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1.
PLoS One ; 19(7): e0306769, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38980835

RESUMEN

OBJECTIVES: 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). STUDY DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.


Asunto(s)
Conducto Arterioso Permeable , Recién Nacido de muy Bajo Peso , Humanos , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/fisiopatología , Recién Nacido , Femenino , Masculino , Estudios Prospectivos , Hemodinámica , Edad Gestacional , Ultrasonografía
2.
Kyobu Geka ; 77(6): 442-445, 2024 Jun.
Artículo en Japonés | MEDLINE | ID: mdl-39009538

RESUMEN

We present the case of 60s male who underwent ductus arteriosus closure at the age of 10. He presented with hoarseness and a 25 mm-sized saccular aortic aneurysm was identified at the site of the closed ductus through the computed tomography( CT). The patient successfully underwent 1-debranch thoracic endovascular aortic repair resulting in improved hoarseness. While rare, several reports have documented aneurysm formation long after ductus arteriosus closure. Recent studies highlight favorable outcomes with endovascular repair. Despite its rarity, aneurysmal formation after ductus closure remains a serious complication. Given the increasing population of patients with prior ductus arteriosus closure and the discontinuation of long-term follow-up, awareness of the complication of aneurysmal formation is crucial. Not only congenital cardiologists but also general physicians should consider this differential diagnosis for patients presenting with symptoms such as hoarseness or back pain and a history of ductus closure.


Asunto(s)
Aneurisma de la Aorta Torácica , Procedimientos Endovasculares , Humanos , Masculino , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Conducto Arterial/diagnóstico por imagen , Conducto Arterial/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Conducto Arterioso Permeable/cirugía , Conducto Arterioso Permeable/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Resultado del Tratamiento , Reparación Endovascular de Aneurismas
3.
J Cardiothorac Surg ; 19(1): 393, 2024 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-38937830

RESUMEN

BACKGROUND: Although rare, paradoxical embolism sometimes occurs with patent ductus arteriosus (PDA). This study presents a case of PDA-associated paradoxical embolism with acute ischemic stroke (AIS) and pulmonary embolism (PE) following thoracoscopic surgery. CASE PRESENTATION: A 65-year-old woman developed acute-onset aphasia and right hemiparesis on the third day following thoracoscopic resection for a right lung tumor. Brain magnetic resonance imaging revealed multiple infarcts, and lower extremity venous Doppler ultrasound revealed deep vein thrombosis. The patient subsequently developed dyspnea, tachycardia, and hypoxemia. PE was confirmed by percutaneous transfemoral venous selective pulmonary angiography, which meanwhile demonstrated a PDA lesion. The patient, after receiving catheter-directed thrombolysis and inferior vena cava filter placement, improved in both neurological and respiratory status. CONCLUSION: For an uncommon but potentially fatal case with PDA-induced paradoxical embolism causing AIS and PE, early recognition and treatment are vital. Further studies are warranted to determine the optimal management and prognosis of patients with PDA-related embolic events.


Asunto(s)
Conducto Arterioso Permeable , Embolia Intracraneal , Embolia Pulmonar , Humanos , Femenino , Embolia Pulmonar/etiología , Anciano , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/cirugía , Embolia Intracraneal/etiología , Embolia Paradójica/etiología , Imagen por Resonancia Magnética
4.
Interv Cardiol Clin ; 13(3): 355-368, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38839169

RESUMEN

Transcatheter ductal closure has proven to be safe and effective to occlude the patent ductus arteriosus (PDA) in premature infants. We have developed a robust multidisciplinary PDA program. After gaining experience performing transcatheter ductal closure in the cardiac catheterization laboratory, we transitioned to performing the procedure at the patient's bedside in the neonatal intensive care unit using echocardiographic guidance. The bedside approach has the potential to expand this therapy to patients who currently undergo expectant PDA management because of lack of availability of this therapy, and allow for earlier referral, which will reduce time of exposure to this pathologic shunt.


Asunto(s)
Cateterismo Cardíaco , Conducto Arterioso Permeable , Recien Nacido Prematuro , Humanos , Conducto Arterioso Permeable/cirugía , Conducto Arterioso Permeable/diagnóstico , Recién Nacido , Cateterismo Cardíaco/métodos , Dispositivo Oclusor Septal , Ecocardiografía/métodos
5.
J Cardiothorac Surg ; 19(1): 391, 2024 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-38926785

RESUMEN

As the pediatric patient with right pulmonary artery agenesis (PAA) matured, she progressively presented symptoms of pulmonary hypertension and hemoptysis. There is limited clinical literature on this condition, and currently, there is no consensus regarding its diagnosis and treatment. This article presents a case study of a 16-year-old female patient with right pulmonary artery hypoplasia, providing a comprehensive summary and analysis of her developmental progression, pathology, diagnosis, and treatment.


