Trombocitopenia severa inducida por un oclusor para DAP: reporte de caso en tecnovigilancia

Introducción: El ductus arterioso persistente (DAP) es una cardiopatía congénita de especial interés. La oclusión intervencionista es el tratamiento de elección, no obstante, el dispositivo médico "oclusor para DAP", usado en este procedimiento, puede dar lugar a la aparición de eventos adversos de rara frecuencia como hemorragia, trombocitopenia, entre otros. Reporte de caso: Se presenta un caso de una paciente pediátrica con trombocitopenia severa posterior a la intervención. Durante su hospitalización, la paciente mantuvo niveles bajos de plaquetas hasta que logra su recuperación y sale de alta sin una nueva manifestación hematológica. El caso fue reportado como sospecha de incidente adverso asociada al oclusor para DAP. Conclusión: Al realizarse el análisis causa-raíz, se concluye que el tamaño del oclusor para DAP podría ser la principal causa de la trombocitopenia. El presente caso es una muestra que los dispositivos médicos pueden causar eventos adversos severos, por lo que, es necesaria la implementación de tecnovigilancia, principalmente a los dispositivos médicos de alto riesgo.

Introduction: Patent ductus arteriosus (PDA) is a congenital heart condition of special interest. Interventional occlusion is the treatment of choice; however, a PDA occlude, used in this procedure, is a medical device that rarely could lead to adverse events such as hemorrhage, thrombocytopenia, etc. Case report: We present a case of a pediatric patient with severe thrombocytopenia after surgery. During her hospitalization, platelet levels remained lower and, finally, she was fully recovered without any hematological manifestation. The case was reported as a suspected adverse incident related to PDA occlude. Conclusion: After performing a cause-root analysis, we concluded that the size of the PDA occlude may be the main cause of thrombocytopenia. This case demonstrates that medical devices could lead to adverse events. Thus, it is important for clinicians to implement medical device surveillance, mainly for high-risk medical devices.

Clinical efficacy analysis of different interventional approaches for patent ductus arteriosus in children (≤7 years) / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

Effects of patent ductus arteriosus on bronchopulmonary dysplasia in very low birth weight preterm infants / 中国新生儿科杂志

Objective:To study the effects of patent ductus arteriosus (PDA) on bronchopulmonary dysplasia (BPD) in very low birth weight preterm infants (VLBWIs).Methods:From January 2018 to December 2020,VLBWIs hospitalized in NICU of our hospital were retrospectively analyzed.They were assigned into BPD group and non-BPD group according to whether BPD occurred. Clinical data including the severity of BPD , the diameter and duration of PDA and ibuprofen usage were analyzed. The predictive values of PDA diameter and duration for BPD were calculated using area under curve (AUC) of receiver operating characteristic curve (ROC) analysis.Results:A total of 173 VLBWIs were enrolled, including 42 in the BPD group and 131 in the non-BPD group. The incidence of hemodynamically significant PDA (hsPDA) in the BPD group was significantly higher than the non-BPD group (45.2% vs. 22.1%, P=0.001).hsPDA ( OR=2.806, 95% CI 1.307-5.745, P=0.005), PDA diameter ≥1.5 mm ( OR=7.003, 95% CI 1.323-48.884, P<0.001) and PDA duration >1 w ( OR=7.754, 95% CI 1.203-49.989, P=0.031) were all risk factors for BPD.As for the severity of BPD, hsPDA, PDA diameter ≥1.5 mm, PDA duration >1 w and FiO 2max >30% within 72 h after birth were risk factors for grade Ⅱ~Ⅲ BPD. The incidence of ibuprofen usage was significantly higher in grade Ⅱ~Ⅲ BPD group. If the diameter of PDA was 1.25 mm, the AUC was 0.806 (95% CI 0.706-0.906, P<0.001), sensitivity 82.6% and specificity 68.7% for grade Ⅱ~Ⅲ BPD. If the PDA duration was 10.5 d, the AUC was 0.821 (95% CI 0.718-0.925, P<0.001), sensitivity 65.2% and specificity 91.3%. Conclusions:hsPDA, larger PDA diameter and longer PDA duration are risk factors for the occurrence and severity of BPD in VLBWIs.

