Newborn

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  3 (2024)
Volume  2 (2023)
Volume  1 (2022)
Related articles

VOLUME 1 , ISSUE 4 ( October-December, 2022 ) > List of Articles

ORIGINAL RESEARCH

Efficacy of Pharmacologic Therapy for Patent Ductus Arteriosus Closure in Preterm Small for Gestational Age Infants

Ankur Srivastava, Sharandeep Kaur, Majeeda Kamaluddeen, Prashanth Murthy, Amelie Stritzke, Essa Al Awad, Sumesh Thomas, Khorshid Mohammad, Amuchou Soraisham

Keywords : Ibuprofen, Indomethacin, Intrauterine growth restriction, Patent ductus arteriosus, Prematurity

Citation Information : Srivastava A, Kaur S, Kamaluddeen M, Murthy P, Stritzke A, Al Awad E, Thomas S, Mohammad K, Soraisham A. Efficacy of Pharmacologic Therapy for Patent Ductus Arteriosus Closure in Preterm Small for Gestational Age Infants. 2022; 1 (4):327-332.

DOI: 10.5005/jp-journals-11002-0048

License: CC BY-NC 4.0

Published Online: 23-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Objective: To determine the association between the degree of intrauterine growth restriction (IUGR) [defined by birth weight (BW) Z-score] and the efficacy of pharmacologic patent ductus arteriosus (PDA) closure and the rate of surgical PDA ligation in preterm neonates. Materials and methods: In this retrospective cohort study, we included neonates born below 30 weeks’ gestational age (GA), who received medical treatment for PDA between January 2010 and December 2018. Birth weight Z-scores were calculated using Olsen nomograms and classified into three categories: above −0.5; from −0.5 to −2.0; below−2. We compared responses to PDA treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and PDA ligations between these groups utilizing multivariable logistic regression analysis. Results: Of 769 neonates with PDA, 517 (67.2%) neonates received medical treatment for PDA. Of which, 323 (62.5%) had BW Z-score above −0.5, 154 (29.8%) had from −0.5 to −2.0., and 40 (7.7%) had below −2. The efficacy of the first course of NSAIDs for the PDA closure was not different among the three groups (51% vs 49% vs 50%). Multivariable logistic regression analysis showed there was no significant difference in PDA closure rate following the first course of NSAIDs between neonates with BW Z-score below −2 and those with BW Z-score above −0.5 [adjusted odds ratio (aOR): 0.68; 95% CI: 0.33–1.39] as well as those with BW Z-score from −0.5 to −2.0 (aOR: 0.89; 95% CI: 0.59–1.35). However, the odds of PDA ligation were significantly higher among neonates with BW Z-scores below −2 (aOR: 2.67, 95% CI: 1.12–6.34) but not among neonates with Z-scores from −0.5 to −2.0 (aOR: 1.41; 95% CI: 0.84–2.39), as compared to those with BW Z-scores above –0.5. Conclusion: We observed a similar rate of PDA closure following the first course of NSAIDs between appropriately grown and growth-restricted neonates. However, severe growth restriction (BW Z-score below −2) is associated with higher rates of PDA ligation as compared to normally grown infants.

HTML PDF Share
  1. Benitz WE; Committee on Fetus and Newborn, American Academy of Pediatrics. Patent Ductus Arteriosus in preterm infants. Pediatrics 2016;137(1):10.1542. DOI: 10.1542/peds.2015-3730.
  2. Cotton RB, Stahlman MT, Kovar I, et al. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978;92(3):467–473. DOI: 10.1016/s0022-3476(78)80451-x.
  3. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants. Cochrane Database Syst Rev 2018;4(4):CD010061. DOI: 10.1002/14651858.CD010061.pub3.
  4. Jain A, Shah PS. Diagnosis, evaluation, and management of Patent Ductus Arteriosus in preterm neonates. JAMA Pediatr 2015; 169(9):863–872. DOI: 10.1001/jamapediatrics.2015.0987.
  5. Lokku A, Mirea L, Lee SK, et al. Trends and outcomes of Patent Ductus Arteriosus treatment in very preterm infants in Canada. Am J Perinatol 2017;34(5):441–450. DOI: 10.1055/s-0036-1593351.
  6. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003;3:13. DOI: 10.1186/1471-2431-3-13.
  7. Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004;191(2):481–487. DOI: 10.1016/j.ajog.2004.01.036.
  8. Rakza T, Magnenant E, Klosowski S, et al. Early hemodynamic consequences of patent ductus arteriosus in preterm infants with intrauterine growth restriction. J Pediatr 2007;151(6):624–628. DOI: 10.1016/j.jpeds.2007.04.058.
  9. Robel-Tillig E, Knupfer M, Vogtmann C. Cardiac adaptation in small for gestational age neonates after prenatal hemodynamic disturbances. Early Hum. Dev 2003;72(2):123–129. DOI: 10.1016/s0378-3782(03)00045-8.
  10. Heymann MA. Prostaglandins and leukotrienes in the perinatal period. Clin Perinatol 1987;14(4):857–880. PMID: 2827932.
  11. Madeleneau D, Aubelle M.S, Pierron C, et al. Efficacy of a first course of ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight. PLoS One 2015;10(4):e0124804. DOI: 10.1371/journal.pone.0124804.
  12. Boghossian NS, Do BT, Bell EF, et al. Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants. Early Hum Dev 2017;113:10–17. DOI: 10.1016/j.earlhumdev.2017.07.011.
  13. Sehgal A, McNamara PJ. Does echocardiography facilitate the determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr 2009;168(8):907–914. DOI: 10.1007/s00431-009-0983-3.
  14. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 1978;187(1):1–7. DOI: 10.1097/00000658-197801000-00001.
  15. Mohammad K, Scott JN, Leijser LM, et al. Consensus approach for standardizing the screening and classification of preterm brain injury diagnosed with cranial ultrasound: A Canadian perspective. Front Pediatr 2021;9; 618236. DOI: 10.3389/fped.2021.618236.
  16. Olsen IE, Groveman SA, Lawson ML, et al. New intrauterine growth curves based on United States data. Pediatrics 2010;125(2):e124–e124. DOI: 10.1542/peds.2009-0913.
  17. Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: A Delphi procedure. Ultrasound Obstet Gynecol 2016;48(3):333–339. DOI: 10.1002/uog.15884.
  18. Beune IM, Bloomfield FH, Ganzevoort W, et al. Consensus based definition of growth restriction in the newborn. J Pediatr 2018;196:71.e1–76.e1. DOI: 10.1016/j.jpeds.2017.12.059.
  19. Villamor-Martinez E, Kilani MA, Degraeuwe PL, et al. Intrauterine growth restriction and patent ductus arteriosus in very and extremely preterm infants: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2019;10:58. DOI: 10.3389/fendo.2019.00058.
  20. Guellec I, Lapillonne A, Renolleau S, et al. Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction. Pediatrics 2011;127(4):e883–e891. DOI: 10.1542/peds.2010-2442.
  21. Zeitlin J, El Ayoubi M, Jarreau PH, et al. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr 2010;157(5):733.e1–739.e1. DOI: 10.1016/j.jpeds.2010.05.002.
  22. Waleh N, Kajino H, Marrache AM, et al. Prostaglandin E2-mediated relaxation of the ductus arteriosus: Effects of gestational age on G-protein-coupled receptor expression, signalling, and vasomotor control. Circulation. 2004;110(16):2326–2332. DOI: 10.1161/01.CIR.0000145159.16637.5D.
  23. McElrath TF, Allred EN, Van Marter L, et al. ELGAN Study Investigators. Perinatal systemic inflammatory responses of growth-restricted preterm newborns. Acta Paediatr 2013;102(10):e439–e442. DOI: 10.1111/apa.12339.
  24. Jaillard S, Houfflin-Debarge V, Riou Y, et al. Effects of catecholamines on the pulmonary circulation in the ovine fetus. Am J Physiol Regul Integr Comp Physiol 2001;281(2):R607–R614. DOI: 10.1152/ajpregu.2001.281.2.R607.
  25. Magnenant E, Jaillard S, Deruelle P, et al. Role of the alpha2-adrenoceptors on the pulmonary circulation in the ovine fetus. Pediatr Res 2003;54:44–51. DOI: 10.1203/01.PDR.0000065726.43910.91.
  26. Deruelle P, Houfflin-Debarge V, Magnenant E, et al. Effects of antenatal glucocorticoids on pulmonary vascular reactivity in the ovine fetus. Am J Obstet Gynecol 2003;189(1):208–215. DOI: 10.1067/mob.2003.444.
  27. Goland RS, Jozak S, Warren WB, et al. Elevated levels of umbilical cord plasma corticotropin-releasing hormone in growth-retarded fetuses. J Clin Endocrinol Metab 1993;77(5):1174–1179. DOI: 10.1210/jcem.77.5.8077309.
  28. Ibara S, Tokunaga M, Ikenoue T, et al. Histologic observation of the ductus arteriosus in premature infants with intrauterine growth retardation. J Perinatol 1994;14(5):411–416. PMID: 7830159.
  29. Engbers AGJ, Flint RB, Völler S, et al. Enantiomer specific pharmacokinetics of ibuprofen in preterm neonates with patent ductus arteriosus. Br J Clin Pharmacol 2020;86(10):2028–2039. DOI: 10.1111/bcp.14298.
  30. Qiu X, Lodha A, Shah PS, et al. Neonatal outcomes of small for gestational age preterm infants in Canada. Am J Perinatol 2012;29(2):87–94. DOI: 10.1055/s-0031-1295647.
  31. Nobile S, Marchionni P, Carnielli. Neonatal outcome of small for gestational age preterm infants. Eur J Pediatr 2017;176(8):1083–1088. DOI: 10.1007/s00431-017-2957-1.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.