Asunto(s)
Conducto Arterioso Permeable , Embolización Terapéutica , Hemoptisis , Hipertensión Pulmonar , Arteria Pulmonar , Humanos , Femenino , Hemoptisis/etiología , Hemoptisis/terapia , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugía , Arteria Pulmonar/diagnóstico por imagen , Adolescente , Embolización Terapéutica/métodos , Hipertensión Pulmonar/etiología , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/cirugía
6.
J Cardiothorac Surg ; 19(1): 319, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840135

RESUMEN

BACKGROUND: Aberrant left coronary artery from pulmonary artery (ALCAPA) is a very rare congenital heart defect. Its coexistence with patent ductus arteriosus (PDA) is extremely rare. The high pressures created by the left-to-right shunt in the pulmonary arteries can delay symptoms and create a real challenge in diagnosing ALCAPA. Missing this diagnosis can have severe results, including extensive ischemia and sudden death. CASE PRESENTATION: We present a case of an infant born with a large PDA. Initially treated conservatively, however, due to congestive heart failure and lack of weight gain, she underwent surgical ligation of the PDA at the age of four and a half months. Following surgery, she developed pulmonary edema. Echocardiography revealed decreased ventricular function. ECG revealed ST elevations on lateral leads, and serum troponin was significantly increased. The patient underwent cardiac magnetic resonance imaging (MRI), which revealed signs of wall ischemia and decreased function of the left ventricle (LV) with unclear coronary anatomy. Diagnostic catheterization revealed an ALCAPA. She underwent surgical intervention, and the left coronary artery was re-implanted in the aortic sinus. Follow-up revealed slow improvement of cardiac function. DISCUSSION AND LITERATURE REVIEW: The coexistence of PDA and ALCAPA is a very rare occurrence. We found at least 10 reported cases in the literature. Delayed diagnosis might be detrimental. The prognosis of these patients is variable. CONCLUSION: An unusual post-surgical course following PDA repair requires a high index of suspicion and appropriate evaluation for ALCAPA, preferably with angiography.


Asunto(s)
Conducto Arterioso Permeable , Arteria Pulmonar , Humanos , Conducto Arterioso Permeable/cirugía , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/diagnóstico por imagen , Femenino , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugía , Arteria Pulmonar/diagnóstico por imagen , Lactante , Anomalías de los Vasos Coronarios/cirugía , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Vasos Coronarios/cirugía , Vasos Coronarios/diagnóstico por imagen , Síndrome de Bland White Garland/cirugía , Síndrome de Bland White Garland/diagnóstico , Síndrome de Bland White Garland/complicaciones
8.
Interv Cardiol Clin ; 13(3): 421-430, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38839174

RESUMEN

Since PDA stenting was first attempted in the early 1990s, significant technical advancements have improved outcomes and some centers have even transitioned to exclusive PDA stenting for all infants with duct-dependent pulmonary circulation. In addition to its use in infants with duct-dependent pulmonary circulation, PDA stenting has also been adapted as a percutaneous palliative option for suprasystemic pulmonary arterial hypertension and as a component of the hybrid procedure. In this article, the authors aim to review indications and outcomes for PDA stenting, describe the procedure, and discuss future directions.


Asunto(s)
Conducto Arterioso Permeable , Stents , Humanos , Conducto Arterioso Permeable/cirugía , Cateterismo Cardíaco/métodos , Cuidados Paliativos/métodos , Resultado del Tratamiento
12.
Acta Paediatr ; 113(8): 1781-1790, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38798138

RESUMEN

AIM: Progressive respiratory deterioration in infants at high risk of bronchopulmonary dysplasia (BPD) is associated with patent ductus arteriosus (PDA) exposure. This study aimed to design an early predictive model for BPD or death in preterm infants using early echocardiographic markers and clinical data. METHODS: Infants born with gestational age (GA) ≤ 29 weeks and/or birth weight (BW) < 1500 g at Cork University Maternity Hospital, Ireland were retrospectively evaluated. Those with echocardiography performed between 36 h and 7 days of life were eligible for inclusion. Exclusion criteria were pulmonary hypertension and major congenital anomalies. The primary outcome was a composite of BPD and death before discharge. RESULTS: The study included 99 infants. A predictive model for the primary outcome was developed, which included three variables (BW, Respiratory Severity Score and flow pattern across the PDA), and yielding an area under the curve of 0.98 (95% CI 0.96-1.00, p < 0.001). Higher scores were predictive of the primary outcome. A cut-off of -1.0 had positive and negative predictive values of 89% and 98%, and sensitivity and specificity of 98% and 88%, respectively. CONCLUSION: Our prediction model is an accessible bedside tool that predicts BPD or death in premature infants.


