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1.
J Surg Res ; 243: 41-46, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31154131

RESUMO

BACKGROUND: Studies comparing percutaneous closure of patent ductus arteriosus (PDA) with surgical ligation tend to exclude premature infants and have not assessed procedural charges. We compared our contemporary outcomes and charges of device closure to surgical ligation of PDA in preterm infants. MATERIAL AND METHODS: Preterm infants who underwent isolated PDA closure during their newborn hospitalization (January 2014 to September 2017) were grouped based on intention to treat (surgery versus device closure). Patient demographics, procedural details, and immediate postprocedural outcomes were compared. Procedural charges for device closure versus surgical ligation were compared. RESULTS: Compared with the device group (n = 33), patients undergoing surgical ligation (n = 39) were younger, smaller, and required more preoperative support (P < 0.05). The procedure time was shorter for surgical ligation (P < 0.01). Although there was no procedural mortality in either group, the complication rate was higher for device closure than for surgical ligation (15.2% versus 0%; P = 0.02). The proportion of patients returning to preprocedural respiratory support by 48 h after procedure was similar. There was a higher proportion of surgical patients who required increased inotropic support in the first 24 h after procedure (P = 0.19). The procedural charges for transcatheter device closure were twice as expensive as those for surgical ligation. CONCLUSIONS: In our early experience with percutaneous PDA closure, we found a percutaneous approach in preterm infants feasible and well tolerated. Both surgical ligation and device closure were associated with perioperative or postoperative complications. Procedural charges were higher for percutaneous closure, driven by device charge and catheterization room utilization. Further investigation is needed to establish guidelines for first-line therapy for PDA closure in preterm infants, including cost-benefit analysis.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/terapia , Doenças do Prematuro/terapia , Cateterismo Cardíaco/instrumentação , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Análise de Intenção de Tratamento , Ligadura , Masculino , Estudos Retrospectivos , Resultado do Tratamento
2.
Cardiol Young ; 29(5): 725-726, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31155010

RESUMO

ABSTRACTPatent ductus arteriosus is among the most common congenital heart diseases. With the increasing use of transcatheter closure procedures, the incidence of complications related to the procedure has increased. Embolization of the ductus closure device to the pulmonary artery is a very rare complication. Since those procedures are often performed under non-operating room anesthesia, anesthetic management of such patients is of great importance. Herein, anesthetic management of embolization of the ductus closure device to the pulmonary artery in a little girl was presented. This is the first case regarding the anesthetic management of such complication.


Assuntos
Anestesia , Permeabilidade do Canal Arterial/terapia , Embolização Terapêutica/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Manuseio das Vias Aéreas/métodos , Pré-Escolar , Sedação Consciente , Falha de Equipamento , Feminino , Humanos
5.
Cardiol Young ; 29(4): 519-523, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31032755

RESUMO

INTRODUCTION: The CeraFlexTM PDA occluder is a new flexible device with a unique delivery system that may be beneficial with regard to not changing the device position after releasing. We prospectively evaluate the efficacy of the device and also the device behaviour patterns during release. METHODS: The study included 21 patients. Their median age was 1.2 years (from 6 months to 28 years) and weight was 9.6 kg (from 5.4 to 82 kg). All of the ducts were conical except one atypical ductus. Median ductal diameter at the pulmonary end was 3.8 mm (from 2.2 to 8.2 mm). The ductus was closed using an antegrade approach, but special attention was paid to the patterns of device behaviour during and just after releasing. RESULTS: Three different modes of device behaviour were observed during and just after releasing: (1) Neither difficulty nor change of position in 13 patients (62%), (2) a little difficulty in releasing but no change of position in 6 (29%), and (3) change of the device position in 2 (9%). There was no residual shunt on the next day except in one patient, in whom late device embolisation occurred. The device was retrieved and another, bigger device implanted. CONCLUSION: The CeraFlexTM PDA occlude device seems to be safe and efficacious for patent ductus arteriosus closure. Its unique delivery system generally fixes the device in a stable position that does not change after release (91%). Minor difficulty in releasing is not uncommon; however, the major disadvantage is the need for larger sheaths for delivery.


