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Low Ductal Peak Flow Velocity Prior to Pharmacological Patent Ductus Arteriosus Treatment Predicts Treatment Failure in Extremely Preterm Infants
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: 0000-0001-8382-8687
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2010 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

BACKGROUND

Patent ductus arteriosus (PDA) is frequent in preterm infants and associated with increased mortality and morbidity. Low gestational ages (GA), sepsis and lack of prenatal steroid exposure are previously identified predictors of pharmacological PDA treatment failure.

OBJECTIVE

To identify early factors affecting ductal closure during pharmacological treatment in extremely preterm infants, with special focus on pulmonary circulation.

DESIGN/METHODS

Newborn infants, born at 22-27 gestational weeks between January 2006 and December 2008 at Uppsala University Children's Hospital and pharmacologically treated for PDA, were retrospectively identified (Figure 1). Medical charts were assessed for the first day of life, for the days of echocardiographic examination and for the days of treatment. Perinatal factors, vital parameters, ventilatory settings, treatments, fluid intake, complications and outcomes were registered and pre-treatment echocardiography was reviewed. Follow-up echocardiography defined successful or failed ductal closure. 

RESULTS

Thirty-two infants were identified (Figure 1). Prophylactic treatment was initiated 3 days after birth (range 1-8) in both groups (P=0.952) with one single course of 3-5 doses indomethacin (n=28) or ibuprofen (n=3).

Infants who failed closure had lower GA (23+6 weeks vs. 25+6 weeks, P=0.048), higher median heart rate during first day of life (155 bpm vs. 145 bpm, P=0.027), were on ventilator 

20%, P=0.004), and required longer total time of ventilatory support during hospital stay (28 days vs. 4 days, P=0.013). Other perinatal factors, vital parameters, treatments and fluid intake and incidences of BPD, IVH, NEC and ROP were similar between groups.

Pre-treatment echocardiography revealed lower left to right ductal peak flow velocity in infants that failed closure (P=0.009, Figure 2). When adjusted for ductal diameter, low peak flow velocity was still associated with pharmacological treatment failure (P=0.017), indicating that higher pulmonary arterial pressure might oppose ductal constriction after birth (Figure 3). 

CONCLUSIONS

Low ductal peak flow velocity is an early predictor of pharmacological PDA treatment failure in extremely preterm infants, possibly reflecting the influence of pulmonary arterial pressure on ductus constriction. 

Place, publisher, year, edition, pages
2010. 2845.225
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-216814OAI: oai:DiVA.org:uu-216814DiVA: diva2:690957
Conference
Pediatric Academic Societies annual meeting (PAS), 1-4 maj, Vancouver, Kanada
Available from: 2014-01-26 Created: 2014-01-26 Last updated: 2017-03-23

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Olsson, Karl Wilhelm

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