Asunto(s)
Displasia Broncopulmonar , Recien Nacido Prematuro , Humanos , Displasia Broncopulmonar/mortalidad , Recién Nacido , Estudios Retrospectivos , Femenino , Masculino , Medición de Riesgo/métodos , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/mortalidad , Conducto Arterioso Permeable/complicaciones
13.
Acta Paediatr ; 113(8): 1833-1844, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38807279

RESUMEN

AIM: To describe sodium and potassium intake, their sources and plasma concentrations, and the association between intake and morbidity in very-low-birthweight (VLBW, <1500 g) infants during the first week of life. METHODS: This retrospective cohort study comprised 951 VLBW infants born at <32 weeks. Infants were divided into three groups according to gestational age: 23-26 (n = 275), 27-29 (n = 433) and 30-31 (n = 243) weeks. Data on fluid management and laboratory findings were acquired from an electronic patient information system. RESULTS: The median sodium intake was highest in the 23-26 week group, peaking at 6.4 mmol/kg/day. A significant proportion of sodium derived from intravascular flushes; it reached 27% on day 1 in the 23-26 week group. High cumulative sodium intake in the first postnatal week was associated with weight gain from birth to day 8 in the 23-26 week group. High intake of sodium associated with an increased risk of surgically ligated patent ductus arteriosus (PDA), bronchopulmonary dysplasia and intraventricular haemorrhage, whereas low intake of potassium associated with an increased risk of PDA. CONCLUSION: Sodium intake in the most premature infants exceeded recommendations during the first postnatal week. Saline flushes accounted for a significant proportion of the sodium load.


Asunto(s)
Recién Nacido de muy Bajo Peso , Humanos , Recién Nacido , Estudios Retrospectivos , Masculino , Femenino , Potasio/sangre , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/etiología , Conducto Arterioso Permeable/epidemiología , Sodio en la Dieta/administración & dosificación , Sodio en la Dieta/efectos adversos
14.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 41(6): 758-760, 2024 Jun 10.
Artículo en Chino | MEDLINE | ID: mdl-38818565

RESUMEN

Char syndrome is a rare autosomal dominant genetic disorder characterized by patent ductus arteriosus, facial dysmorphism, and dysplasia of fingers/toes. It may also be associated with multiple papillae, dental dysplasia, and sleep disorders. TFAP2B has proven to be a pathogenic gene for neural crest derivation and development, and several variants of this gene have been identified. Bone morphogenetic protein signaling plays an important role in embryonic development by participating in limb growth and patterning, and regulation of neural crest cell development. TFAP2B is an upstream regulatory gene for bone morphogenetic proteins 2 and 4. Variants of the TFAP2B gene may lead to abnormal proliferation of neural crest cells by affecting the expression of bone morphogenetic proteins, resulting in multiple organ dysplasia syndrome. In addition, TFAP2B variants may only lead to patent ductus arteriosus instead of typical Char syndrome.


Asunto(s)
Conducto Arterioso Permeable , Humanos , Conducto Arterioso Permeable/genética , Factor de Transcripción AP-2/genética , Anomalías Múltiples/genética , Proteínas Morfogenéticas Óseas/genética , Proteínas Morfogenéticas Óseas/metabolismo , Cresta Neural/metabolismo , Cresta Neural/embriología , Cara/anomalías , Dedos/anomalías
15.
BMC Pediatr ; 24(1): 376, 2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38822298

RESUMEN

BACKGROUND: Patent ductus arteriosus (PDA) is commonly encountered morbidity which often occurs as up to 60% of extremely preterm infants born at < 29 weeks gestational age (GA). PURPOSE: This study aims to assess the clinical risk factors associated with PDA ligation among very low birth weight infants (VLBWI) and evaluate the neurodevelopmental outcomes of those who underwent PDA ligation. METHODS: A total of 540 VLBWI were initially diagnosed with PDA in our 50-bed level IV NICU at Seoul St. Mary's Hospital, The Catholic University of Korea, between January 2015 and June 2023. Among these 540 VLBWI with PDA, only 221 had consistent hemodynamically significant (hs) PDA which required intervention including fluid restriction, medical treatment, or surgical ligation. In this study, only those 221 VLBWI with hsPDA who underwent neurodevelopmental assessment at corrected 18-24 months of age were included in this study analysis. RESULTS: Out of 221 VLBWI diagnosed with hemodynamically significant (hs) PDA, 133 (60.2%) underwent PDA ligation, while the remaining 88 (39.8%) had their hs PDAs closed either medically or with fluid restriction. The mean gestational age and birth weight were significantly lower in PDA ligation group compared to no PDA ligation group (27.02 ± 2.17 vs. 27.98 ± 2.36, 907.31 ± 258.36 vs. 1006.07 ± 283.65, p = 0.001, 0.008). Resuscitation including intubation at delivery and intraventricular hemorrhage (IVH) (grade ≥ 3) were significantly higher in PDA ligation group. The clinical outcomes in the PDA ligation group revealed significantly worse oucomes compared to the no PDA ligation group. Both resuscitation, including intubation at delivery, and IVH (grade ≥ 3), consistently exhibited an increased risk for PDA ligation in a multivariable logistic regression analysis. Concerning neurodevelopmental outcomes, infants who underwent PDA ligation demonstrated significantly lower cognitive scores. However, only IVH (grade ≥ 3) and PVL were consistently associated with an increased risk of abnormal neurodevelopment at the corrected age of 18-24 months. CONCLUSION: In our study, despite the consistent association between cognitive developmental delays in VLBWI who underwent PDA ligation, we observed that sicker and more vulnerable VLBWIs, specifically those experincing severe IVH, consistently exhibited an increased risk for both PDA ligation and abnormal neurodevelopment at the corrected age of 18-24 months.


Asunto(s)
Conducto Arterioso Permeable , Recién Nacido de muy Bajo Peso , Humanos , Conducto Arterioso Permeable/cirugía , Conducto Arterioso Permeable/complicaciones , Ligadura , Femenino , Masculino , Factores de Riesgo , Recién Nacido , Lactante , Estudios Retrospectivos , Preescolar , Trastornos del Neurodesarrollo/etiología , Trastornos del Neurodesarrollo/epidemiología , Edad Gestacional
16.
Indian Pediatr ; 61(7): 656-660, 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-38803099

RESUMEN

OBJECTIVE: We evaluated ductal closure rates in preterm neonates with hemodynamically significant patent ductus arteriosus (hsPDA) who received paracetamol (PCM) as first-line therapy. METHODS: In this retrospective chart review, we included inborn preterm (< 37 weeks) neonates (January 2017-December 2021) with hsPDA (ductal diameter > 1.5 mm and left atrium-to-aortic root ratio (La/Ao > 1.4) who were treated with oral or intravenous PCM. Primary outcome was hsPDA closure (defined as small or no PDA) following 3-day treatment. Secondary outcomes were need for retreatment and surgical ligation, pulmonary hypertension (PH), and in-hospital morbidities. RESULTS: Out of 2784 preterm birth, 117 neonates were diagnosed with hsPDA. Out of 96 neonates who received PCM in the first course, 20 died before the completing the first course. The median (IQR) gestation and birth weight of neonates who received PCM were 28 (26, 29) weeks and 841 (714, 1039) g, respectively. Out of 76 neonates who completed treatment with first course of PCM (57 intravenous, 19 oral), 43 (56.6%) achieved successful closure and five (6.6%) developed PH. Out of 14 neonates who received a second course of PCM, 10 achieved closure of hsPDA while one neonate expired. CONCLUSION: Paracetamol is associated with successful closure of hsPDA in 56.6% of preterm neonates after one course and 70% of premies after two courses.


Asunto(s)
Acetaminofén , Conducto Arterioso Permeable , Recien Nacido Prematuro , Centros de Atención Terciaria , Humanos , Conducto Arterioso Permeable/tratamiento farmacológico , Acetaminofén/uso terapéutico , Recién Nacido , India , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Femenino , Masculino , Analgésicos no Narcóticos/uso terapéutico , Resultado del Tratamiento
17.
J AAPOS ; 28(3): 103923, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38692561