Risk factors for hemodynamically significant patent ductus arteriosus in preterm infants requiring surgical ligation: a nested case-control study / 中华实用儿科临床杂志

Objective:To analyze the risk factors for premature infants with hemodynamically significant patent ductus arteriosus (hs-PDA) requiring surgical treatment, and to explore the indications for surgical treatment in premature infants with hs-PDA.Methods:A nested case-control study was conducted.The data of premature infants with gestational age<30 weeks who were diagnosed with hs-PDA in the Neonatal Intensive Care Unit of Peking Union Medical College Hospital from January 2007 to May 2020 were analyzed retrospectively.The hs-PDA patients treated surgically were included in the operation group.The hs-PDA patients of the same gestational age and gender who were not treated surgically were taken as the control group.The ratio of the case number between the operation and control groups was 1∶2.The clinical data during pregnancy, at birth and after birth of premature infants were compared between the 2 groups.The measurement data were tested by the independent sample t test or Mann- Whitney U test.The classification and enumeration data were compared by the Fisher′ s exact probability method.The risk factors for premature infants with hs-PDA requiring surgical treatment were analyzed by the conditional Logistic regression method. Results:A total of 182 premature infants with hs-PDA were enrolled in the study, including 10 in the operation group and 20 in the control group.The patients underwent PDA ligation 30.5(22.7, 37.0) d after birth, and the median preo-perative invasive ventilation duration was 9.7(17.5, 27.2) d. Compared with the control group(20 cases), the preterm infants in the operation group had a lower birth weight [(891.5±118.0) g vs.(1 054.4±230.2) g, t=2.091], a wider arterial duct diameter [3.2(2.8, 4.0) mm vs.2.0(2.0, 3.0) mm, Z=-3.300], and longer invasive ventilation duration [25.0(18.7, 38.2) d vs.3.0(1.0, 7.5) d, Z=-3.688]. Besides, the operation group applied the pulmonary surfactant for more times [2(1, 3) times vs.1(1, 2) times, Z=-2.440], and inhaled a higher concentration of oxygen on the 14 th day after birth [29(25, 36)% vs.21(21, 29)%, Z=-2.358] than the control group.Moreover, compared with the control group, the operation group took longer to achieve adequate enteral feeding [48.2(51.5, 63.5) d vs.42.5(23.5, 48.0) d, Z=2.789], and gained a higher maximum vasoactive inotropic score (VIS) [3.0(0, 3.5) points vs.0(0, 0) points, Z=-2.630]. The difference in all the above-mentioned indicators between the 2 groups was statistically significant (all P<0.05). Univariate Logistic regression analysis showed that the arterial duct diameter, application times of the pulmonary surfactant, the maximum VIS score, and the time taken to achieve sufficient enteral feeding were all related to the need for surgical treatment of hs-PDA in the operation group (all P<0.05). Multivariate Logistic regression analysis revealed that the invasive ventilation duration ( OR=0.747, 95% CI: 0.560-0.998, P=0.048) was an independent risk factor for hs-PDA premature infants requiring surgical treatment. Conclusions:The factors related to the need for surgical treatment in preterm infants with hs-PDA include a wide arterial duct diameter, multiple applications of the pulmonary surfactant, a high concentration of inhaled oxygen on the 14 th day, and the long time to achieve sufficient enteral feeding.The independent risk factor for the surgical treatment in hs-PDA children is the long invasive ventilation duration.

Risk factors and complication of hemodynamically significant patent ductus arteriosus in preterm infants with gestational age <32 weeks / 国际儿科学杂志

Objective:To study the risk factors and complications of hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants <32 weeks.Methods:From January 2021 to March 2022, a total of 150 premature infants with gestational age <32 weeks admitted to the Neonatal Intensive Care Unit of Liaocheng People′s Hospital were enrolled.Nine patients who did not meet the requirements were excluded and a total of 141 infants were finally analyzed retrospectively, including PDA group with 95 cases and non-PDA group with 46 cases.According to whether hsPDA existed or not, PDA group were dirided into hsPDA group with 42 cases and non-hsPDA group with 53 cases.Univariate and regression analyses were used to determine the risk factors and complication of hsPDA.Results:Univariate analysis showed that gestational age( t=-6.861, P<0.01), birth weight( t=-4.392, P<0.01), mode of delivery( χ2=9.018, P<0.01), caffeine( χ2=4.337, P<0.05) and suffocation( χ2=7.918, P<0.01)were associated with hsPDA.Logistic regression analysis showed that gestational age( OR=2.435, P<0.01, 95% CI: 1.669~3.552)was an independent risk factor for hsPDA in gestational age <32 weeks preterm infants.The incidences of necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity in the hsPDA group were higher than those in the non-hsPDA group( P<0.05). Conclusion:Gestational age is an independent risk factor for hsPDA with gestational age <32 weeks.Necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity are related complications of hsPDA.

Conducto arterioso permeable: mecanismos moleculares del cierre y su relacion con el tratamiento

El conducto arterioso establece una conexión esencial entre la arteria aorta descendente proximal y la arteria pulmonar principal cerca del origen de la rama pulmonar izquierda, siendo vital durante la vida fetal y generalmente cerrándose poco después del nacimiento en la mayoría de los recién nacidos a término; no obstante, en recien nacidos pretermino, es común la persistencia del conducto arterioso debido a estímulos vasodilatadores que mantienen su permeabilidad y flujo sanguíneo constante, requiriendo enfoques de tratamiento que involucran la inhibición de la prostaglandina E2 y antiinflamatorios no esteroides, aunque la comparación de su eficacia con métodos conservadores sigue siendo poco clara, especialmente en recién nacidos prematuros extremos. La presente revisión tiene como objetivo proporcionar una comprensión de los mecanismos moleculares clave detrás de la fisiopatología del conducto arterioso persistente y su abordaje terapéutico.

The ductus arteriosus establishes an essential connection between the proximal descending aorta and the main pulmonary artery near the origin of he left pulmonary branch, being vital during fetal life and generally closing shortly after birth in most term newborns; However, in preterm infants, persistence of the ductus arteriosus is common due to vasodilator stimuli that maintain its patency and constant blood flow, requiring treatment approaches involving prostaglandin E2 inhibition and nonsteroidal anti-inflammatory drugs, although the comparison of their efficacy with conservative methods remains unclear, especially in extremely preterm infants. The present review aims to provide an understanding of the key molecular mechanisms behind the pathophysiology of patent ductus arteriosus and its therapeutic approach.

Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.@*METHODS@#A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants.@*RESULTS@#The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (P<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (P<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%CI: 0.802-0.944, P<0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%.@*CONCLUSIONS@#Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.

Tratamiento intervencionista de las cardiopatías congénitas con hiperflujo pulmonar / Interventional treatment of congenital heart defects with pulmonary hyperflow

Resumen Introducción: En los últimos años se han desarrollado diversos dispositivos oclusores que permiten evitar la cirugía cardíaca en los pacientes con cardiopatías congénitas con hiperflujo pulmonar. Objetivo: Describir la experiencia en el cierre percutáneo de las cardiopatías con hiperflujo. Método: Mediante un estudio descriptivo y retrospectivo se revisaron las historias clínicas de los pacientes sometidos a intervencionismo cardíaco de 2016 a 2020. Resultados: De 706 procedimientos realizados en el periodo, el 35% fueron terapéuticos. De ellos, 189 correspondieron a nuestra serie de pacientes intervenidos con diagnósticos de persistencia del conducto arterioso (PCA) (n = 164), comunicación interauricular (CIA) (n = 21) y comunicación interventricular (CIV) (n = 4). Los datos clínicos y demográficos fueron en PCA 3.4 años (0.7-15) y 10.2 kg (6.1-46), en CIA 7.2 años (6-15) y 17.5 kg (15-38), y en CIV 7.25 años (6-9) y 20.75 kg (16-27). Referente al tamaño de los defectos cardíacos, el promedio fue para PCA 4.3 mm, para CIA 19.1 mm y para CIV 6.75 mm. Los dispositivos más utilizados fueron Amplatzer PDA y ASD, y Occlutech PDA. La tasa de éxito fue adecuada: PCA 95%, CIA 90% y CIV 75%. Reportamos una baja incidencia de complicaciones y generalmente menores, como shunt residual y hemólisis. Conclusiones: El manejo intervencionista de las cardiopatías congénitas con hiperflujo pulmonar es cada vez más frecuente con la disponibilidad de oclusores en nuestro medio, así como por el desarrollo de nuevos centros y el mayor entrenamiento de cardiólogos intervencionistas, lo que ha permitido mejores tasas de éxito y menor índice de complicaciones.

