent on other comorbidities. After the closure of the PDA, most children have a normal life expectancy. Spontaneous closure of the PDA is rare. With the use of indomethacin, close to 80-90% of infants will have successful closure of the PDA. In adults, surgical closure is always required, provided the patient has not developed fixed pulmonary hypertension. […] The morbidity and mortality are linked to the volume of blood flow via the PDA. If left untreated, pulmonary hypertension can develop, which will lead to premature death. Premature infants with PDA may develop respiratory distress syndrome. Surgical complications of the PDA include injury to the recurrent laryngeal nerve, occlusion of the descending aorta, injury to the pulmonary artery and phrenic nerve, and death.

• #3 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  The outcome for the majority of patients in whom the PDA is ligated or medically treated is good. However, in most of these infants, it is the presence of other disorders that dictate the prognosis. Spontaneous closure of the ductus is very rare after the first three months of birth. Further, even in infants treated medically with ibuprofen, sometimes the ductus may reopen and require surgical closure. In all adults, the presence of a ductus requires surgical closure. In fact, before the ductus is closed in the adult population, the status of the pulmonary vasculature must be determined. Thus, patients with mild pulmonary hypertension have a normal life expectancy. The surgical mortality for ductus varies from 2-20% depending on the infant’s age and other co-existing comorbidities. If left untreated, the mortality rate increases with age.

• #4 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  With treatment, most babies born with PDA live healthy and active lives. […] If PDA doesn’t close on its own, healthcare providers can correct it, if needed. Babies and children with moderate and large sized PDAs that are not treated in the correct timeframe may be at higher risk for developing heart complications as adults. Talk with your healthcare provider about whether your baby needs follow-up care.

• #5 Factors Predicting Spontaneous Closure of Patent Ductus Arteriosus in Very Low Birth Weight Neonates

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11439460/

  In our study of VLBW infants, several variables were associated with spontaneous hsPDA closure. […] The spontaneous closure rate in our population was 48.1%, which is considerably lower than several studies reporting spontaneous closure rates ranging from 71% to 85%. […] Our finding that infants delivered vaginally were less likely to close spontaneously is consistent with Ngo S et al., who found that infants delivered vaginally were more likely to be diagnosed with PDA than those delivered by CS. […] Our study supports this result; however, the lack of an evidence base demonstrates a clear need for further research into this potentially clinically significant area. […] Our study sought to explore the associations between key variables and spontaneous PDA in a neonate sample. […] We found that CD, lower average pre-diagnosis PCO2, higher average PO2, and lower pre-diagnosis daily fluid goal are associated with spontaneous closure.

• #6 Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1708-z

  Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). […] Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. […] Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). […] Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm.

• #7 Application of Neonatologist Performed Echocardiography in the assessment of a patent ductus arteriosus | Pediatric Research

  https://www.nature.com/articles/s41390-018-0077-x

  Identifying early echocardiographic predictors of ductal patency might lead to a more targeted approach. This approach could potentially reduce side-effects of the current therapy by avoiding unnecessary treatment and reduce prolonged exposure to a potential harmful shunt. […] A recent national based cohort study showed that an early echocardiographic screening of the PDA was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage. […] The ultimate decision to treat the PDA lies in the hands of the clinician and should be based on integration of the hemodynamic indices of shunt volume within the clinical context. […] It is important to highlight the role of NPE after treatment. A follow-up study after PDA treatment can be used to evaluate the presence of a pulmonary branch stenosis and confirm presence or absence of coarctation of the aorta when it is suspected in presence of a PDA. […] Despite widespread uncertainty about the management of the PDA, NPE is increasingly recognized as an important tool for screening, diagnosing, and assessing hemodynamic significance of the PDA.

• #8

  https://link.springer.com/article/10.1007/s00246-021-02731-w

  To construct a model with the indices obtained by echocardiography to predict whether patent ductus arteriosus (PDA) was required to be treated with pharmacologic treatment or surgical ligation, we performed a prospective observational study, including all neonates with gestational age30 weeks and assessed the hemodynamics of PDA by serial daily echocardiography examination at postnatal age of 012 h, 24 h, 48 h, and 72 h, respectively. […] The results showed that a total of forty-two preterm infants were enrolled in the study. 15 (35.7%) preterms were in the intervention group and 27 (64.3%) preterms were in the non-intervention group. Compared with the non-intervention group, the intervention group had a higher proportion of left ventricular volume overload and systemic shunt effect. […] These findings denoted that serial daily echocardiographic assessment can be useful in predicting whether a PDA will be closed with NSAIDs and/or surgical ligation in preterm infants with gestational age30 weeks.