Assuntos
Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Desenho de Prótese , Resultado do Tratamento , Turquia , Adulto Jovem
6.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30940676

RESUMO

BACKGROUND AND OBJECTIVES: Thrombocytopenia is associated with late closure of patent ductus arteriosus (PDA). There are few studies evaluating platelet transfusions to treat PDA. We compared liberal platelet-transfusion criteria (to maintain a platelet count >100 000 per µL) versus standard criteria achieve earlier PDA closure among thrombocytopenic preterm neonates (<35 weeks' gestation) with hemodynamically significant PDA (hs-PDA) presenting within the first 2 weeks of life. METHODS: Thrombocytopenic (<100 000 per µL) preterm neonates with hs-PDA were enrolled and randomly allocated to the liberal and standard transfusion groups: 22 in each arm. They underwent echocardiography daily until closure of PDA, completion of 120 hours follow-up, or death. All subjects received standard cotreatment with nonsteroidal antiinflammatory drugs. Primary outcome of time to PDA closure was compared by survival analysis. Multivariate Cox proportional hazard regression was performed with randomization group, baseline platelet count, gestational age, and age at enrollment as predictor variables. RESULTS: Median time to PDA closure was 72 (95% confidence interval [CI] 55.9-88.1) versus 72 (95% CI 45.5-98.4) hours in the liberal versus restrictive transfusion groups, respectively (unadjusted hazard ratio 0.88 [95% CI 0.4-1.9]; P = .697). Despite adjusting for potential confounders, there was no significant difference in time to PDA closure. In the liberal transfusion group, 41% of infants had any grade of intraventricular hemorrhage compared with 4.5% in the restrictive group (P = .009). CONCLUSIONS: Attempting to maintain a platelet count >100 000 per µL by liberally transfusing platelets in preterm thrombocytopenic neonates with hs-PDA does not hasten PDA closure.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/terapia , Recém-Nascido Prematuro , Transfusão de Plaquetas/métodos , Trombocitopenia/diagnóstico por imagem , Trombocitopenia/prevenção & controle , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Masculino , Contagem de Plaquetas/métodos
7.
Adv Neonatal Care ; 19(3): 179-187, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30720481

RESUMO

BACKGROUND: Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion. PURPOSE: The purpose of this article is to review pathophysiology and treatment options for PDA. METHODS: A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol). RESULTS: Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay. IMPLICATIONS FOR RESEARCH: Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies. IMPLICATIONS FOR PRACTICE: Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.


Assuntos
Permeabilidade do Canal Arterial/fisiopatologia , Canal Arterial/fisiologia , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Fenômenos Fisiológicos Cardiovasculares , Pressão Positiva Contínua nas Vias Aéreas/métodos , Inibidores de Ciclo-Oxigenase/uso terapêutico , Diuréticos/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/terapia , Ecocardiografia Doppler , Procedimentos Endovasculares/métodos , Feto/fisiologia , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Ligadura/métodos , Respiração com Pressão Positiva/métodos , Respiração Artificial/métodos , Fatores de Tempo
8.
An Pediatr (Barc) ; 91(4): 251-255, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-30777716

RESUMO

INTRODUCTION: Patent ductus arteriosus (PDA) is considered a risk factor for necrotising enterocolitis (NEC) and other gastrointestinal complications in preterm infants. The aim of this study is to determine whether there is a higher incidence of abdominal surgery and the associated morbidity and mortality in preterm infants who require treatment due to a significant PDA. METHODS: An observational study was conducted that included preterm infants with <37 weeks of gestational age, and a diagnosis of PDA in the last 10 years. Depending on the treatment received, the patients were divided into 3 groups: medical (A), medical and surgical (B), and no treatment (C). An analysis was performed on the pre- and peri-natal variables, as well as the incidence of gastrointestinal complications (NEC, and need for surgery for this reason), and overall mortality. RESULTS: The study included a sample of 144 patients, of whom 91 were assigned to group A, 16 to B, and 37 to C. The mean gestational age by groups was 28, 26.7, and 30.1 weeks, respectively. The mean birth weight was 1083.9 gr, 909.3 gr, and 1471.2 gr, respectively. As regards the incidence of NEC, a total of 21, 5, and 5 cases, respectively, were found in each group, with 43%, 60% and 35%, respectively requiring abdominal surgery. Mortality by groups was 12%, 19%, and 3%, respectively CONCLUSION: Patients who required treatment for a significant PDA had a higher incidence of gastrointestinal complications and higher mortality than untreated patients, with no statistically significant differences being found. In the group of patients that required treatment, lower gestational age and birth weight, could explain the increase in morbidity and mortality found in these patients.