Abstract Introduction: In recent years, various occlusive devices have been developed that make it possible to avoid cardiac surgery in patients with congenital heart disease with pulmonary hyperflow. Objective: To describe the experience in percutaneous closure in heart disease with hyperflow. Material and methods: Through a descriptive, retrospective study, the medical records of patients undergoing cardiac intervention were reviewed, from 2016 to 2020. Results: Of 706 procedures performed in this time, 35% corresponded to various therapeutic cases. Of these, 189 corresponded to our series of operated patients with diagnoses of PDA (n = 164), ASD (n = 21) and VSD (n = 4). The clinical and demographic data were: in PDA 3.4 years (0.7-15) and 10.2 kg (6.1-46), in ASD 7.2 years (6-15) and 17.5 kg (15-38), and in VSD 7.25 years (6-9) and 20.75 kg (16-27). Regarding the size of the heart defects, the average was 4.3 mm PDA, 19.1 mm ASD and 6.75 mm VSD. The most used occluding devices were Amplatzer PDA and ASD, and Occlutech PDA. The success rate was adequate, PDA 95%, ASD 90% and VSD 75%. We report a low incidence of complications and generally minor ones such as residual shunt and hemolysis. Conclusions: The interventional management of the congenital heart diseases with pulmonary hyperflow is increasingly frequent with the availability of occlusive as well as the development of new centers and more training of interventional cardiologists, which has allowed better success rates and lower complication rate.

Persistencia de conducto arterioso en adulto: a propósito de un caso / Persistence of the duct arteriosus in adults: a propos of a case

Congenital heart disease includes a wide range of heart defects that appear at birth, corresponding to the most frequent group of genetic alterations. They represent the most frequent birth defects in the world, affecting millions of newborns annually. Chile is not exempt from this public health problem, estimating a prevalence of 8-10 per 1,000 live births, similar to international figures. Some of these defects are not diagnosed in a timely manner due to various causes, including causes such as poor clinical translation and limited accessibility to the Public Health system. Thanks to the improvement of technological resources, more cases of congenital heart disease are diagnosed every day and the time of diagnosis is getting earlier. The case presented below refers to a 47-year-old male patient with several comorbidities, who underwent a Doppler echocardiogram during his hospitalization due to acute respiratory failure, where a systodiastolic flow was detected in one of the compatible pulmonary arteries, with a patent ductus arteriosus.

Post Ligation Cardiac Syndrome: an Educational Presentation

ABSTRACT Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be remembered, as its prompt diagnosis and proper management can change clinical outcomes.

Timing of surgical ligation of patent ductus arteriosus in very low birth weight infants / 中国当代儿科杂志

OBJECTIVES@#To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI).@*METHODS@#The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed.@*RESULTS@#A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups.@*CONCLUSIONS@#Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option.

