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Çok düşük doğum ağırlıklı yenidoğanlarda patent duktus arteriozus sıklığı ve klinik sonuçlara etkisi: üçüncü düzey bir merkezin verileri

Year 2018, Volume: 15 Issue: 3, 129 - 133, 12.12.2018

Abstract

Amaç: Patent duktus arteriozus (PDA) sıklığı, gebelik haftası ve doğum ağırlığıyla ters orantılıdır. Patent duktus arteriozus sıklığı, <1000 gr bebeklerde; %40-55, <1500 gr bebeklerde: %30 olarak belirtilmektedir. Patent duktus arteriozus, bronkopulmoner displazi (BPD), nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), intraventriküler kanama (İVK) ve uzun dönem olumsuz nörogelişimsel sonuçlar ile ilişkili olup, 3 farklı tedavi yaklaşımı (konservatif tedavi, siklooksijenaz (COX) inhibitörleri, cerrahi tedavi) vardır. Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA; <1500g) prematüre bebeklerde hemodinamik anlamlı PDA’nın sıklığının belirlenmesi ve bu bebeklerde demografik ve klinik özelliklerin belirlenmesi amaçlanmıştır.

Materyal ve Metod: Çalışmamızda Ocak 2013 ile Aralık 2016 tarihleri arasında ünitemizde izlenen, gebelik yaşı <30 hafta olan ÇDDA bebeklerin tıbbi kayıtları retrospektif olarak incelendi. Bebeklerin demografik ve klinik özellikleri kayıt edildi. Çalışmaya dahil edilen bebekler patent duktus arteriozusu olan ve olmayanlar olarak iki gruba ayrılarak, demografik ve klinik özellikleri açısından karşılaştırıldı. Major konjenital anomalisi olanlar ve ilk ekokardiyografik değerlendirme öncesi kaybedilen hastalar çalışma dışı bırakıldı.

Bulgular: Toplam 602 ÇDDA bebeğin dahil edildiği çalışmamızda, 257 bebekte (%42,7) hemodinamik anlamlı PDA (haPDA) saptandı ve 11 bebeğe (%1,8) PDA ligasyonu uygulandı. Patent duktus arteriozusu olanlarda gebelik yaşı ve doğum ağırlığı anlamlı olarak düşük; RDS, geç neonatal sepsis, ROP, İVK (evre ≥3), orta-ağır BPD oranları anlamlı olarak yüksek; invaziv ve non-invaziv solunum desteği ile ek oksijen gereksinim süresi, tam enteral beslenmeye geçiş zamanı ve hastanede kalış süresi anlamlı olarak daha uzun olduğu saptandı (p< 0,05).

Sonuç: Çalışmamızda ÇDDA’lı bebeklerde hemodinamik anlamlı PDA oranı %42,7 olarak bulundu. Üniteler arasında farklı klinik yaklaşımlardan dolayı haPDA oranları değişmektedir.

References

  • 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.
  • Referans 2 Bhat R, Das UG. Management of patent ductus arteriosus in premature infants. Indian J Pediatr 2015;82(1):53-60.
  • Referans 3 Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010;125(5):1020-30.
  • Referans 4 Weisz DE, McNamara PJ. Patent ductus arteriosus ligation and adverse outcomes: causality or bias? J Clin Neonatol 2014;3(2):67-75.
  • 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.
  • Referans 6 Dargaville PA, Gerber A, Johansson S, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics 2016;138(1). pii: e20153985.
  • Referans 7 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.
  • Referans 8 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 9 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123(7):991-999.Referans 10 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.
  • Referans 11 Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decision based upon clinical staging. An Surg 1978;187(1):1-7.
  • Referans 12 Katakam LI, Cotten CM, Goldberg RN, Dang CN, Smith PB. Safety and effectiveness of indomethacin versus ibuprofen for treat-ment of patent ductus arteriosus. Am J Perinatol 2010;27(5):425-9.
  • Referans 13 Linder N, Bello R, Hernandez A, et al. Treatment of patent ductus arteriosus: indomethacin or ibuprofen? Am J Perinatol 2010;2 (5):399-404.
  • Referans 14 Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS, Canpolat FE, Dilmen U. 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.
  • Referans 15 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. baskı, 2013, pp.722- 745.
  • Referans 16 Köksal N, Aygün C, Uras N. Türk Neonatoloji Derneği. Prematüre Bebekte Patent Duktus Arteriosus’a Yaklaşim Rehberi 2016.
  • Referans 17 Philips JB, Garcia-Pratz JA, Fulton DR, Kim MS. http://www.uptodate.com/contents/ management of patent ductus arteriosus in preterm infants.
  • Referans 18 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.
  • Referans 19 Clyman RI, Ballard PL, Sniderman S. Prenatal administration of betamethasone for prevention of patient ductus arteriosus. J Pediatr 1981;98(1):123-6.
  • Referans 20 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventingmortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010;(7):CD000174.
  • Referans 21 Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL; Trial of Indomethacin Prophylaxis in Preterms Investigators. Long- term effects of indomethacin prophylaxis in extremely low birth weight infants. N Engl J Med 2001;344(26):1966-72.
  • Referans 22 Sun Y, Hellström A, Smith Lois E.H. Retinopathy of prematurity. Fanaroff and Martin’s Neonatal Perinatal Medicine- Diseases of the Fetus and Newborn, 10th ed. Martin RJ, Fanaroff AA, Walsh MC (eds): Saunders Elsevier, 2015;1767-74.
  • Referans 23 Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, Sekar K. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009;123(1):e138-44.
  • Referans 24 Chock VY, Punn R, Oza A, Benitz WE, Van Meurs KP, Whittemore AS, Behzadian F, Silverman NH. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus. Pediatr Res 2014;75(4):570-5.
  • Referans 25 Sangem M, Asthana S, Amin S. Multiple courses of indomethacin and neonatal outcomes in premature infants. Pediatr Cardiol 2008;29(5):878-84.