Assuntos
Abdome/cirurgia , Permeabilidade do Canal Arterial/terapia , Enterocolite Necrosante/cirurgia , Gastroenteropatias/cirurgia , Recém-Nascido Prematuro , Peso ao Nascer , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
9.
Congenit Heart Dis ; 14(1): 46-51, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811796

RESUMO

Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta-analyses of trials using nonsteroidal anti-inflammatory drugs have shown effectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administration. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure after discharge. Careful postdischarge follow-up is important, however, because potential adverse effects of long-standing aortopulmonary shunts may be an indication for catheter-based ductal closure. Identification of extremely preterm infants at greatest risk of potential harm from a persistently patent ductus, who may benefit most from treatment are urgently needed.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tratamento Conservador/métodos , Tomada de Decisões , Permeabilidade do Canal Arterial/terapia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
PLoS One ; 14(2): e0212256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759169

RESUMO

This study aimed to determine the natural course of patent ductus arteriosus (PDA) with noninterventional conservative management and whether the presence and/or prolonged duration of hemodynamically significant (HS) PDA increased the risk of mortality and morbidities in extremely preterm (EPT) infants. We retrospectively reviewed the medical records of EPT infants born at 23-28 weeks of gestation (n = 195) from January 2011 to June 2014, when PDA was managed with noninterventional conservative treatment. We stratified infants into three subgroups of 23-24, 25-26, and 27-28 weeks and analyzed the prevalence and natural evolution of HS PDA, defined as ventilator dependency and PDA size ≥2 mm. Multivariate regression analyses determined if the presence and/or prolonged duration of HS PDA increased the risk for mortality and/or morbidities. The overall incidence of HS PDA was 57% (111/195) at the end of the first postnatal week. In subgroup analyses, infants with 23-24 weeks of gestation had the highest incidence (93%, 50/54), with 64% (47/74) for 25-26 weeks and 21% (14/67) for 27-28 weeks. Six (5%) of 111 infants with HS PDA were discharged without ductus closure, 4 had spontaneous PDA closure on follow up, and device closure was performed for 2 infants. In the multivariate analyses, the presence or prolonged duration (per week) of HS PDA was not associated with the risk of mortality and/or morbidities. Spontaneous closure of HS PDA was mostly achieved, even in EPT infants, with a noninterventional conservative approach. In conclusion, our data showed the incidence and natural course of HS PDA in EPT infants and suggested that the presence or prolonged duration of HS PDA might not increase the rate of mortality or morbidities.


Assuntos
Permeabilidade do Canal Arterial , Canal Arterial/fisiopatologia , Mortalidade Infantil , Lactente Extremamente Prematuro , Tratamento Conservador , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/terapia , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
Early Hum Dev ; 131: 10-14, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30771741

RESUMO

BACKGROUND: The current treatment approach in patent ductus arteriosus suggests the identification of high-risk infants that may benefit the most from treatment. Small for gestational age infants are a high-risk population in which the treatment approach to the patent ductus arteriosus and outcomes have not been described. AIM: To compare the patent ductus arteriosus treatment approach and outcomes in small for gestational age and appropriate for gestational age infants. STUDY DESIGN: Retrospective analysis of infants born between January 1, 2011 and December 31, 2015 at <33 weeks' GA and admitted to neonatal intensive care units (NICU) part of the Canadian Neonatal Network. RESULTS: 595 of 2507 small for gestational age infants (23.7%) and 4714 of 20,002 appropriate for gestational age infants (23.6%) had a patent ductus arteriosus. The patent ductus arteriosus treatment approach (conservative, medical, surgical) was similar in both groups. Small for gestational age infants with and without a patent ductus arteriosus had increased risk of the composite outcome of death or bronchopulmonary dysplasia (aOR 3.40; 95% CI 2.73, 4.24; and aOR 2.72; 95% CI 2.24, 3.31) respectively. CONCLUSIONS: Patent ductus arteriosus management did not differ between small for gestational age and appropriate for gestational age infants. Small for gestational age infants had increased risk of death or bronchopulmonary dysplasia regardless of their patent ductus arteriosus status.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Recém-Nascido Pequeno para a Idade Gestacional , Displasia Broncopulmonar/etiologia , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/terapia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Vasc Endovascular Surg ; 53(3): 264-266, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30691353