Value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight infants / 中国当代儿科杂志

OBJECTIVES@#To study the value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight (VLBW) infants.@*METHODS@#A retrospective analysis was performed for 51 VLBW infants who were admitted from March 2020 to June 2021, with an age of ≤3 days and a length of hospital stay of ≥14 days. According to the diameter of patent ductus arteriosus (PDA) on days 14 and 28 after birth, the infants were divided into three groups: large PDA group (PDA diameter ≥2 mm), small PDA group (PDA diameter <2 mm), and PDA closure group (PDA diameter =0 mm). The echocardiographic parameters measured at 72 hours after birth were compared among the three groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the echocardiographic parameters in predicting persistent patency of the ductus arteriosus (PDA≥2 mm) at the ages of 14 and 28 days.@*RESULTS@#On day 14 after birth, there were 17 infants in the large PDA group, 11 in the small PDA group, and 23 in the PDA closure group. On day 28 after birth, there were 14 infants in the large PDA group, 9 in the small PDA group, and 26 in the PDA closure group. There were significant differences in gestational age, birth weight, rate of pulmonary surfactant use, and incidence rate of hypotension among the three groups (P<0.05). PDA diameter, end-diastolic velocity of the left pulmonary artery, left ventricular output, and left ventricular output/superior vena cava flow ratio measured at 72 hours after birth were associated with persistent patency of the ductus arteriosus at the ages of 14 and 28 days (P<0.05), and the ratio of the left atrium to aorta diameter was associated with persistent patency of the ductus arteriosus at the age of 28 days (P<0.05). The ROC curve analysis showed that the area under the curve that the PDA diameter measured at 72 hours after birth predicting the persistent patency of the ductus arteriosus at the ages of 14 and 28 days was the largest (0.841 and 0.927 respectively), followed by end-diastolic velocity of the left pulmonary artery, with the area under the curve of 0.793 and 0.833 respectively.@*CONCLUSIONS@#The indicators obtained by beside echocardiography at 72 hours after birth, especially PDA diameter and end-diastolic velocity of the left pulmonary artery, can predict persistent patency of the ductus arteriosus at the ages of 14 and 28 days in VLBW infants, which provides a basis for the implementation of early targeted treatment strategy for PDA.

A Rare Case of Cornelia de Lange Syndrome Achieving Intracardiac Repair of Tetralogy of Fallot Following Ectopic Patent Ductus Arteriosus Banding / 日本心臓血管外科学会雑誌

We describe the case of a 1-year and 7-month-old girl who was born at 36 weeks and 6 days of pregnancy weighing 1,351 g. In addition to the diagnosis of Cornelia de Lange syndrome and Tetralogy of Fallot, we confirmed shunt blood flow from the lesser curvature of the aortic arch to the main pulmonary artery. Thus, we additionally diagnosed ectopic patent ductus arteriosus (PDA). Ultrasonography showed interruption and retrograde flow of the diastolic blood flow in the anterior cerebral artery. Therefore, we made a diagnosis of blood stealing due to an ectopic PDA, and we performed surgical intervention via a median sternotomy at 25 days. When we ligated the shunt blood vessel, the percutaneous oxygen saturation decreased from the high 90% range to the low 70% range, thus we temporarily released the ligation. We narrowed the ectopic PDA so that the percutaneous oxygen saturation could be maintained the high 80% range. Postoperative ultrasonography showed improvement of the pressure waveform in the anterior cerebral artery. After discharge, oxygen demand increased gradually with weight gain, and we performed intracardiac repair using a monocusp valve patch at 1 year and 7 months. We report a rare case of Cornelia de Lange syndrome wherein we achieved intracardiac repair of Tetralogy of Fallot after ectopic PDA banding in the neonatal period.

Péptido natriurético cerebral tipo B como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el recién nacido prematuro / B-type brain natriuretic peptide as marker of hemodynamic overload of the patent ductus arteriosus in the preterm infant

Resumen Introducción: El ecocardiograma es el método de referencia para el diagnóstico del conducto arterioso permeable (CAP) hemodinámicamente significativo (CAP-hs) del recién nacido prematuro (RNP). El péptido natriurético tipo B (BNP) puede ser útil en el diagnóstico y el manejo del CAP-hs. Objetivo: Evaluar la utilidad del BNP como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el RNP con edad gestacional < 32 semanas o peso < 1500 gramos, e identificar el mejor punto de corte para los valores de BNP que mejor prediga un CAP con repercusión hemodinámica que requiera tratamiento farmacológico o quirúrgico. Método: Estudio retrospectivo, observacional y descriptivo de RNP < 32 semanas de gestación o peso < 1500 gramos en los que se realizó ecocardiograma y determinación del BNP. Análisis de muestra global y por subgrupos, en función del CAP-hs. Resultados: Se analizaron 29 pacientes. Se encontró una correlación significativa entre la relación CAP/peso y los valores del BNP (prueba de Spearman: 0.71; intervalo de confianza del 95%: 0.45-0.87; p < 0.001). El mejor punto de corte del BNP para predecir CAP-hs fue 486.5 pg/ml, con una sensibilidad del 81% y una especificidad del 92% (p < 0.001). Conclusión: El punto de corte del BNP identificado en el presente estudio se correlacionó con la presencia de CAP-hs.