The incidence of patent ductus arteriosus (PDA) in very low birth weight infants and its impact on clinical outcomes: data from a third level center

Year 2018, Volume: 15 Issue: 3, 129 - 133, 12.12.2018

Abstract

Background: Bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and long term negative neurodevelopmental outcomes. are associated with PDA. The aim of this study was to determine the frequency of hemodynamically significant (hs) PDA and the demographic and clinical characteristics of very low birth weight (VLBW) premature infants.

Material and Methods: We retrospectively evaluated the medical records of VLBW preterm infants with a gestational age <30 weeks between January 2013 and December 2016. Infants with major congenital anomalies and those who were death before the first echocardiographic evaluation were excluded from the study. Eligible infants were divided into two groups, including group I: with hsPDA and group II: without hsPDA. Demographic and clinical characteristics of infants were recorded and compared between the 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. Gestational age and birth weight were significantly lower in infants with hsPDA. RDS, late neonatal sepsis, ROP, IVH (grade ≥3), moderate-severe BPD rates were significantly higher; invasive and non-invasive respiratory support, duration of additional oxygen requirement, time to complete enteral feeding, and duration of hospital stay were significantly longer in infants with hs PDA (p <0.05).

Conclusion: In our study, the rate of hsPDA was found to be 42.7% in VLBW infants. The rates of hsPDA can vary due to different clinical approaches among the units. Although, it is clearly associated with long and short-term morbidities, proper interventions in time should be aimed at minimizing morbidities.

References

  • 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.
  • Referans 2 Bhat R, Das UG. Management of patent ductus arteriosus in premature infants. Indian J Pediatr 2015;82(1):53-60.
  • Referans 3 Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010;125(5):1020-30.
  • Referans 4 Weisz DE, McNamara PJ. Patent ductus arteriosus ligation and adverse outcomes: causality or bias? J Clin Neonatol 2014;3(2):67-75.
  • 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.
  • Referans 6 Dargaville PA, Gerber A, Johansson S, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics 2016;138(1). pii: e20153985.
  • Referans 7 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.
  • Referans 8 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 9 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123(7):991-999.Referans 10 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.
  • Referans 11 Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decision based upon clinical staging. An Surg 1978;187(1):1-7.
  • Referans 12 Katakam LI, Cotten CM, Goldberg RN, Dang CN, Smith PB. Safety and effectiveness of indomethacin versus ibuprofen for treat-ment of patent ductus arteriosus. Am J Perinatol 2010;27(5):425-9.
  • Referans 13 Linder N, Bello R, Hernandez A, et al. Treatment of patent ductus arteriosus: indomethacin or ibuprofen? Am J Perinatol 2010;2 (5):399-404.
  • Referans 14 Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS, Canpolat FE, Dilmen U. 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.
  • Referans 15 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. baskı, 2013, pp.722- 745.
  • Referans 16 Köksal N, Aygün C, Uras N. Türk Neonatoloji Derneği. Prematüre Bebekte Patent Duktus Arteriosus’a Yaklaşim Rehberi 2016.
  • Referans 17 Philips JB, Garcia-Pratz JA, Fulton DR, Kim MS. http://www.uptodate.com/contents/ management of patent ductus arteriosus in preterm infants.
  • Referans 18 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.
  • Referans 19 Clyman RI, Ballard PL, Sniderman S. Prenatal administration of betamethasone for prevention of patient ductus arteriosus. J Pediatr 1981;98(1):123-6.
  • Referans 20 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventingmortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010;(7):CD000174.
  • Referans 21 Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL; Trial of Indomethacin Prophylaxis in Preterms Investigators. Long- term effects of indomethacin prophylaxis in extremely low birth weight infants. N Engl J Med 2001;344(26):1966-72.
  • Referans 22 Sun Y, Hellström A, Smith Lois E.H. Retinopathy of prematurity. Fanaroff and Martin’s Neonatal Perinatal Medicine- Diseases of the Fetus and Newborn, 10th ed. Martin RJ, Fanaroff AA, Walsh MC (eds): Saunders Elsevier, 2015;1767-74.
  • Referans 23 Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, Sekar K. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009;123(1):e138-44.
  • Referans 24 Chock VY, Punn R, Oza A, Benitz WE, Van Meurs KP, Whittemore AS, Behzadian F, Silverman NH. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus. Pediatr Res 2014;75(4):570-5.
  • Referans 25 Sangem M, Asthana S, Amin S. Multiple courses of indomethacin and neonatal outcomes in premature infants. Pediatr Cardiol 2008;29(5):878-84.
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Ufuk Çakır 0000-0002-9409-185X

Cüneyt Tayman 0000-0002-1861-2262

Buse Özer Bekmez This is me 0000-0002-0397-1369

Mehmet Büyüktiryaki 0000-0001-8937-4671

Publication Date December 12, 2018
Submission Date August 15, 2018
Acceptance Date October 25, 2018
Published in Issue Year 2018 Volume: 15 Issue: 3

Cite

Vancouver Çakır U, Tayman C, Özer Bekmez B, Büyüktiryaki M. Çok düşük doğum ağırlıklı yenidoğanlarda patent duktus arteriozus sıklığı ve klinik sonuçlara etkisi: üçüncü düzey bir merkezin verileri. Harran Üniversitesi Tıp Fakültesi Dergisi. 2018;15(3):129-33.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty