The study of clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA

Authors

  • Bhabagrahi Mallick Department of Pediatrics, IMS and SUM Hospital, Bhubaneswar, Odisha, India
  • Sarthak R. Nayak Department of Biochemistry, IMS and SUM Hospital, Bhubaneswar, Odisha, India
  • Subrat Ku. Tripathy Department of Biochemistry, IMS and SUM Hospital, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20183029

Keywords:

Echocardiography, Ibuprofen, PDA, Prostaglandin

Abstract

Background: Patency of ductus arteriosus is vital for fetal survival. Ductus often fails to close in premature infants called patent ductus arteriosus (PDA). Our objective is to find the clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA.

Methods: 20 infants diagnosed as PDA clinically and confirmed by echocardiography. Symptomatic infants initially treated with fluid restriction and frusemide. Non responders treated with per rectal ibuprofen with dose of 10 mg/kg stat followed by 5 mg/kg x 2 doses at 24 hour intervals. Failure to ductal closure followed by similar second course of ibuprofen. Echocardiography repeated after 72 hours of each therapy. Surgical ligation of ductus was carried after failure to drug therapies. Secondary outcomes during hospitalization were documented.

Results: PDA was diagnosed in seventeen infants during first week and three after seven postnatal day. Mean gestational age and birth weight were 31±2 weeks and 1466±378grams respectively. Three babies responded well to fluid therapy. Thirteen infants out of seventeen had ductal closure after first course and two to second course of ibuprofen. Two had undergone surgical treatment. Six infants detected with sepsis, five with intraventricular hemorrhage and retinopathy of prematurity. Two developed bronchopulmonary dysplasia. Pulmonary hemorrhage and NEC were found in one each. Two babies died.

Conclusions: PDA is inversely related to gestational age and birth weight. Prostaglandin synthase inhibitors are essential in ductal closure. Surgical ligation is reserved for medical therapy failure. Co-morbidities in PDA are less in well treated babies.

References

Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate. 2006;89:330-5.

Spitzer AR, Davis J, Clarke WT, Bernhaum J, Fox WW. Pulmonary hypertension and persistent fetal circulation in the newborn. Clin Perinatol. 1988 Jun 1;15(2):389-413.

Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA, et al. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr. 2005 Dec 1;147(6):786-90.

Bancalari E, Claure N, Ganzalez A. Patent ductus arteriosus and respiratory outcome in premature infants. Biol Neonate. 2005;88:192-201.

Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated? Curr Opin Pediatr. 2004;16:146-51.

Bose BL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007;92:498-502.

Bose CL, Laughon ML. Treatment to prevent patency of the ductus arteriosus: Beneficial or harmful? J Pediatr. 2006;148:713-14.

Clyman RI, Chome N. Patent ductus arteriosus: evidence for and against treatment. J Pediatr. 2007;150: 216-9.

Perlman JM, Hill A, Volpe JJ. The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant. J Pediatr. 1981;99:767-71.

Clyman RI, Mauray F, Heymann MA, Roman C. Cardiovascular effects of patent ductus arteriosus in preterm lambs with respiratory distress. J Pediatr. 1987;111:579-87.

Cotton RB, Stahlman MT, Dovar I, Catterton WZ. Medical management of smallpreterm infants with symptomatic patent ductus arteriosus. J Pediatr. 1979;2:467-73.

Corff KE, Sekar KC. Clinical considerations for the pharmacological management of patent ductus arteriosus with cyclooxygenase inhibitors in premature infants. J Pediatr Pharmacol Ther. 2007;12:147-57.

Zahaka KG, Patel CR. Congenital cardiac defects. In Neonatal perinatal medicine - Disorders of the fetus and infants. Eds- Fanaroff AA, Martin RJ. 6th Edn.; 1997:1155-1157.

Koch J, Hensley G, Roy L, Brown S, Ramaciotti Cl, Rosenfeld C. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics. 2006;117(4):1113-21.

Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C. Conservative treatment for PDA in the preterm. Arch Dis Child Fetal Neonatal Ed. 2007;92(4):244-7.

Bose CL, Laughon MM. PDA: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007;92(6):498-502.

Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductusarteriosus in preterm infants. Cochrane Database Syst Rev. 2003;2:CD003745.

Van Overmeire B, Smets K, Lecoutere D, Van de Broek H, Weyler J, Degroote K, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med. 2000;343:674-81.

Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2003;3:CD003951.

Burke RP, Jacobs JP, Cheng W, Trento A, Fontana GP. Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants. Pediatrics. 1999;104: 27-30.

Ohlsson A, Wakia R, Shah S. Ibuprofen for the treatment of patent ductus arteriousus in preterm and/or low birth weight infants. Cochrane Syst Rev. 2005;4:CD003481.

Herrera C, Holberton J, Davis P. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Syst Rev. 2007;2:CD003480.

Archer N. Patent Ductus Arteriosus in the Newborn. Arch Dis Child. 1993;69:529-32.

Ellison RC, Peckham GJ, Lang P, Talner NS, Lerer TJ, Lin L, et al. Evaluation of the preterm infant for patent ductus arteriosus. Pediatr. 1983 Mar 1;71(3):364-72.

Cotton RB, Stahlman MT, Kovar I, Catterton W. Medical management of small preterm infants with symptomatic patent ductus arteriosus. Pediatr. 1978;92:467-74.

Blanco EC, Siasi B, Cabal LA. Persistent pateney of ductus arteriosus in premature newborn infants, Am J cardiol. 1973;31:120.

Heymann MA, Rudolph AM, Silvermann NH. Closure of the ductus arteriosus in premature infants by inhibition of prostaglandin synthesis. N EngI J Med. 1976;295:530-33.

Yeh TF, Carr I. Pharmacologic Closure of Patent Ductus Arteriosus in Drug Therapy in the Neonatal and Small Infant Year Book Medical Publishers; 1985:116-130.

Gentile R, Stevenson G, Dooley T, Franklin D, Kawabori I, Pearlman A. Pulsed Doppler echocardiographic determination of time of ductal closure in normal newborn infants. J Pediatr. 1981;98:443-8.

Aranda JV, Thomas R. Systematic review: intravenous ibuprofen in preterm newborns. Semin Perinatol. 2006;30:114-20.

Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfield CR. Prevalence of spontaneous closure of the ductus arteriosus in the neonates at a birth weight of 1000 grams or less. Pediatr. 2006;4:1113-21.

Thomas RL, Parker GC, Van Overmeire B, Aranda JV. A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr. 2005;164:135-40.

Clyman RI. Ibuprofen and patent ductus arteriosus. N Engl J Med. 2000;343:728-9.

Koehne PS, Helfenstein D, Pees C, Walch E, Obladen M. Neurodevelopmental outcome of very low birth weight infants after intervention for patent ductus arteriosus with cyclooxygenase inhibitors. EPAS. 2007;615911:14.

Ment LR, Vohr B, Allen W, Westerveld M, Sparrow SS, Schneider KC, et al. Outcome of children in the indomethacin intraventricular hemorrhage prevention trial. Pediatrics. 2000;105:485-91.

Ment LR, Vohr BR, Makuch RW, Westerveld M, Katz KH, Schneider KC, et al. Prevention of intraventricular hemorrhage by indomethacin in male preterm infants. J Pediatr. 2004;145:832-4.

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Published

2018-07-23

How to Cite

Mallick, B., Nayak, S. R., & Tripathy, S. K. (2018). The study of clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA. International Journal of Basic & Clinical Pharmacology, 7(8), 1593–1598. https://doi.org/10.18203/2319-2003.ijbcp20183029

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Original Research Articles