• #9 B-Type Natriuretic Peptide to Predict Ductus Intervention in Infants <28 Weeks | Pediatric Research

  https://www.nature.com/articles/pr2008193

  Patent ductus arteriosus (PDA) is frequent in neonates with gestational age of less than 28 wk. […] B-type natriuretic peptide (BNP) has been proposed as a screening tool for PDA in preterm infants. […] In conclusion, plasma BNP proved to be a good predictor for ductus intervention (area under the curve: 0.86) with the best cutoff at 550 pg/mL on the second day of life in ventilated infants less than 28 wk gestation (sensitivity: 83%; specificity: 86%). […] The present study demonstrates that in preterm infants 28 wk on the second DOL, when clinical signs are absent and echocardiographic markers for the timing of ductus intervention are controversial, plasma BNP levels are strongly related to the need for subsequent ductus intervention and not only to the presence of PDA. […] We defined a cutoff BNP value of 550 pg/mL as having high sensitivity and specificity for ductus intervention.

• #10 B-Type Natriuretic Peptide to Predict Ductus Intervention in Infants <28 Weeks | Pediatric Research

  https://www.nature.com/articles/pr2008193

  Overall, in this study, circulating BNP levels correlated well to the echocardiographic and clinical assessment of PDA. […] Because the optimal timing to treat the PDA in premature infants is an unresolved issue and controversy still exists about the indication for ductus intervention, we believe that BNP measurement can be used as an adjunct to echocardiography and may be helpful for the timing of ductus intervention. […] In conclusion, although increasing circulating BNP level can be a useful biologic marker in neonatal intensive care units to predict the need for early PDA treatment, it cannot replace echocardiography in diagnosing a PDA. Plasma BNP values of above 550 pg/mL have high sensitivity and specificity to predict the necessity of medical PDA intervention in ventilated preterm infants 28 wk already on d 2 of life.

• #11 Application of Neonatologist Performed Echocardiography in the assessment of a patent ductus arteriosus | Pediatric Research

  https://www.nature.com/articles/s41390-018-0077-x

  The presence of a PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion. The PDA is associated with several morbidities including intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and death. […] Although some trials of pharmacological therapy have shown a reduction in short-term morbidities such as pulmonary hemorrhage and severe IVH, data on long-term outcomes are limited to one large trial of prophylactic treatment using indomethacin showing no beneficial effect in the treatment group. […] Currently, opinion is divided regarding if, when, and how to treat a PDA. […] The possible co-linearity between the presence of a PDA, lower gestational age, and most of the outcomes measured, make it difficult to accept a one size fits all approach to the PDA. Rather, the PDA should be considered as a dynamic physiologic shunt that at a certain threshold or after a specific duration of exposure, may become harmful.

• #12 Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1708-z

  Unfortunately, no validated prediction models currently exist to permit early identification of those infants with increased probabilities of persistent PDA and PDA-associated harm. […] The objectives of this study are to use a prospective cohort of untreated preterm infants with PDA to accurately predict the timing of spontaneous ductal closure (and conversely, long-term ductal patency) in preterm infants with PDA, and the identification of measurable echocardiographic predictors and biomarkers that are present in the first postnatal month that are associated with mortality, chronic lung disease (CLD), and long-term neurological impairment. […] Developing a clinically useful prediction model will allow clinicians and clinical trialists to estimate the probability of an infant’s PDA closing and the chronological age at which closure will likely occur.

• #13 Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1708-z

  We expect to accurately predict the probability of mortality or requirement for supplemental oxygen or positive-pressure support at 36-weeks PMA using a combination of echocardiographic measures, biomarkers, and clinical measures from the first 4-weeks postnatal. […] We will also evaluate the impact of spontaneous PDA closure and duration of PDA exposure on the 36-weeks PMA outcomes. […] We will develop prediction models that will estimate an infant’s probability of motor delays at 22 to 26-months. […] A combination of echocardiographic measures, biomarkers, and clinical measures collected in the first postnatal month is expected to accurately predict the probability of PDA-associated motor impairment at 22 to 26-months corrected age.

• #14 Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1708-z

  The current study will make significant contributions to scientific knowledge and effective PDA management. […] Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in high-risk infants most likely to receive benefit. […] However, the effectiveness of more selective PDA treatment closure strategies remains unclear. […] The American Academy of Pediatrics and experts on PDA in preterm infants agree that future outcomes-based randomized clinical trials are needed to determine the effectiveness of selective pharmacological and/or interventional treatments for high-risk infants with PDA. […] The goal is to eventually deliver prompt, personalized PDA treatment to only those infants most likely to benefit, thereby reducing the side-effects and costs associated with unnecessary and potentially harmful PDA overtreatment.

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