Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study
To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. T...
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| Veröffentlicht in: | PloS one 2024-07, Vol.19 (7), p.e0306769 |
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| creator | Chesi, Elena Rossi, Katia Ancora, Gina Baraldi, Cecilia Corradi, Mara Di Dio, Francesco Di Fazzio, Giorgia Galletti, Silvia Mescoli, Giovanna Papa, Irene Solinas, Agostina Braglia, Luca Di Caprio, Antonella Cuoghi Costantini, Riccardo Miselli, Francesca Berardi, Alberto Gargano, Giancarlo |
| description | To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g).
A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present.
218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA.
The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain. |
| doi_str_mv | 10.1371/journal.pone.0306769 |
| format | Article |
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A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present.
218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA.
The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0306769</identifier><identifier>PMID: 38980835</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analgesics ; Biology and Life Sciences ; Birth weight ; Data collection ; Death ; Diagnosis ; Ductus Arteriosus, Patent - diagnostic imaging ; Ductus Arteriosus, Patent - physiopathology ; Female ; Flow distribution ; Gestational Age ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Infant, Newborn ; Infant, Very Low Birth Weight ; Infants ; Infants (Newborn) ; Low birth weight ; Male ; Mechanical properties ; Mechanical ventilation ; Medicine and Health Sciences ; Mortality ; Mortality risk ; Neonates ; Newborn babies ; Nonsteroidal anti-inflammatory drugs ; Observational studies ; Patent ductus arteriosus ; Pediatrics ; Premature babies ; Prospective Studies ; Pulmonary hypertension ; Risk ; Ultrasonic imaging ; Ultrasonography ; Ultrasound ; Ventilation</subject><ispartof>PloS one, 2024-07, Vol.19 (7), p.e0306769</ispartof><rights>Copyright: © 2024 Chesi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Chesi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Chesi et al 2024 Chesi et al</rights><rights>2024 Chesi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c427t-3f01aad0461b4145e215db39cd077d2625882898f97de55e10aead3335bdb1543</cites><orcidid>0000-0002-3534-7499 ; 0009-0004-0718-9173 ; 0000-0001-5991-8949 ; 0000-0001-7951-5717</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233010/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233010/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23864,27922,27923,53789,53791,79370,79371</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38980835$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Aylanc, Hakan</contributor><creatorcontrib>Chesi, Elena</creatorcontrib><creatorcontrib>Rossi, Katia</creatorcontrib><creatorcontrib>Ancora, Gina</creatorcontrib><creatorcontrib>Baraldi, Cecilia</creatorcontrib><creatorcontrib>Corradi, Mara</creatorcontrib><creatorcontrib>Di Dio, Francesco</creatorcontrib><creatorcontrib>Di Fazzio, Giorgia</creatorcontrib><creatorcontrib>Galletti, Silvia</creatorcontrib><creatorcontrib>Mescoli, Giovanna</creatorcontrib><creatorcontrib>Papa, Irene</creatorcontrib><creatorcontrib>Solinas, Agostina</creatorcontrib><creatorcontrib>Braglia, Luca</creatorcontrib><creatorcontrib>Di Caprio, Antonella</creatorcontrib><creatorcontrib>Cuoghi Costantini, Riccardo</creatorcontrib><creatorcontrib>Miselli, Francesca</creatorcontrib><creatorcontrib>Berardi, Alberto</creatorcontrib><creatorcontrib>Gargano, Giancarlo</creatorcontrib><title>Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g).
A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present.
218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA.
The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.</description><subject>Analgesics</subject><subject>Biology and Life Sciences</subject><subject>Birth weight</subject><subject>Data collection</subject><subject>Death</subject><subject>Diagnosis</subject><subject>Ductus Arteriosus, Patent - diagnostic imaging</subject><subject>Ductus Arteriosus, Patent - physiopathology</subject><subject>Female</subject><subject>Flow distribution</subject><subject>Gestational Age</subject><subject>Hemodynamics</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infant, Newborn</subject><subject>Infant, Very Low Birth Weight</subject><subject>Infants</subject><subject>Infants (Newborn)</subject><subject>Low birth weight</subject><subject>Male</subject><subject>Mechanical properties</subject><subject>Mechanical ventilation</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Mortality risk</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Observational studies</subject><subject>Patent ductus arteriosus</subject><subject>Pediatrics</subject><subject>Premature babies</subject><subject>Prospective Studies</subject><subject>Pulmonary hypertension</subject><subject>Risk</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Ventilation</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNptUstu1DAUjRCIlsIfILDEpixm8CPOY1WNKh6VKsEC1pbjx4xHTjzYTkfzK3wtN0xadVCVRZx7zzm-5-YUxVuCl4TV5NM2jHGQfrkLg1lihqu6ap8V56RldFFRzJ4_Op8Vr1LaYsxZU1UvizPWtA1uGD8v_vyQ2QwZ6VHlMSEZs4kuJDheSp8CGsKw2Jg-6MMge6ek9weU3HpwFj6G_BGpEKPxIJLQ3uUN2oUQURizCj2U3IDuTDwgH_aocxH6e-PWmwwNC_S0RCvUjz47BUOYCGqbEDNKedSH18ULCzOYN_P7ovj15fPP62-L2-9fb65XtwtV0jovmMVESo3LinQlKbmhhOuOtUrjuta0orxpKPi1ba0N54ZgaaRmjPFOd4SX7KJ4f9Td-ZDEvNYkGNBrTis8IW6OCB3kVuyi62U8iCCd-FcIcS1gcU55I0irW0U7ahnXZddZ2dWdxZoYYmtdWw1aV_NtY9cbPfmO0p-InnYGtxHrcCcIoYxhgkHhclaI4fdoUha9S8p4LwcTxuPgbdPisgHoh_-gT9ubUWsJDuDPBLhYTaJi1WBcNTUECVDLJ1DwaAPBgBBaB_UTQnkkqBhSisY-mCRYTBG-H0ZMERZzhIH27vGCHkj3mWV_Aefl8nM</recordid><startdate>20240709</startdate><enddate>20240709</enddate><creator>Chesi, 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ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study</title><author>Chesi, Elena ; Rossi, Katia ; Ancora, Gina ; Baraldi, Cecilia ; Corradi, Mara ; Di Dio, Francesco ; Di Fazzio, Giorgia ; Galletti, Silvia ; Mescoli, Giovanna ; Papa, Irene ; Solinas, Agostina ; Braglia, Luca ; Di Caprio, Antonella ; Cuoghi Costantini, Riccardo ; Miselli, Francesca ; Berardi, Alberto ; Gargano, Giancarlo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-3f01aad0461b4145e215db39cd077d2625882898f97de55e10aead3335bdb1543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Analgesics</topic><topic>Biology and Life Sciences</topic><topic>Birth weight</topic><topic>Data collection</topic><topic>Death</topic><topic>Diagnosis</topic><topic>Ductus Arteriosus, Patent - diagnostic imaging</topic><topic>Ductus Arteriosus, Patent - physiopathology</topic><topic>Female</topic><topic>Flow distribution</topic><topic>Gestational 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Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chesi, Elena</au><au>Rossi, Katia</au><au>Ancora, Gina</au><au>Baraldi, Cecilia</au><au>Corradi, Mara</au><au>Di Dio, Francesco</au><au>Di Fazzio, Giorgia</au><au>Galletti, Silvia</au><au>Mescoli, Giovanna</au><au>Papa, Irene</au><au>Solinas, Agostina</au><au>Braglia, Luca</au><au>Di Caprio, Antonella</au><au>Cuoghi Costantini, Riccardo</au><au>Miselli, Francesca</au><au>Berardi, Alberto</au><au>Gargano, Giancarlo</au><au>Aylanc, Hakan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-07-09</date><risdate>2024</risdate><volume>19</volume><issue>7</issue><spage>e0306769</spage><pages>e0306769-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g).
A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present.
218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA.
The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>38980835</pmid><doi>10.1371/journal.pone.0306769</doi><orcidid>https://orcid.org/0000-0002-3534-7499</orcidid><orcidid>https://orcid.org/0009-0004-0718-9173</orcidid><orcidid>https://orcid.org/0000-0001-5991-8949</orcidid><orcidid>https://orcid.org/0000-0001-7951-5717</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2024-07, Vol.19 (7), p.e0306769 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3077752604 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analgesics Biology and Life Sciences Birth weight Data collection Death Diagnosis Ductus Arteriosus, Patent - diagnostic imaging Ductus Arteriosus, Patent - physiopathology Female Flow distribution Gestational Age Hemodynamics Hemorrhage Humans Hypertension Infant, Newborn Infant, Very Low Birth Weight Infants Infants (Newborn) Low birth weight Male Mechanical properties Mechanical ventilation Medicine and Health Sciences Mortality Mortality risk Neonates Newborn babies Nonsteroidal anti-inflammatory drugs Observational studies Patent ductus arteriosus Pediatrics Premature babies Prospective Studies Pulmonary hypertension Risk Ultrasonic imaging Ultrasonography Ultrasound Ventilation |
| title | Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study |
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