Abstract Introduction: The echocardiogram is the gold standard, in the diagnosis of the hemodynamically significant patent ductus arteriosus (hs-PDA) of the premature newborn (PNB). Type B natriuretic peptide (BNP) may be useful in the diagnosis and management of CAP-hs. Objective: To assess the utility of BNP as a marker of hemodynamic overload of the patent ductus arteriosus in newborns with gestational age < 32 weeks or weight < 1500 grams, and to identify the best cut-off point for BNP levels that would best predict a PDA with hemodynamic impact requiring pharmacological and/or surgical treatment. Methods: Retrospective, observational and descriptive study of PNB < 32 weeks gestation or weight < 1500 grams, in which echocardiogram and BNP determination was performed. Analysis of the global sample and by subgroups, depending on the hs-PDA status was performed. Results: A total of 29 patients were analyzed. A significant correlation was found between the PDA/weight ratio and BNP levels (Spearman: 0.71; 95% confidence interval: 0.45-0.87; p < 0.001). The best BNP cut-off point to predict CAP-hs was 486.5 pg/ml with a sensitivity of 81% and specificity of 92% (p < 0.001). Conclusion: The BNP cut-off point identified in the present study was correlated with the presence of CAP-hs.

Risk factors of hypotension after ligation of patent ductus arteriosus in very/extremely low birth weight infants / 中国新生儿科杂志

Objective:To study the risk factors of hypotension after ligation of patent ductus arteriosus (PDA) in very/extremely low birth weight infants (VLBWI/ELBWI).Method:From March 2016 to January 2021, preterm infants with birth weight <1 500 g receiving bedside PDA ligation in the neonatal intensive care unit (NICU) of our hospital were enrolled in the study. According to the occurrence of hypotension within 72 hours after ligation, the infants were assigned into non-hypotension group and hypotension group. The general status and perioperative conditions of the two groups were analyzed. Multivariate Logistic regression was used to analyze the risk factors of hypotension.Result:A total of 44 cases were enrolled, including 33 in non-hypotension group and 11 in hypotension group. Univariate analysis showed that hypotension group had significantly more cases with body weight <1 100 g during surgery and receiving preoperative high frequency oscillatory ventilation (HFOV) than non-hypotension group ( P<0.05). Multivariate Logistic regression analysis showed that weight <1 100 g during surgery ( OR=12.045, 95% CI 1.351~107.394, P=0.026) and receiving preoperative HFOV ( OR=27.832, 95% CI 1.363~568.292, P=0.031)were independent risk factors of hypotension. Conclusion:Hypotension is one of the common complications of PDA ligation in VLBWI/ELBWI. The infant's body weight during ligation and receiving preoperative HFOV are independent risk factors of hypotension.

Risk factors of hemodynamically significant patent ductus arteriosus in extremely preterm infants / 中国新生儿科杂志

