Management of preterm infants and incidence of patent ductus arteriosus
The effect of different methods of perinatal management for patent ductus arteriosus ‹PDA) occurrence is unknown. Therefore, we compared methods of perinatal management and PDA incidence in preterm infants before and after the introduction of early aggressive nutrition ‹EAN› in our institution. Infa...
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| Published in | Journal of Iwate Medical Assiociation Vol. 71; no. 5; pp. 201 - 212 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Iwate Medical Association
01.12.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-3284 2434-0855 |
| DOI | 10.24750/iwateishi.71.5_201 |
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| Abstract | The effect of different methods of perinatal management for patent ductus arteriosus ‹PDA) occurrence is unknown. Therefore, we compared methods of perinatal management and PDA incidence in preterm infants before and after the introduction of early aggressive nutrition ‹EAN› in our institution. Infants ‹gestational age <34 weeks› who were admitted as inpatients between 2006 and 2008 ‹no EAN, period A) and between 2012 and 2014 ‹EAN, period B› were assessed. Maternal and neonatal factors affecting PDA incidence were investigated. Compared to period A, infant immaturity was more severe and the PDA incidence was higher in period B. More severe immaturity and a higher rate of concomitant respiratory distress syndrome ‹RDS› were noted in infants who developed PDA, both in periods A and B. Multiple logistic regression analysis showed that PDA onset was associated with the presence or absence of RDS, gestational age, and echocardiographic indicators immediately after birth. Despite changes in our institution’s perinatal management, the incidence of PDA was unaffected, with infant immaturity being the most important PDA risk factor. Our results indicate that echocardiographic indicators immediately after birth could be used to predict PDA onset in preterm infants with a low gestational age and RDS. |
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| AbstractList | The effect of different methods of perinatal management for patent ductus arteriosus ‹PDA) occurrence is unknown. Therefore, we compared methods of perinatal management and PDA incidence in preterm infants before and after the introduction of early aggressive nutrition ‹EAN› in our institution. Infants ‹gestational age <34 weeks› who were admitted as inpatients between 2006 and 2008 ‹no EAN, period A) and between 2012 and 2014 ‹EAN, period B› were assessed. Maternal and neonatal factors affecting PDA incidence were investigated. Compared to period A, infant immaturity was more severe and the PDA incidence was higher in period B. More severe immaturity and a higher rate of concomitant respiratory distress syndrome ‹RDS› were noted in infants who developed PDA, both in periods A and B. Multiple logistic regression analysis showed that PDA onset was associated with the presence or absence of RDS, gestational age, and echocardiographic indicators immediately after birth. Despite changes in our institution’s perinatal management, the incidence of PDA was unaffected, with infant immaturity being the most important PDA risk factor. Our results indicate that echocardiographic indicators immediately after birth could be used to predict PDA onset in preterm infants with a low gestational age and RDS. |
| Author | Toya, Yukiko Yoshida, Taro Tsuchiya, Shigekuni Toyoshima, Hiroshi Matsumoto, Atsushi Takashimizu, Nao Oyama, Kotaro Sotodate, Genichiro Ito, Ai Konishi, Yu |
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| References | Isaacs EB, Gadian DG, Sabatini S, et al.: The effect of early human diet on caudate volumes and IQ. Pediatr Res 63, 308-314, 2008. Nagashima T, Kobayashi M, Teramoto S, et al.: Analysis of very low birth weight infants born at the Jikei University School of Medicine Women’s and Children’s Medical Center: focus on patent ductus arteriosus. Jikeikai Med J 54, 1–9, 2007. Kalis NN, Pieper C, van der Merwe PL, et al.: Factors influencing successful closure with indomethacin of the patent ductus arteriosus in premature infants. Cardiovasc JS Afr 12, 268–272, 2001. Wilson DC, Cairns P, Halliday HL, et al.: Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77, F4-F, 1977. Aoki R, Yokoyama U, Ichikawa Y, et al.: Decreased serum osmolality promotes ductus arteriosus constriction. Cardiovasc Res 104, 326-336, 2014. Yeh TF, Raval D, Luken J, et al.: Clinical evaluation of premature infants with patent ductus arteriosus: a scoring system with echocardiogram, acid-base, and blood gas correlations. Crit Care Med 9, 655-657, 1981. Watanabe T, Sawaki R, Matsudai T, et al.: The clinical features of neonates with hypermagnesemia at our hospital. Jpn J Pediatr 67, 1337-1341, 2014. Iyer P and Evans N: Re-evaluation of the left atrial to aortic root ratio as a marker of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 70, F112-F117, 1994. Kusuda S, Fujimura M, Uchiyama A, et al.: Trend in morbidity and mortality among very-low-birth-weight infants from 2003 to 2008 in Japan. Pediatr Res 72, 531-538, 2012. Yokoyama U, Minamisawa S and Ishikawa Y: Regulation of vascular tone and remodeling of the ductus arteriosus. J Smooth Muscle Res 46, 77-87, 2010. Thibeault DW, Emmanouilides GC and Dodge ME: Pulmonary and circulatory function in preterm lambs treated with hydrocortisone in utero. Biol Neonate 34, 238–247, 1978. Wilson DC, Cairns P, Halliday HL, et al.: Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77, F4-11, 1977. Koch J, Hensley G, Roy L, et al.: Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000g or less. Pediatrics 117, 1113–1121, 2006. Toyoshima K, Momma K and Nakanishi T: Fetal reversed constrictive effect of indomethacin and postnatal delayed closure of the ductus arteriosus following administration of transplacental magnesium sulfate in rats. Neonatology 96, 125-131, 2009. Toyoshima K, Masutani S, Senzaki H, et al.: Left atrial volume is superior to the ratio of the left atrium to aorta diameter for assessment of the severity of patent ductus arteriosus in extremely low birth weight infants. Circ J 78, 1701-1709, 2014. Oozeki K, Takigawa I, Matsui S, et al.: Prenatal steroid therapy and the prognosis of extremely immature infants. J Jpn Soc Perin Neon Med 48, 840-844, 2013. Chen YY, Wang HP, Chang JT, et al.: Perinatal factors in patent ductus arteriosus in very low-birthweight infants. Pediatr Int 56, 72-76, 2014. Cotton RB, Lindstrom DP and Stahlman MT: Early prediction of symptomatic patent ductus arteriosus from perinatal risk factors a discriminant analysis model. Acta Paediatr Scand 70, 723-727, 1981. Kawarabayashi T, Kishikawa T and Sugimori H: Effects of external calcium, magnesium, and temperature on spontaneous contractions of pregnant human myometrium. Biol Reprod 40, 942-948, 1989. The STOP-ROP Multicenter Study Group: Supplemental therapeutic oxygen for prethreshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial. I: Primary outcomes. Pediatrics 105, 295-310, 2000. Toyoshima K, Kawataki M, Sato Y, et al.: Serial echocardiographic assessment of mVcfc-ESWS relation in very low birth infant with perinatal complications. J Jpn Pediatr Soc Premature and Newborn Med 14, 45-52, 2002. Polat TB, Celik IH and Erdeve O: Early predictive echocardiographic features of hemodynamically significant patent ductus arteriosus in preterm VLBW infants. Pediatr Int 58, 589-594, 2016. Kluckow M and Evans N: Early echocardio-graphic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 127, 774-779, 1995. Brownfoot FC, Crowther CA and Middleton P: Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 8, CD006764, 2008. Lee JH, Greenberg RG, Quek BH, et al.: Association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants. Cardiol Young 27, 1732-1739, 2017. Amorim MM, Santos LC and Faúndes A: Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia. Am J Obstet Gynecol 180, 1283-1288, 1999. Pereira SS, Kempley ST, Shah DK, et al.: Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants. Acta Paediatr 107, 1909-1916, 2018. Clyman RI, Ballard PL, Sniderman S, et al.: Prenatal administration of betamethasone for prevention of patient ductus arteriosus. J Pediatr 98, 123-126, 1981. Schmidt B, Whyte RK, Asztalos EV, et al.: Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. JAMA 309, 2111-2120, 2013. |
| References_xml | – reference: Cotton RB, Lindstrom DP and Stahlman MT: Early prediction of symptomatic patent ductus arteriosus from perinatal risk factors a discriminant analysis model. Acta Paediatr Scand 70, 723-727, 1981. – reference: Iyer P and Evans N: Re-evaluation of the left atrial to aortic root ratio as a marker of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 70, F112-F117, 1994. – reference: Toyoshima K, Momma K and Nakanishi T: Fetal reversed constrictive effect of indomethacin and postnatal delayed closure of the ductus arteriosus following administration of transplacental magnesium sulfate in rats. Neonatology 96, 125-131, 2009. – reference: Koch J, Hensley G, Roy L, et al.: Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000g or less. Pediatrics 117, 1113–1121, 2006. – reference: Kluckow M and Evans N: Early echocardio-graphic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 127, 774-779, 1995. – reference: Thibeault DW, Emmanouilides GC and Dodge ME: Pulmonary and circulatory function in preterm lambs treated with hydrocortisone in utero. Biol Neonate 34, 238–247, 1978. – reference: Chen YY, Wang HP, Chang JT, et al.: Perinatal factors in patent ductus arteriosus in very low-birthweight infants. Pediatr Int 56, 72-76, 2014. – reference: Lee JH, Greenberg RG, Quek BH, et al.: Association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants. Cardiol Young 27, 1732-1739, 2017. – reference: Amorim MM, Santos LC and Faúndes A: Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia. Am J Obstet Gynecol 180, 1283-1288, 1999. – reference: Kawarabayashi T, Kishikawa T and Sugimori H: Effects of external calcium, magnesium, and temperature on spontaneous contractions of pregnant human myometrium. Biol Reprod 40, 942-948, 1989. – reference: Kalis NN, Pieper C, van der Merwe PL, et al.: Factors influencing successful closure with indomethacin of the patent ductus arteriosus in premature infants. Cardiovasc JS Afr 12, 268–272, 2001. – reference: The STOP-ROP Multicenter Study Group: Supplemental therapeutic oxygen for prethreshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial. I: Primary outcomes. Pediatrics 105, 295-310, 2000. – reference: Isaacs EB, Gadian DG, Sabatini S, et al.: The effect of early human diet on caudate volumes and IQ. Pediatr Res 63, 308-314, 2008. – reference: Watanabe T, Sawaki R, Matsudai T, et al.: The clinical features of neonates with hypermagnesemia at our hospital. Jpn J Pediatr 67, 1337-1341, 2014. – reference: Kusuda S, Fujimura M, Uchiyama A, et al.: Trend in morbidity and mortality among very-low-birth-weight infants from 2003 to 2008 in Japan. Pediatr Res 72, 531-538, 2012. – reference: Brownfoot FC, Crowther CA and Middleton P: Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 8, CD006764, 2008. – reference: Toyoshima K, Masutani S, Senzaki H, et al.: Left atrial volume is superior to the ratio of the left atrium to aorta diameter for assessment of the severity of patent ductus arteriosus in extremely low birth weight infants. Circ J 78, 1701-1709, 2014. – reference: Yokoyama U, Minamisawa S and Ishikawa Y: Regulation of vascular tone and remodeling of the ductus arteriosus. J Smooth Muscle Res 46, 77-87, 2010. – reference: Schmidt B, Whyte RK, Asztalos EV, et al.: Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. JAMA 309, 2111-2120, 2013. – reference: Polat TB, Celik IH and Erdeve O: Early predictive echocardiographic features of hemodynamically significant patent ductus arteriosus in preterm VLBW infants. Pediatr Int 58, 589-594, 2016. – reference: Aoki R, Yokoyama U, Ichikawa Y, et al.: Decreased serum osmolality promotes ductus arteriosus constriction. Cardiovasc Res 104, 326-336, 2014. – reference: Yeh TF, Raval D, Luken J, et al.: Clinical evaluation of premature infants with patent ductus arteriosus: a scoring system with echocardiogram, acid-base, and blood gas correlations. Crit Care Med 9, 655-657, 1981. – reference: Clyman RI, Ballard PL, Sniderman S, et al.: Prenatal administration of betamethasone for prevention of patient ductus arteriosus. J Pediatr 98, 123-126, 1981. – reference: Nagashima T, Kobayashi M, Teramoto S, et al.: Analysis of very low birth weight infants born at the Jikei University School of Medicine Women’s and Children’s Medical Center: focus on patent ductus arteriosus. Jikeikai Med J 54, 1–9, 2007. – reference: Pereira SS, Kempley ST, Shah DK, et al.: Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants. Acta Paediatr 107, 1909-1916, 2018. – reference: Wilson DC, Cairns P, Halliday HL, et al.: Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77, F4-11, 1977. – reference: Toyoshima K, Kawataki M, Sato Y, et al.: Serial echocardiographic assessment of mVcfc-ESWS relation in very low birth infant with perinatal complications. J Jpn Pediatr Soc Premature and Newborn Med 14, 45-52, 2002. – reference: Wilson DC, Cairns P, Halliday HL, et al.: Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77, F4-F, 1977. – reference: Oozeki K, Takigawa I, Matsui S, et al.: Prenatal steroid therapy and the prognosis of extremely immature infants. J Jpn Soc Perin Neon Med 48, 840-844, 2013. |
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| SubjectTerms | left atrium/aortic root ratio left pulmonary artery mean diastolic velocity/peak systolic velocity ratio patent ductus arteriosus respiratory distress syndrome serum osmolality |
| Title | Management of preterm infants and incidence of patent ductus arteriosus |
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