Carlo Dani1, Fabio Mosca2, Francesco Cresi3, Paola Lago4, Gianluca Lista5, Nicola Laforgia6, Antonello Del Vecchio7, Luigi Corvaglia8, Piermichele Paolillo9, Daniele Trevisanuto10, Letizia Capasso11, Vassilios Fanos12, Gianfranco Maffei13, Luca Boni14. 1. Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Italy. Electronic address: cdani@unifi.it. 2. NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 3. Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy. 4. NICU, Ca' Foncello Hospital, Treviso, Italy. 5. Division of Neonatology, "V. Buzzi" Children's Hospital - ASST FBF/Sacco, Milan, Italy. 6. Neonatal Intensive Care Unit, University Aldo Moro of Bari, Bari, Italy. 7. Neonatal Intensive Care Unit, Department of Women's and Children's Health, "Di Venere" Hospital of Bari, Bari, Italy. 8. Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 9. Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care, Casilino General Hospital, ASL RM B, Roma, Italy. 10. Department of Woman's and Child's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy. 11. Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università Federico II of Naples, Naples, Italy. 12. Neonatal Intensive Care Unit, Institute of Puericulture and Neonatal Section, Department of Surgery, University of Cagliari, Cagliari, Italy. 13. Neonatal Intensive Care Unit, University Hospital of Foggia, Foggia, Italy. 14. Clinical Trials Coordinating Center, Careggi University Hospital of Florence, Florence, Italy.
Abstract
BACKGROUND: Infants born at 23-24 weeks' gestation have the highest risk of developing a hemodynamically significant patent ductus arteriosus (hsPDA), that is refractory to pharmacological closure requiring surgical ligation. Thus, these patients might have the greatest benefits from hsPDA closure, although previous studies on PDA closure were not focused on this population. AIM: To compare the occurrence of hsPDA, failure rate of the first course of ibuprofen in closing hsPDA, and need of surgical closure in infants born at 23+0-24+6 weeks' gestation to those in infants born at 25+0-28+6 weeks' gestation. STUDY DESIGN: This is a retrospective multicenter study including infants born at 23+0-28+6 weeks of gestation admitted to the neonatal care units from January 2013 to December 2017. All infants underwent echocardiographical assessment for hsPDA diagnosis and eventually pharmacological treatment, and surgical closure. RESULTS: We studied a total of 842 infants of which 562 (67%) developed a PDA. Among those with PDA, 511 (91%) received a pharmacological treatment for a hsPDA. We found that a hsPDA occurred in 70% (106/151) of infants born at 23-24 weeks and in 59% (405/691) of infants born at 25-28 weeks of gestation (P < 0.001). Failure of closure with the first-treatment cycle (69 vs. 40%; P < 0.001) and need of surgical closure (19 vs 10%) were more frequent (P < 0.011) in infants born at 23-24 than 25-28 gestational weeks. Paracetamol vs. ibuprofen treatment and gestational age of 23-24 versus 25-28 weeks increased closure failure, while less severe RDS and maternal clinical chorioamnionitis decreased it. CONCLUSIONS: Among extremely preterm infants, infants born at 23-24 weeks of gestation have the highest risk of developing a hsPDA refractory to pharmacological treatment requiring surgical closure. Our findings support the need of individualized more careful strategies for hsPDA management in this special population.
BACKGROUND:Infants born at 23-24 weeks' gestation have the highest risk of developing a hemodynamically significant patent ductus arteriosus (hsPDA), that is refractory to pharmacological closure requiring surgical ligation. Thus, these patients might have the greatest benefits from hsPDA closure, although previous studies on PDA closure were not focused on this population. AIM: To compare the occurrence of hsPDA, failure rate of the first course of ibuprofen in closing hsPDA, and need of surgical closure in infants born at 23+0-24+6 weeks' gestation to those in infants born at 25+0-28+6 weeks' gestation. STUDY DESIGN: This is a retrospective multicenter study including infants born at 23+0-28+6 weeks of gestation admitted to the neonatal care units from January 2013 to December 2017. All infants underwent echocardiographical assessment for hsPDA diagnosis and eventually pharmacological treatment, and surgical closure. RESULTS: We studied a total of 842 infants of which 562 (67%) developed a PDA. Among those with PDA, 511 (91%) received a pharmacological treatment for a hsPDA. We found that a hsPDA occurred in 70% (106/151) of infants born at 23-24 weeks and in 59% (405/691) of infants born at 25-28 weeks of gestation (P < 0.001). Failure of closure with the first-treatment cycle (69 vs. 40%; P < 0.001) and need of surgical closure (19 vs 10%) were more frequent (P < 0.011) in infants born at 23-24 than 25-28 gestational weeks. Paracetamol vs. ibuprofen treatment and gestational age of 23-24 versus 25-28 weeks increased closure failure, while less severe RDS and maternal clinical chorioamnionitis decreased it. CONCLUSIONS: Among extremely preterm infants, infants born at 23-24 weeks of gestation have the highest risk of developing a hsPDA refractory to pharmacological treatment requiring surgical closure. Our findings support the need of individualized more careful strategies for hsPDA management in this special population.
Authors: David J McCulley; Erik A Jensen; Jennifer M S Sucre; Sarah McKenna; Laura G Sherlock; Evgenia Dobrinskikh; Clyde J Wright Journal: Am J Physiol Lung Cell Mol Physiol Date: 2022-05-03 Impact factor: 6.011
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