RESUMEN

BACKGROUND: Hemodynamically significant patent ductus arteriosus (hsPDA) shunt may predispose infants to retinopathy of prematurity (ROP) because of its higher preductal cardiac output and blood oxygen content, which may augment ocular oxygen delivery. METHODS: A retrospective cohort study of preterm infants, born at <27 weeks' gestation and admitted at <24h postnatal age to a large quaternary referral was conducted. The primary composite outcome was death at <32 weeks or moderate-to-severe ROP (≥stage 2 or requiring treatment) in either eye. Secondary outcomes included ROP requiring treatment, and any ROP. Univariate analysis of patient characteristics and outcomes was performed as well as logistic regression. A receiver operating characteristics curve was generated for the outcome of ROP ≥stage 2 or requiring treatment. RESULTS: A total of 91 patients were screened, of whom 86 (54 hsPDA, 32 controls) were eligible for inclusion. hsPDA patients were younger and lighter at birth and had a higher burden of hyperglycemia and respiratory illness. The rates of the composite outcome (death <32 weeks or moderate-to-severe ROP) and of any ROP were more frequent in the hsPDA group. hsPDA shunt exposure was independently associated with development of any ROP among survivors to assessment (P = 0.006). PDA cumulative exposure score of 78 (clinical equivalent = 7 days high-volume shunt exposure) predicts moderate-to-severe ROP with 80% sensitivity and 78% specificity. CONCLUSIONS: Among infants <27 weeks, hsPDA shunt is associated with increased risks of a composite outcome of death or moderate-to-severe ROP, as well as ROP of any stage. Shunt modulation as a strategy to reduce ROP represents a biologically plausible avenue for investigation.


Asunto(s)
Conducto Arterioso Permeable , Edad Gestacional , Retinopatía de la Prematuridad , Humanos , Retinopatía de la Prematuridad/fisiopatología , Conducto Arterioso Permeable/fisiopatología , Estudios Retrospectivos , Recién Nacido , Femenino , Masculino , Hemodinámica/fisiología , Factores de Riesgo , Recien Nacido Prematuro , Curva ROC
18.
Eur J Cardiothorac Surg ; 65(5)2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38724226

RESUMEN

OBJECTIVES: The goal was to evaluate neonatal outcomes based on treatment strategies and time points for haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight preterm infants, with a particular focus on surgical closure. METHODS: This retrospective study included very-low-birth-weight infants born between 2014 and 2021 who received active treatment for hsPDA. Neonatal outcomes were compared between (i) primary surgical closure versus primary ibuprofen; (ii) early (<14th post-natal day) versus late primary surgical closure (≥14th post-natal day); and (iii) primary versus secondary surgical closure after ibuprofen failure. Further analysis using 1:1 propensity score matching was performed. Logistic regression was conducted to analyse the risk factors for post-ligation cardiac syndrome (PLCS) and/or acute kidney injury (AKI). RESULTS: A total of 145 infants with hsPDA underwent active treatment for closure. The in-hospital death rate and the incidence of severe bronchopulmonary dysplasia (BPD) were similar between the primary surgical closure group and the primary ibuprofen group in a 1:1 matched analysis. Severe BPD was significantly higher in the late surgical closure group than in the early primary surgical closure group with 1:1 propensity score matching (72.7% vs 40.9%, P=0.033). The secondary surgical closure group showed the mildest clinical condition; however, the probability of PLCS/AKI was highest (38.6%) compared to the early (15.2%) or the late primary surgical group (28.1%, P<0.001), especially in extremely premature infants (gestational age < 28 weeks). CONCLUSIONS: Surgical patent ductus arteriosus closure is not inferior to pharmacologic treatment. Considering the harmful effect of a prolonged patent ductus arteriosus shunt exposure, a timely decision and timely efforts should be made to minimize the risk of severe BPD and PLCS/AKI after surgical closure.


Asunto(s)
Conducto Arterioso Permeable , Ibuprofeno , Recién Nacido de muy Bajo Peso , Humanos , Conducto Arterioso Permeable/cirugía , Recién Nacido , Estudios Retrospectivos , Masculino , Femenino , Ibuprofeno/uso terapéutico , Ligadura/métodos , Recien Nacido Prematuro , Edad Gestacional , Puntaje de Propensión , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Resultado del Tratamiento , Factores de Riesgo
19.
Respir Med Res ; 85: 101096, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38744231

