Perinatal risk factors and clinical features of hemodynamically significant patent ductus arteriosus in premature infants
Keywords:
premature infants, perinatal risk factors, hemodynamically significant patent ductus arteriosus, clinical featuresAbstract
The clinical features of the hemodynamically significant patent ductus arteriosus (HSPDA) depend on its diameter, which determines the frequency and severity of early complications of the disease. There are conflicting data on the relationship between perinatal factors and the development of large-diameter HSPDA in premature infants.
Purрose — to determine the most significant risk factors in the perinatal history affecting the diameter of the ductus arteriosus and early complications of HSPDA in premature infants.
Materials and methods. We examined 40 premature babies (gestational age — 29–36 weeks) with HSPDA, who were admitted for observation in the first day of life in the department of anesthesiology and intensive care of newborns of the MI «Dnipropetrovsk Regional Children's Clinical Hospital» DRC». To analyze the effect of the perinatal history on the diameter of the HSPDA in the first day of life, patients were divided into two groups: Group I (n=19) — children with HSPDA diameter <2 mm, Group II (n=21) — children HSPDA diameter >2 mm. The presence of chronic foci of infection in the mother was determined according to the medical documentation, chorioamnionitis based on the pathological examination of the placenta. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. Echocardiography with dopplerometry was performed at 5–11 hours of life to determine HSPDA.
Results. The risk of developing HSPDA >2 mm in diameter in premature infants whose mothers had early gestosis is 4.72 (CI=1.15–19.41; p<0.03). A high degree of risk of development of a HSPDA diameter >2 mm was also established in premature infants in the presence of chronic foci of infection in the mother (OR=10.56; CI=1.9–58.53; p<0.005), chorioamnionitis (OR=13.5; CI=1.51–120.78, p<0.009). Intrauterine infection in premature infants predetermined an increase in the size of HSPDA >2 mm. On the first day of life, a HSPDA diameter >2 mm in premature infants is a risk factor for such early complications as necrotizing enterocolitis (OR=14.55; CI=1.6–131.96, p<0.007), intraventricular hemorrhage (OR=4,29; CI=1.14–16.18, p<0.03), acute kidney injury on the third (OR=15.94; CI=3.38–75.10, p<0.001) and the fifth day of life (OR=35.63; CI=5.73–221.50, p<0.001).
Conclusions. A complicated perinatal anamnesis in premature infants is a risk factor for the development of large-diameter HSPDA, determines the occurrence of early complications of the disease, therefore, prevention of HSPDA should be started during pregnancy.
The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent was obtained from the parents of the children for the research.
References
Behbodi E, Villamor-Martinez E, Degraeuwe PL, Villamor E. (2016). Chorioamnionitis appears not to be a Risk Factor for Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis. Sci Rep. 28 (6): 37967. https://doi.org/10.1038/srep37967; PMid:27892517 PMCid:PMC5125028
Boichenko AD. (2016). Challenging iisues in diagnosis and management of hemodynamically significant patent ductus arteriosus in preterm infants. Sovremennaya pediatriya. 8 (80): 22-25. https://doi.org/10.15574/SP.2016.80.22
Coffman Z, Steflik D, Chowdhury SM, Twombley K, Buckley J. (2020). Echocardiographic predictors of acute kidney injury in neonates with a patent ductus arteriosus. J Perinatol. 40 (3): 510-514. https://doi.org/10.1038/s41372-019-0560-1; PMid:31767977
Du JF, Liu TT, Wu H. (2016). Risk factors for patent ductus arteriosus in early preterm infants: a case-control study. Zhongguo Dang Dai Er Ke Za Zhi. 18 (1): 15-19. doi: 10.7499/j.issn.1008-8830.2016.01.004.
Kim ES, Kim EK, Choi CW et al. (2010). Intrauterine inflammation as a risk factor for persistent ductus arteriosus patency after cyclooxygenase inhibition in extremely low birth weight infants. J Pediatr. 157 (5): 745-750.e1. https://doi.org/10.1016/j.jpeds.2010.05.020; PMid:20598319
Lee JA, Sohn JA, Oh S, Choi BM. (2020). Perinatal risk factors of symptomatic preterm patent ductus arteriosus and secondary ligation. Pediatr Neonatol. 61 (4): 439-446. https://doi.org/10.1016/j.pedneo.2020.03.016; PMid:32362475
Majed B, Bateman DA, Uy N, Lin F. (2019). Patent ductus arteriosus is associated with acute kidney injury in the preterm infant. Pediatr Nephrol. 34: 1129-1139. https://doi.org/10.1007/s00467-019-4194-5; PMid:30706125
Muk T, Jiang PP, Stensballe A, Skovgaard K, Sangild PT, Nguyen DN. (2020). Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs. Front Immunol. 30 (11): 565484. https://doi.org/10.3389/fimmu.2020.565484; PMid:33193334 PMCid:PMC7643587
Ohlsson A, Walia R, Shah SS. (2020). Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database of Systematic Reviews: 2. Art. No: CD003481. https://doi.org/10.1002/14651858.CD003481.pub8; PMid:32045960
Park HW, Choi YS, Kim KS, Kim SN. (2015). Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis. PLoS One. 10 (9): e0138114. https://doi.org/10.1371/journal.pone.0138114; PMid:26375582 PMCid:PMC4574167
Redline RW. (2015). Classification of placental lesions. Am J Obstet Gynecol. 213 (4): 21-28. https://doi.org/10.1016/j.ajog.2015.05.056; PMid:26428500
Rios DR, Bhattacharya S, Levy PT, McNamara PJ. (2018). Circulatory Insufficiency and Hypotension Related to the Ductus Arteriosus in Neonates. Front Pediatr. 6: 62. Published 2018 Mar 15. https://doi.org/10.3389/fped.2018.00062; PMid:29600242 PMCid:PMC5863525
Selewski DT, Charlton JR, Jetton JG et al. (2015). Neonatal Acute Kidney Injury. Pediatrics. 136 (2): e463-473. https://doi.org/10.1542/peds.2014-3819; PMid:26169430
Shepherd JL, Noori S. (2019). What is a hemodynamically significant PDA in preterm infants? Congenit Heart Dis. 14 (1): 21-26. https://doi.org/10.1111/chd.12727; PMid:30548469
Stritzke A, Thomas S, Amin H, Fusch C, Lodha A. (2017). Renal consequences of preterm birth. Mol Cell Pediatr. 4 (1): 2. https://doi.org/10.1186/s40348-016-0068-0; PMid:28101838 PMCid:PMC5243236
Downloads
Published
Issue
Section
License
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
