The effect of antenatal magnesium sulphate administration on patent ductus arteriozus in very low birth weight preterms

Abstract

Background: The prevalence of patent ductus arteriosus (PDA) is inversely proportional to gestational age and birth weight, and may lead to many premature morbidities and mortality. There are contradictory results regarding the fact that magnesium sulphate (MgSO4), that is used as tocolytic in premature labor, increases the frequency of PDA. In our study, we aimed to determine the effect of antenatal MgSO4 application on haemodynamically significant PDA (hsPDA) in very low birth weight (VLBW; <1500g) premature infants.

Methods: We retrospectively evaluated the medical records of VLBW preterm infants with very low birth weight (VLBW; <1500g) between January 2013 and December 2016.The demographic and clinical characteristics of the infants were recorded. The preterms included in the study were divided into two groups as with hsPDA and without hsPDA. Demographic, clinical features and MgSO4 administration were compared between two groups.

Results: A total of 602 VLBW infans were included. 257 (42.7%) infants had hsPDA, and 11 (1.8%) infants with hsPDA had PDA ligation due to being unresponsive to medical treatment. The rate of administration of antenatal MgSO4 in the hsPDA group was 61.8% (n = 159), and the rate of antenatal MgSO4 administration in the non-hsPDA group was found to be statistically significant (31.6%) (n = 109) (p <0.001).

Conclusions: In our study, the rate of antenatal MgSO4 administration and premature morbidities were found to be higher in the hsPDA group than infants without hsPDA.

 

Keywords: Hemodynamically significant patent ductus arteriosus, premature, very low birth weight, magnesium sulfate

Keywords

• Hemodynamically significant patent ductus arteriosus,premature,very low birth weight,magnesium sulfate

Çok düşük doğum ağırlıklı prematürelerde antenatal magnezyum sülfat kullanımının patent duktus arteriozusa etkisi

Abstract

Amaç: Patent duktus arteriozus (PDA) sıklığı, gebelik haftası ve doğum ağırlığıyla ters orantılıdır ve birçok prematüre morbiditesine ve mortalitesine neden olabilir. Erken eyleminde tokolitik olarak kullanılan magnezyum sülfatın (MgSO4) PDA sıklığını artırdığıyla ilgili çelişkili sonuçlar vardır. Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA; <1500g) prematürelerde antenatal MgSO4 uygulanmasının hemodinamik anlamlı PDA’nın (haPDA) üzerine etkisini belirlenmesi amaçlanmıştır.

Materyal ve metod: Çalışmamızda Ocak 2013 ile Aralık 2016 tarihleri arasında ünitemizde izlenen, ÇDDA bebekler retrospektif olarak incelendi. Bebeklerin demografik ve klinik özellikleri kayıt edildi. Çalışmaya dahil edilen prematürelerin haPDA’sı olan ve olmayanlar olarak iki gruba ayrılarak, demografik, klinik özellikleri ve MgSO4 uygulanması açından karşılaştırıldı.

Bulgular: Toplam 602 ÇDDA bebeğin dahil edildiği çalışmamızda, 257 bebekte (%42,7) haPDA saptandı ve 11 bebeğe (%1,8) PDA ligasyonu uygulandı. Hemodinamik anlamlı PDA grubunda antenatal MgSO4 uygulanma oranı %61,8 (n=159), haPDA olmayan gruptaki antenatal MgSO4 uygulanma oranına %31,6 (n=109) göre istatistiksel olarak anlamlı yüksek olarak tespit edildi (p<0,001).

Sonuç: Çalışmamızda ÇDDA’lı bebeklerde haPDA grubunda antenatal MgSO4 kullanım oranı ve prematüre morbiditeleri daha yüksek olarak bulundu.  

 

Anahtar kelimeler: Hemodinamik anlamlı patent duktus arteriozus, prematüre, çok düşük doğum ağırlığı, magnezyum sülfat

Keywords

• Hemodinamik anlamlı patent duktus arteriozus,prematüre,çok düşük doğum ağırlığı,magnezyum sülfat

References

1. Referans 1 Prescott S, Keim-Malpass J. Patent Ductus Arteriosus in the Preterm Infant: Diagnostic and Treatment Options. Adv Neonatal Care. 2017; 17(1):10-18.
2. Referans 2 Bhat R, Das UG. Management of patent ductus arteriosus in premature infants. Indian J Pediatr. 2015; 82(1):53-60.
3. Referans 3 Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010; 125(5):1020-30.
4. Referans 4 Halil H, Tayman C, Cakır U, Buyuktiryaki M, Serkant U, Oğuz SS. Serum Endocan Level as a Predictive Marker for Hemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight İnfants. Am J Perinatol. 2017; 34(13):1312-1317.
5. Referans 5 Oncel MY, Erdeve O. Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus. World J Clin Pediatr. 2016; 5(1):75-81.
6. Referans 6 del moral T, Gonzalez-Quintero VH, Claure N, Vanbuskirk S, Bancalari E. Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants. J Perinatol. 2007; 27(3):154-7.
7. Referans 7 Katayama Y, Minami H, Enomoto M, Takano T, Hayashi S, Lee YK. Antenatal magnesium sulfate and the postnatal response of the ductus arteriosus to indomethacin in extremely preterm neonates. J Perinatol. 2011; 31(1):21-4.
8. Referans 8 Basu SK, Chickajajur V, Lopez V, Bhutada A, Pagala M, Rastogi S. Immediate clinical outcomes in preterm neonates receiving antenatal magnesium for neuroprotection. J Perinat Med. 2011; 40(2):185-9.

9. Referans 9 Elimian A, Verma R, Ogburn P, Wiencek V, Spitzer A, Quirk JG. Magnesium sulfate and neonatal outcomes of preterm neonates. J Matern Fetal Neonatal Med. 2002; 12(2):118-22.
10. Referans 10 Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et all. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med. 2008; 359(9):895-905.
11. Referans 11 Garg BD. Antenatal magnesium sulfate is beneficial or harmful in very preterm and extremely preterm neonates: a new insight. J Matern Fetal Neonatal Med. 2018: 1-7.
12. Referans 12 Huusom LD, Wolf HT. Antenatal magnesium sulfate treatment for women at risk of preterm birth is safe and might decrease the risk of cerebral palsy. BMJ Evid Based Med. 2018; 23(5):195-196.
13. Referans 13 Chollat C, Sentilhes L, Marret S. Fetal Neuroprotection by Magnesium Sulfate: From Translational Research to Clinical Application. Front Neurol. 2018; 9:247.
14. Referans 14 Diguisto C, Foix L'Helias L, Morgan AS, Ancel PY, Kayem G, Kaminski M, et all. Neonatal Outcomes in Extremely Preterm Newborns Admitted to Intensive Care after No Active Antenatal Management: A Population-Based Cohort Study. J Pediatr. 2018; pii: S0022-3476(18)31049-7.
15. Referans 15 Chollat C, Sentilhes L, Marret S. Protection of brain development by antenatal magnesium sulphate for infants born preterm. Dev Med Child Neurol. 2018; doi: 10.1111/dmcn.14038.
16. Referans 16 Dargaville PA, Gerber A, Johansson S, De Paoli AG, Kamlin CO, Orsini F, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics. 2016; 138(1). pii: e20153985.
17. Referans 17 Leal YA, Álvarez-Nemegyei J, Lavadores-May AI, Girón-Carrillo JL, Cedillo-Rivera R, Velazquez JR. Cytokine profile as diagnostic and prognostic factor in neonatal sepsis. J Matern Fetal Neonatal Med 2018; 1-7. doi: 10.1080/14767058.2018.
18. Referans 18 Walsh MC, Wilson-Costello D, Zadell A, Newman N, Fanaroff A. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol. 2003; 23(6):451-6.Referans 19 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005; 123(7):991-999.
19. Referans 20 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92(4):529-34.
20. Referans 21 Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et all. Neonatal necrotizing enterocolitis. Therapeutic decision based upon clinical staging. An Surg. 1978; 187(1):1-7.
21. Referans 22 Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS, et all. Oral paracetamol versus oral ibuprofen in the management of patent ductus arteriosus in preterm infants: a randomized controlled trial. J Pediatr. 2014; 164(3):510-4.e1.
22. Referans 23 Moore P, Brook MM. Patent Ductus Arteriosus and aorticopulmonary window. İç: Moss and Adams’ Heart Disease. Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Wolters Kluwer- Lipincott Williams& Wilkins, Philadelphia, ABD, 8. eds, 2013:722- 745.
23. Referans 24 Köksal N, Aygün C, Uras N. Türk Neonatoloji Derneği. Prematüre Bebekte Patent Duktus Arteriosus’a Yaklaşim Rehberi 2016.
24. Referans 25 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventingmortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010; (7):CD000174.
25. Referans 26 Philips JB, Garcia-Pratz JA, Fulton DR, Kim MS. http://www.uptodate.com/contents/ management of patent ductus arteriosus in preterm infants.
26. Referans 27 Vick GW, Satterwhite C, Cassady G, Philips J, Yester MV, Logic JR. Radionuclide angiography in the evaluation of ductal shunts in preterm infants. J Pediatr. 1982; 101(2):264-8.
27. Referans 28 Clyman RI, Ballard PL, Sniderman S. Prenatal administration of betamethasone for prevention of patient ductus arteriosus. J Pediatr. 1981; 98(1):123-6.
28. Referans 29 Klauser CK, Briery CM, Keiser SD, Martin RW, Kosek MA, Morrison JC. Effect of antenatal tocolysis on neonatal outcomes. J Matern Fetal Neonatal Med. 2012; 25(12): 2778-81.
29. Referans 30 Edwards JM, Edwards LE, Swamy GK, Grotegut CA. Effect of Cord Blood Magnesium Level at Birth on Non-neurologic Neonatal Outcomes. Am J Perinatol. 2018 Feb 12. doi: 10.1055/s-0038-1627097.