Search

To evaluate the efficacy of dual patent ductus arteriosus (PDA) pharmacotherapy compared to monotherapy we searched Medline, Embase, Cochrane Library, and references of relevant articles through October 20, 2021 for randomized clinical trials (RCTs) and cohort studies comparing dual PDA treatment vs. monotherapy. Data were analyzed using a fixed effects model. The fixed effects model assumes that all studies included in a meta-analysis are estimating a single true underlying effect, that of ductal closure. Primary outcome was ductal closure; secondary outcome was surgical ligation. Of 170 articles retrieved, three cohort studies and two RCTs were included, totaling 470 patients: 384 babies received monotherapy and 86 dual therapy. Because of the small numbers, RCTs and cohort studies were pooled for analysis. Ductus closed in 67% of those who received combination compared with 58% those with monotherapy. Overall fixed effect shows an OR of 1.97 [1.10; 3.53; p = 0.023] favoring dual therapy. Dual pharmacologic treatment appears more effective than monotherapy. Future well-powered, high-quality, prospective RCTs are needed to further investigate this potential approach., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: To study paracetamol (PCM) use as first line therapy for significant patent ductus arteriosus (sPDA) closure, stratified by echocardiography., Methods: In this retrospective observational study, a prepublished score comprising PDA size and velocity, PDA:left pulmonary artery ratio, diastolic flow in main and LPA, LA:Ao ratio and left ventricular:aortic ratio were included for shunt severity. Successful closure was defined a priori as closure or ≥50% reduction in score. Comparisons were made between infants with sPDA who were treated and not treated., Results: During November 2017-2018, 227 infants from 23 to 31 +6 weeks' gestational age (GA) were admitted; 50 (22%) infants were diagnosed with PDA, 32 treated with PCM, overall treatment rate of 32/227 (14%). Successful therapy was noted in 23/32 (72%) and was higher when treated at ≤7 days (80 versus 68%, p  = .68), in infants >26 weeks GA (62.5 versus 100%, p  = .07) and BW >1000 g (65.4 versus 100%, p  = .14). Univariate analysis noted statistical significance only for GA. Eighteen infants were managed conservatively. Treated infants had a lower GA and BW, higher composite ECHO score (14.4 ± 0.5 versus 19 ± 0.4, p  < .001)., Conclusions: Composite scoring helped reduce exposure, and focus more on infants with lower GA and BW with greater shunt severity.

Background/objectives: The hemodynamically insignificant (hisPDA) ductus arteriosus often progresses to hemodynamic significance. In this review, we sought risk factors predictive of progression., Methods: Early hisPDAs were subdivided into those that closed spontaneously vs. those that progressed to hsPDA., Results: Sixty percent of early hisPDAs subsequently progressed to hsPDAs. In all but one, the ductus never closed, but rather became progressively more significant over time. The echocardiographic parameters best associated with subsequent progression were an increased transductal diameter (1.81 ± 0.77 vs. 1.21 ± 0.44 mm; p < 0.001) and the presence of diastolic flow reversal. ROC curve analysis showed that the best ductal diameter criterion for predicting the progression to hsPDA was >1.4 (sensitivity = 91; specificity = 81). The combined morbidity score was higher in those infants who progressed to hsPDA as compared with those who did not (p = 0.0038)., Conclusions: Increased ductal diameter and diastolic flow reversal on the first echocardiogram were best correlated with progression of hisPDA to hsPDA.

Objective: The ductus arteriosus is a blood vessel that connects the pulmonary artery to the descending aorta during fetal life and generally undergoes spontaneous closure shortly after birth. In premature neonates it often fails to close (patent ductus arteriosus-PDA), which can result in diversion of a significant part of the left-ventricular cardiac output to the pulmonary circulation. This left-to-right shunt may result in significant increase of pulmonary blood flow and decrease of systemic perfusion (hemodynamically significant PDA-hsPDA), which may lead to severe neonatal morbidity. The study objective was to find the relationship between hsPDA and perfusion index (PI), a photoplethysmographic parameter related to systemic perfusion., Approach: PI measures the relative systolic increase in tissue light absorption due to the systolic increase in the tissue blood volume. PI has been found to be directly related to tissue perfusion and is therefore expected to be affected by hsPDA., Main Results: PI was found to be higher in preterm neonates with hsPDA after first week of life, in comparison to those with closed DA, despite the lower systemic perfusion, probably due to reverse flow during diastole., Significance: In our study, perfusion index increased despite the lower systemic perfusion, indicating that in neonates with hsPDA, perfusion index is not necessarily a measure of perfusion. Nevertheless, PI can be used as a screening tool for suspicious PDA, in order to select a relatively small group of neonates for a more definitive examination by echocardiography, which is not suitable for universal screening.

Introduction: Several echocardiographic scoring systems have been developed to assess the severity of patent ductus arteriosus (PDA) shunting in preterm infants., Objective: The objective of this study was to compare the ability of two different scoring systems to evaluate the hemodynamic significance of the PDA and to predict long-term PDA-associated morbidities., Subjects: El-Khuffash cohort (previously described) was derived from a multicenter, prospective, observational study conducted in tertiary neonatal intensive care units in Ireland, Canada, and Australia., Results: A total of 141 infants with a mean gestational age of 26 ± 1.4 weeks and a mean birth weight of 952 ± 235 g were evaluated on day 2 of life. The two scores were well correlated with each other and both scores positively predicted chronic lung disease/death in this population., Conclusion: There appears to be an overall stepwise progression in the incidence of poor outcome parameters from "closed" to "borderline" to "hemodynamically significant" PDA. Both the El-Khuffash and Shaare Zedek scores are predictive of PDA-associated morbidities., Competing Interests: Conflict of Interest: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)