RESUMO

Transcatheter closure has become the leading approach for closure of most instances of patent ductus arteriosus. However, there are some complications associated with this procedure. We report a case involving the embolization of a device in the right pulmonary artery during placement. A 20-year-old woman was referred to our hospital for percutaneous transcatheter closure of patent ductus arteriosus. During the deployment of an Amplatzer duct occluder device, it was disconnected from the connector and became embolized in the lower branch of the right pulmonary artery. We could not grasp the device with a gooseneck snare. After various attempts, the device was captured and removed by a BiPal bioptome endomyocardial biopsy forceps. Based on our findings, we recommend that endomyocardial biopsy forceps should be considered as an alternative when such complications occur.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Remoção de Dispositivo/instrumentação , Permeabilidade do Canal Arterial/terapia , Migração de Corpo Estranho/terapia , Dispositivo para Oclusão Septal/efeitos adversos , Remoção de Dispositivo/métodos , Permeabilidade do Canal Arterial/diagnóstico por imagem , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Falha de Prótese , Equipamentos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
13.
Asian Cardiovasc Thorac Ann ; 27(3): 217-220, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30193530

RESUMO

Delayed migration of a ductal occluder device into the aorta after transcatheter closure of a patent ductus arteriosus is extremely rare. We present a case of delayed migration of a ductal occluder into the descending aorta 4 months after its deployment in an 11-year-old girl. Successful surgical removal of the device from the descending aorta and triple-ligation of the ductus arteriosus was performed via a left thoracotomy. The patient made an uneventful recovery.


Assuntos
Aorta , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Migração de Corpo Estranho/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aortografia/métodos , Procedimentos Cirúrgicos Cardíacos , Criança , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo/métodos , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler em Cores , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Ligadura , Toracotomia , Resultado do Tratamento
14.
J Pediatr ; 205: 41-48.e6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30340932

RESUMO

OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. RESULTS: At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). CONCLUSIONS: In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.


Assuntos
Acetaminofen/uso terapêutico , Tratamento Conservador , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/terapia , Ibuprofeno/uso terapêutico , Indometacina/uso terapêutico , Pressão Positiva Contínua nas Vias Aéreas , Permeabilidade do Canal Arterial/classificação , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
15.
Catheter Cardiovasc Interv ; 93(1): 89-96, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30269408

RESUMO

BACKGROUND: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. METHODS: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. RESULTS: Eighty ELBW infants (median procedure weight: 1060 [range 640-2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650-1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2-9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5-4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. CONCLUSIONS: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.


Assuntos
Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Permeabilidade do Canal Arterial/terapia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Peso ao Nascer , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Hemodinâmica , Humanos , Lactente , Recém-Nascido , Ligadura , Pulmão/fisiopatologia , Masculino , Respiração , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Desmame do Respirador
17.
J Pediatr ; 203: 225-233.e1, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30243544

RESUMO

OBJECTIVE: To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants. STUDY DESIGN: This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs. For each epoch and NICU, we calculated proportions of infants receiving cyclooxygenase inhibitor (COXI) or PDA ligation and determined NICU-specific changes in these therapies between consecutive epochs. Generalized estimating equations were used to examine adjusted relationships between NICU-specific changes in PDA management and contemporaneous changes in local outcomes. RESULTS: We included 642 observations of interepoch change at 119 hospitals summarizing 32 094 infants. NICU-specific changes in COXI use and ligation showed significant dose-response associations with contemporaneous changes in adjusted local outcomes. Each percentage point decrease in NICU-specific proportion treated with either COXI or ligation was associated with a 0.21 percentage point contemporaneous increase in adjusted local in-hospital mortality (95% CI 0.06, 0.33; P = .005) among infants born 400-749 g. In contrast, decreasing NICU-specific ligation rate among infants 1000-1499 g was associated with decreasing adjusted local bronchopulmonary dysplasia (P = .009) and death or bronchopulmonary dysplasia (P = .01). CONCLUSIONS: NICU-specific outcomes of preterm birth co-vary with local PDA management. Treatment for PDA closure may benefit some infants born 400-749 g. Decreasing NICU-specific rates of COXI use or ligation were not associated with increases in local adjusted rates of examined adverse outcomes in larger preterm infants.


