Evidence-based use of acetaminophen for hemodynamically significant ductus arteriosus in preterm infants
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and variable efficacy have highlighted a need for alternative options. Acetaminophen facilitates ductal closure via an alternate pathway of prostaglandin inhibition. Despite treatment with high doses, toxicity is uncommon in preterm infants, possibly due to immature hepatic metabolism. Pooled data from randomized clinical trials of early treatment demonstrate that acetaminophen has similar efficacy as cyclooxygenase inhibitors for PDA closure with a favoura...
Source: Seminars in Perinatology - May 24, 2018 Category: Perinatology & Neonatology Authors: B. Jasani, D.E. Weisz, P. McNamara Tags: 42/4 Source Type: research
Changing patterns of patent ductus arteriosus surgical ligation in the united states
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids ′ Inpatient Database (2000–2012) to determine if PDA ligation rates: 1) changed over time, 2) varied geographically, or 3) influenced surgical complication rates. In 2012, 47,900 infants (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 22, 2018 Category: Perinatology & Neonatology Authors: Jeff Reese, Theresa A. Scott, Stephen W. Patrick Source Type: research
Catheter-based closure of the patent ductus arteriosus in lower weight infants
Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight ( (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 11, 2018 Category: Perinatology & Neonatology Authors: Leeann R. Pavlek, Jonathan L. Slaughter, Darren P. Berman, Carl H. Backes Source Type: research
Transcriptional profiling of the ductus arteriosus: Comparison of rodent microarrays and human RNA sequencing
DA closure is crucial for the transition from fetal to neonatal life. This closure is supported by changes to the DA ′s signaling and structural properties that distinguish it from neighboring vessels. Examining transcriptional differences between these vessels is key to identifying genes or pathways responsible for DA closure. Several microarray studies have explored the DA transcriptome in animal models but va ried experimental designs have led to conflicting results. Thorough transcriptomic analysis of the human DA has yet to be performed. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Michael T. Yarboro, Matthew D. Durbin, Jennifer L. Herington, Elaine L. Shelton, Tao Zhang, Cris G. Ebby, Jason Z. Stoller, Ronald I. Clyman, Jeff Reese Source Type: research
Novel drug targets for ductus arteriosus manipulation: Looking beyond prostaglandins
Forty years ago, non-steroidal anti-inflammatory drugs were first reported to decrease systemic prostaglandin levels and promote ductus arteriosus (DA) closure. And yet, prolonged patency of the DA (PDA) remains a significant clinical problem, complicated by imperfect therapies and wide variations in treatment strategy. There are few pharmacology-based tools available for treating PDA (indomethacin, ibuprofen, acetaminophen), or for maintaining DA patency (PGE1) as is needed to facilitate corrective surgery for ductus-dependent congenital heart defects. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Elaine L. Shelton, Gautam K. Singh, Colin G. Nichols Source Type: research
Association between Prophylactic Indomethacin and Death or Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis of Observational Studies
The use of prophylactic indomethacin in very preterm infants is controversial. The last randomized controlled trial (RCTs) to study this therapy enrolled infants over 20 years ago. More recently, observational studies have investigated the association between exposure to prophylactic indomethacin and neonatal morbidities and mortality. We performed a systematic review and meta-analysis of these studies for the outcomes of death and bronchopulmonary dysplasia (BPD). Two observational studies involving a total of 11,289 very preterm infants were suitable for meta-analysis. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Erik A. Jensen, Elizabeth E. Foglia, Barbara Schmidt Tags: 42/4 Source Type: research
Towards a greater understanding of the ductus arteriosus
(Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Jeff Reese Source Type: research
Comparative physiology of the ductus arteriosus among vertebrates
The ductus arteriosus is typically viewed as a mammalian fetal blood vessel providing a right-to-left shunt of right ventricular outflow away from the lungs and to the systemic circuit, that must close at birth. This review provides a wider comparative examination of the ductus arteriosus in lungfish, reptiles, birds, and mammals. The ductus arteriosus evolved with the lung in the ancestors of the lungfish as a connection between the pulmonary arteries and dorsal aorta. During embryonic development, reptiles, birds, and mammals all possess either one or two paired ductus arteriosi that provide a fetal shunt of blood away f...
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Edward M. Dzialowski Tags: 42/4 Source Type: research
Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity
A persistent left-to right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung ′s interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of bronchopulmonary dysplasia (BPD). Although routine prophylactic treatment of a PDA on the day of birth does not appear to offer any more protection against BPD than delaying treatment for 2–3 days, recent evidence f...
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Ronald I. Clyman Source Type: research
Congenital syphilis
remains a major public health problem worldwide, and its incidence is increasing in the United States. This review highlights the ongoing problem of this preventable infection, and discusses vertical transmission and clinical manifestations while providing a practical algorithm for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis. Every case of congenital syphilis must be seen as a failure of our public health system to provide optimal prenatal care to pregnant women, as congenital syphilis can be prevented by early and repeated prenatal serologic screening of mothers and...
Source: Seminars in Perinatology - April 4, 2018 Category: Perinatology & Neonatology Authors: Joshua M. Cooper, Pablo J. S ánchez Source Type: research
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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research