Objective:To study the risk factors of hemodynamically significant patent ductus arteriosus (hsPDA) in extremely preterm infants (EPI).Method:From July 2017 to April 2020, EPI (gestational age <28 weeks) admitted to the Department of Neonatology of our hospital were included and analyzed retrospectively. According to whether hsPDA existed or not, the infants were assigned into non-hsPDA group and hsPDA group. Demographic findings and possible risk factors of hsPDA were collected.The cumulative fluid overload (FO) within 3 days after birth was calculated. Univariate and multivariate analysis were used to determine the risk factors of hsPDA.Result:A total of 79 infants with gestational age of (27.0±0.9) weeks and birth weight of (987±173)g were enrolled, including 23 cases in non-hsPDA group and 56 cases in hsPDA group. Univariate analysis showed that thrombocytopenia ( P=0.044), respiratory distress syndrome (RDS) treated with pulmonary surfactant (PS) ( P=0.006) and high FO level ( P=0.002) were associated with hsPDA. Multivariate analysis showed that RDS treated with PS ( OR=5.933, 95% CI 1.360~25.883, P=0.018) and high FO level ( OR=1.261, 95% CI 1.063~1.496, P=0.008) were independent risk factors for hsPDA in EPIs. ROC curve analysis showed that the cut-off value of FO was -0.2%, with 85.7% sensitivity and 56.5% specificity distinguishing the presence of hsPDA (AUC=0.712, Youden index=0.422). Conclusion:High level of FO within the first 3 days of life and RDS treated with PS are independent risk factors for hsPDA in EPI. After PS treatment, hemodynamic changes of infants with RDS should be monitored closely. During early fluid management of EPI, FO should be strictly monitored to avoid high FO level.

Predictive value of ultrasonic cardiac output monitor in premature infants with hemodynamic significant patent ductus arteriosus / 中华实用儿科临床杂志

Objective:To evaluate the diagnostic and predictive value of ultrasonic cardiac output monitor (USCOM) in premature infants with hemodynamic significant patent ductus arteriosus (hsPDA).Methods:A total of 165 preterm infants with gestational age less than 34 weeks and within 72 hours after birth in the Neonatal Medical Center of Children′s Hospital of Nanjing Medical University from January 2018 to June 2020 were retrospectively analyzed.According to the echocardiograph (ECHO) results within 72 hours after birth, clinical manifestations and oral administration of Ibuprofen, premature infants were divided into non-patent ductus arteriosus (non-PDA group, 77 cases), non-hsPDA group (59 cases), and hsPDA group (29 cases). USCOM was performed within half of an hour after ECHO.During the course of oral medication of Ibuprofen in the hsPDA group, USCOM was repeatedly examined every 24 hours.ECHO and USCOM were re-examined within 24 hours after the course of oral medication of ibuprofen.Results:Compared with non-hsPDA group and non-PDA group, the gestational age [(31.51±1.62) weeks, (32.09±1.27) weeks vs.(30.82±1.61) weeks, F=8.425, P<0.001], birth weight [(1 154.49±192.55) g, (1 195.58±182.02) g vs.(1 094.66±153.69) g, F=3.366, P=0.037] and the mean blood pressure [(38.37±2.20) mmHg, (38.53±2.37) mmHg vs.(30.52±2.31) mmHg, 1 mmHg=0.133 kPa, F=142.860, P<0.001]were significantly lower in hsPDA group.On the contrary, the heart rate[(129.68±7.11) times/min, (130.34±7.27) times/min vs.(164.76±7.65) times/min, F=271.790, P<0.001], B-type natriuretic peptide[(203.76±108.68) ng/L, (152.43±54.24) ng/L vs.(3 385.31±856.26) ng/L, F=931.30, P<0.001] and left artrium/aorta (1.32±0.12, 1.29±0.09 vs.1.60±0.12, F=84.970, P<0.001)were significantly higher.Among the USCOM parameters, left ventricular cardiac output [(0.40±0.08) L/min, (0.40±0.08) L/min vs.(0.51±0.04) L/min, F=26.760, P<0.001], cardiac index (CI) [(3.76±0.48) L/(min·m 2), (3.54±0.30) L/(min·m 2) vs.(4.43±0.36) L/(min·m 2), F=56.060, P<0.001], stroke volume[(3.75±0.28) mL, (3.70±0.23) mL vs.(4.22±0.36)mL, F=40.170, P<0.001], stroke volume index [(34.42±2.66) mL/m 2, (34.47±3.29) mL/m 2vs.(38.45±3.32) mL/m 2, F=20.080, P<0.001], peak ejection velocity [(1.12±0.12) m/s, (1.11±0.10) m/s vs.(1.23±0.09) m/s, F=14.890, P<0.001] and corrected flow time [(379.02±22.69) ms, (376.51±27.95) ms vs.(403.69±39.04) ms, F=10.120, P<0.001]were significantly higher in hsPDA group, while systemic vascular resistance index (SVRI) [(1 109.49±115.67) ds·cm -5·m 2, (1 070.01±133.55) ds·cm -5·m 2vs.(861.31±115.22) ds cm -5m 2, F=41.130, P<0.001]was significantly lower than that of non-hsPDA and non-PDA group.The area under the receiver operating characteristic curve of CI and SVRI for predicting hsPDA were 0.916 and 0.905, respectively.The sensitivity and specificity of CI>4.05 L/(min·m 2) for predicting hsPDA was 0.828 and 0.860, respectively, which was 0.660 and 1.000 for SVRI<1 002.5 ds·cm -5·m 2.The sensitivity and specificity of combining CI and SVRI for predicting hsPDA was 0.966 and 0.949, respectively. Conclusions:USCOM has a good diagnostic and predictive value for hsPDA in premature infants.The combined application of CI and SVRI can improve the predictive value, and help formulate the early diagnostic and treatment strategy for PDA in premature infants