Assuntos
Displasia Broncopulmonar/mortalidade , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/terapia , Mortalidade Hospitalar , Unidades de Terapia Intensiva Neonatal/organização & administração , Nascimento Prematuro , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/terapia , California , Causas de Morte , Estudos de Coortes , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Ligadura/métodos , Masculino , Análise Multivariada , Gravidez , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
18.
Catheter Cardiovasc Interv ; 92(7): 1323-1328, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30196542

RESUMO

BACKGROUND: Variable patent ductus arteriosus (PDA) morphology and the need to close PDAs in small size patients has led physicians to use Amplatzer Vascular Plugs (AVP) and recently available Amplatzer Duct Occluder II - Additional Sizes (ADO II AS). The purpose of this study was to analyze the safety, efficacy, and complication rates of the ADO II AS and AVPs, specifically AVP II. METHODS: All patients undergoing PDA closure with an AVP or ADO II AS from 2011 to 2016 were included. Clinical, echocardiographic, and angiographic data were collected and reviewed. RESULTS: Four hundred and sixty-nine patients were included. Median age was 27 months (0.75-852) and the median weight was 11.4 kg (1-92). There were 51 patients ≤5 kg. Type A PDA was most common in 48% (n = 225), followed by type E (27.5%, n = 129), type D (13%, n = 61), type C (10.2%, n = 48), and type B (1.3%, n = 6). Devices included AVP II (n = 421), ADO II AS (n = 30), and AVP IV (n = 18), left pulmonary artery stenosis occurred in 4.3% (n = 20). One patient required surgery for severe stenosis; the remaining cases were mild and required no intervention. Device embolization occurred in 3 patients (10%) with the ADO II AS. Successful device closure was achieved in 98.9% of cases. CONCLUSIONS: The AVP II was highly effective for closing PDAs in smaller babies with varying morphologies and is safe when used in small sized patients with relatively low risk of complications. More studies are warranted to clarify the risks of ADO II AS.


Assuntos
Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Cardiovasc J Afr ; 29(4): 246-251, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30204220

RESUMO

BACKGROUND: Methods of closing patent ductus arteriosus (PDA) have evolved over time. We review this development in our setting. METHODS: This was a retrospective analysis of children who had transcatheter PDA closure at Chris Hani Baragwanath Hospital between 1993 and 2008. RESULTS: Over 15 years, 1 254 PDAs were diagnosed, of which 293 required intervention; 139 patients had transcatheter closure, the median age was 1.8 years (interquartile range = 1-4.5 years) and 66% were female (92/139). Mean PDA diameter was 3.2 mm (standard deviation = 1.6 mm), with an average 2:1 shunt. Transcatheter closure was performed using COOK® Flipper coils (n = 93) or Amplatzer™ devices (n = 46). Early occlusion rates for coils were 52% (39/75) and late occlusion occurred in 91% (68/75) of patients. For Amplatzer devices, early occlusion rates were 94% (33/35) and late occlusion was 100%. Amplatzer™ devices, available since 2003, were overwhelmingly used in the later years. CONCLUSIONS: Transcatheter PDA closure was safe and effective in this setting, with outcomes similar to reports elsewhere.


Assuntos
Cateterismo Cardíaco , Permeabilidade do Canal Arterial/terapia , Hospitais Públicos , Setor Público , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Desenho de Prótese , Estudos Retrospectivos , Dispositivo para Oclusão Septal , África do Sul , Fatores de Tempo , Resultado do Tratamento
20.
Med Hypotheses ; 119: 11-13, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30122480

RESUMO

In the early postnatal period, intraventricular hemorrhage may develop in infants with extremely low birth weights due to hemodynamic instability. One of the most significant factors in intraventricular hemorrhage development is fluctuations in the cerebral blood flow due to left-to-right shunting as a result of patent ductus arteriosus, and such cases most frequently develop intraventricular hemorrhage within the first 72 h. The frequency of intraventricular hemorrhage may be reduced through the prevention of fluctuations in the cerebral blood flow in this time frame. Based on our hypothesis, we recommend that extremely low birth weight infants should be delivered and monitored in hypobaric rooms for the first three days after birth, as this may reduce left-to-right shunting as a result of patent ductus arteriosus by preventing the rapid drops seen in pulmonary pressure after birth. A more stable hemodynamic status may be achieved by increasing the cerebral blood flow during an acute term in a hypobaric environment. Gradual transition to the normobaric status at the end of the third day may prevent the long-term negative effects of hypobaric conditions.


Assuntos
Pressão do Ar , Hemorragia Cerebral/prevenção & controle , Parto Obstétrico/métodos , Circulação Cerebrovascular , Permeabilidade do Canal Arterial/terapia , Feminino , Hemodinâmica , Humanos , Hipóxia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/patologia , Monitorização Fisiológica/métodos , Oxigênio/química , Parto , Gravidez , Fatores de Tempo
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