RESUMEN

BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of inhaled corticosteroids (budesonide, beclomethasone, or fluticasone propionate) in preventing bronchopulmonary dysplasia (BPD) for premature infants. METHOD: Electronic databases, including PubMed, EMBASE, Web of science, Scopus, and Cochrane library, were searched from databases inception to January 2022 for eligible randomized controlled trials. Clinical outcomes such as BPD, mortality, BPD or death, adverse events, and neurodevelopmental outcomes were assessed. RESULTS: Overall, budesonide was significantly associated with a reduction in BPD at 36 weeks' postmenstrual age (RR 0.48; 95 % CI [0.38, 0.62]) and patent ductus arteriosus (PDA) (RR 0.75; 95 % CI [0.63, 0.89]) compared with control treatments. Early longer duration inhalation of budesonide alone was associated with a lower risk of BPD at 36 weeks' postmenstrual age and PDA compared with controls. Early shorter duration intratracheal instillation of budesonide with surfactant as vehicle was associated with a lower risk of BPD at 36 weeks' postmenstrual age and all-cause mortality compared with surfactant. There was no statistically significant difference between budesonide and control groups regarding neurodevelopmental impairment. Beclomethasone and fluticasone propionate did not show any superior or inferior effect on clinical outcomes compared to control treatments. CONCLUSION: These findings suggest that budesonide, especially intratracheal instillation of budesonide using surfactant as a vehicle, is a safe and effective option in preventing BPD for preterm infants. More well-design large-scale trials with long-term follow-ups are necessary to verify the present findings.


Asunto(s)
Beclometasona , Displasia Broncopulmonar , Budesonida , Fluticasona , Recien Nacido Prematuro , Humanos , Displasia Broncopulmonar/prevención & control , Displasia Broncopulmonar/epidemiología , Administración por Inhalación , Recién Nacido , Budesonida/administración & dosificación , Budesonida/uso terapéutico , Beclometasona/administración & dosificación , Fluticasona/administración & dosificación , Fluticasona/uso terapéutico , Resultado del Tratamiento , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Conducto Arterioso Permeable/tratamiento farmacológico , Conducto Arterioso Permeable/prevención & control , Femenino , Masculino , Surfactantes Pulmonares/administración & dosificación
20.
Artículo en Alemán | MEDLINE | ID: mdl-38701804

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the signalement, clinical features, and echocardiographic findings of cats diagnosed with patent ductus arteriosus (PDA) as well as short- and medium-term outcome after successful ligation of the PDA. MATERIAL AND METHODS: Over a 10-year period 17 cats were diagnosed with PDA by transthoracic echocardiography. Thirteen cats were surgically treated by thoracotomy and ligation of the PDA. RESULTS: In all cats, a heart murmur was detected. In 88.2% of the cases, this presented as grade 4 out of 6 murmur (15/17 cats). A continuous murmur was more common (10/17 cats; 58.9%) than a systolic murmur (7/17 cats; 41.1%). Echocardiography showed that left ventricular internal diameter end diastole (LVIDd) and left ventricular internal diameter end systole (LVIDs) were significantly above reference values in the majority of cats. Mean diameter of the PDA measured at the widest point of the vessel was 3.4 mm (± 1.08 mm) and mean maximum flow velocity amounted to 5,06 m/sec (2,6m/sec-6,4m/sec). Surgery was successfully performed in all cats treated by surgical ligation and all of these patients were discharged after postoperative inpatient therapy. One cat experienced perioperative bleeding from the PDA, which was stopped efficaciously. This cat exhibited a residual shunt directly postoperatively; this could no longer be visualized in a re-check echocardiography 3 months later. Six cats were followed over a longer period of time. CONCLUSIONS: The surgical prognosis in this case study is very good with a postoperative survival rate of 100%. CLINICAL RELEVANCE: Surgical treatment of PDA is curative in animals not displaying advanced cardiac lesions. The auscultation of a heart murmur can provide initial findings indicative of PDA. Therefore, cardiac auscultation is warranted at every first presentation of a kitten. It must however be taken into consideration that not every cat with PDA necessarily has a continuous murmur but may display a systolic heart murmur. Therefore, it is important give utmost attention to the patients' clinical signs.


Asunto(s)
Enfermedades de los Gatos , Conducto Arterioso Permeable , Ecocardiografía , Animales , Gatos , Conducto Arterioso Permeable/veterinaria , Conducto Arterioso Permeable/cirugía , Conducto Arterioso Permeable/diagnóstico , Enfermedades de los Gatos/cirugía , Enfermedades de los Gatos/diagnóstico , Estudios Retrospectivos , Ecocardiografía/veterinaria , Ligadura/veterinaria , Soplos Cardíacos/veterinaria , Soplos Cardíacos/diagnóstico , Soplos Cardíacos/cirugía , Soplos Cardíacos/etiología , Femenino , Masculino
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