Risk factors and prediction model of thrombocytopenia in children with patent ductus arteriosus after transca-theter closure / 中华实用儿科临床杂志

Objective:To explore the risk factors of thrombocytopenia in children with patent ductus arteriosus (PDA) after transcatheter closure, and to establish a prediction model of thrombocytopenia after transcatheter closure of PDA.Methods:A total of 39 PDA children with thrombocytopenia after transcatheter closure treated in Children′s Hospital of Nanjing Medical University from November 2016 to January 2020 were selected.During the same period, 138 PDA children without thrombocytopenia after transcatheter closure were included in the control group. Logistic regression model was used to explore the possible risk factors of thrombocytopenia after transcatheter closure in PDA children, and a random forest model was established to predict the occurrence of thrombocytopenia after transcatheter closure of PDA. Results:After transcatheter closure of PDA, children developed thrombocytopenia within 1 to 7 days, and the platelet count recovered within 2 to 22 days. Logistic regression model suggested that the diameter of pulmonary artery end of arterial catheter ( OR=9.54, 95% CI: 2.08-48.84, P=0.004)and preoperative platelet count( OR=0.99, 95% CI: 0.98-0.99, P=0.001)were correlated with the occurrence of thrombocytopenia after transcatheter closure of PDA.The random forest model indicated that PDA inner diameter was the most important factor for predicting the occurrence of thrombocytopenia after transcatheter closure of PDA. Conclusions:A large diameter of arterial duct is an important risk factor and increased preoperative platelet count is a protective factor for thrombocytopenia after transcatheter closure of PDA.Diameter is of the greatest significance in predicting the occurrence of thrombocytopenia after transcatheter closure of PDA.

Progress in the treatment of patent ductus arteriosus in extremely low birth weight infants / 国际儿科学杂志

With the progress of perinatal medicine and the improvement of cure rate in preterm infants, the diagnosis and treatment of patent ductus arteriosus in extremely low birth weight infants is a great challenge for neonatal medicine.Continuous left-to-right shunt through catheters can lead to systemic hypotension, pulmonary perfusion, increased left ventricular volume load, prolonged mechanical ventilation, and increased risk of complications and death such as pulmonary hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage.Conservative treatment is still the first choice and drug treatment is not completely effective, while the long-term impact of both on newborns is still unclear, which need a reasonable assessment of the pros and cons.Surgical ligation can improve cardio-pulmonary function, but the indication and time of the arterial catheter are also controversial for its self-closing, thus more evidence-based studies are needed.We review the current management status and controversy of patent ductus arteriosus in extremely low birth weight infants to explore the scientific and effective clinical measures.

Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research / 中国当代儿科杂志

OBJECTIVES@#To study the change in regional oxygen saturation (rSO@*METHODS@#The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO@*RESULTS@#A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (@*CONCLUSIONS@#hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO