Simultaneous type III congenital esophageal atresia and patent ductus arteriosus in a low-weight patient: A case report

BACKGROUND We report a low-birth-weight child(1.8 kg)with neonatal type III congenital esophageal atresia(CEA)combined with symptomatic patent ductus arteriosus(PDA).After comprehensive evaluation,esophageal anastomosis was performed on postnatal day 11 after excluding surgical contraindications,and arterial catheter ligation was performed at the same time.Concurrent surgery for CEA combined with PDA has not been clearly reported in the literature.CASE SUMMARY We report a 6-day-old female child with type III CEA and PDA.The patient presented with foam at the mouth after birth,cough and shortness of breath after feeding.At another hospital,she was considered to have neonatal pneumonia,neonatal jaundice and congenital heart disease and transferred to our hospital.After iodine oil radiography of the esophagus and echocardiography we con-firmed diagnosis of CEA and PDA.The diameter of the PDA was 8 mm,with obvious left to right shunting.We performed right rear extrapleural orificium fistula ligation and esophageal anastomosis,and ligation of PDA via left axilla straight incision after 5 d of hospitalization.The operations were successful,and the incision healed after 12 d,and the patient was discharged.We re-examined the patient 1 mo after surgery.She did not vomit when she ate rice flour.Esophageal angiography showed no stricture of the anastomotic stoma.The patient weighed 3.2 kg.CONCLUSION For CEA patients with multiple risk factors,comprehensive,timely and accurate diagnosis and evaluation,and early treatment may improve prognosis.

Transcatheter Closure vs.Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus:A Systematic Review and Meta-Analysis

Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)in preterm infants with pPDA.Methods:A literature search of Ovid Cochrane Library,Medline,Embase,Epub,Scopus,PMC Preprints,and ClinicalTrials.Gov was conducted from inception to May 06,2022.Eligible studies reported infants diagnosed with pPDA born at≤2000 g birth weight or at≤37 weeks’who underwent TC or SL as treatment.This review was registered in PROSPERO(CRD42022325944).Results:From 97 studies screened,8 studies met the eligibility criteria,with a total of 756 preterm infants undergoing either TC(n=366)or SL(n=390).Compared to TC,SL had higher mortality rates(OR=0.32,95%CI:0.16,0.66,I^(2)=0%).No difference was seen in post-procedural complication rate(OR=0.90,95%CI:0.18,4.44,I^(2)=79%),mean duration of post-procedural mechanical ventilation(MD=−2.21 days,95%CI:−4.88,0.47,I^(2)=60%),hospital stay length(MD=−8.30 days,95%CI:−17.03,0.44,I^(2)=0%)or neonatal intensive care unit stay length(MD=−3.50 days,95%CI:−10.27,3.27,I^(2)=0%).Conclusion:Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL.Despite the promising trends demonstrated in this meta-analysis,further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.

Surgical Closure of Isolated Patent Ductus Arteriosus in Cenhosoa Antananarivo

Introduction: Patent ductus arteriosus (PDA) is a congenital heart disease whose seriousness lies in the risk of pulmonary hypertension, congestive heart failure and death. The aim of this study was to describe the surgical closure of an isolated patent ductus arteriosus (PDA) performed in Soavinandriana Teaching Hospital. Methods: This was a retrospective and descriptive study, during thirteen-years-period (January 2004 to December 2016), performed at Cardiac surgery unit of Soavinandriana Teaching Hospital, including all children underwent surgical closures of an isolated PDA. Demographic data, birth weight, clinical signs, diagnostic imaging, time between diagnosis and surgery and hospital left stays were analyzed. Results: A total of eighty-six children were recorded, including 21 males (24.42%) and 65 females (75.58%), giving sex ratio of 30%. The average age was 33.91 months. Children were born with a low birth weight in 12.79% of cases. PDA was symptomatic in 81.39%. The most circumstances of discovery were recurrent lung infections (31.40%), dyspnea (24.41%) and failure to thrive (19.76%). Echocardiography showed left ventricular dilatation (63.95%), pulmonary hypertension (73.25%). The ductus was large in 97.67% and the mean diameter was 5 mm. Chest X-ray showed cardiomegaly (97.67%) and increased pulmonary vascularity (86.04%). Mean delay of surgical procedures after diagnosis was 15.16 months. Surgical procedures consisted left posterolateral thoracotomy with a section and suture after clamping the ductus. Earlier postoperatives courses were simple in all children. The mean duration of hospitalization was 8.93 days. Conclusion: PDA was most common large (97%) and symptomatic (81%) in our study. Surgical closure of an isolated PAD was the only surgical procedure of congenital heart cardiopathy available in Antananarivo.

Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus

BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content increases,which could lead to abnormal circulation hemodynamics and pulmonary edema.It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.METHODS From January 2018 to March 2020,69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group.At the same time,89 very low-weight preterm neonates without PDA were randomly selected as the control group.All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth.The clinical characteristics and main ultrasonography results were compared between the two groups.Pearson’s analysis was used to analyze the correlation between lung ultrasonography score(LUS)and other related clinical and ultrasonography results in all neonates.In the PDA group,PDA diameters were recorded,and the correlation with LUS and left atrium to aortic(LA/AO)dimension ratio were also analyzed.LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA.When the ratio is≥1.5,it suggests the possibility of hemodynamic changes in persistent PDA.A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.RESULTS A total of 158 neonates were enrolled in this study,including 69 in the PDA group and 89 in the control group.There were no statistical differences in sex,gestational age,birth weight,ventilator dependence,hospitalization length and left ventricular ejection fraction between the two groups(P>0.05).The LUS and LA/AO ratio in the PDA group were higher than those in the control group(P<0.05),but there was no difference of LUS in neonates with or without use of the ventilator(t=0.58,P=0.16).In all cases,LUS was negatively correlated with gestational age(r=-0.28,P<0.01)and birth weight(r=-0.36,P<0.01),while positively correlated with the LA/AO ratio(r=0.27,P<0.01).In the PDA group,PDA diameter was positively correlated with the LA/AO ratio(r=0.39,P<0.01)and LUS(r=0.31,P<0.01).Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA(area under the curve=0.741;sensitivity=93.75%;specificity=50.94%).CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.

Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus

Patent ductus arteriosus(PDA) is a common clinical condition in preterm infants which is inversely related to birth weight and gestational age. Cyclooxygenase inhibitors such as indomethacin and ibuprofen which block the prostaglandin conversion from arachidonic acid are the most commonly used drugs for ductal closure. This review focuses on the safety and efficacy oral medications in the management of PDA in preterm infants. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen probably due to the pharmacokinetic of the drug. However, these medications were reported to be associated with several adverse including transient renal failure, gastrointestinal bleeding and perforation, hyperbilirubinemia and platelet dysfunction. Paracetamol seems be an alternative to PDA therapy with lower adverse events and side effects.

Clinical Exploration of Transcatheter Closure of Patent Ductus Arteriosus With Duct Occluder in Infants

Objectives To explore the feasibility, necessity, and security of transcatheter closure of patent ductus arteriosus （PDA） in infants. Methods There were 230 infants with PDA. The ages were （7.3 ±3.2 ） months and the weight （6.6 ± 2.8） Kg in average. They were separated into two groups. Group A was formed by the infants weighing less than 6 Kg, Group B over 6 Kg. Right heart catheterization was performed first to calculate the ratio of Qp/Qs. Then descending aortography demonstrated the diameter and shape of PDA. Proper occluder was selected to finish the inter- vention. Echocardiography was performed after intervention 24 hours and 1, 3, 6, 12 and 24 months. Results In Group A the technical achievement ratio was 94.6% with the average diameter of PDA （6.2±3.2） mm. In Group B the technical achievement ratio was 100% with the average diameter of PDA （4.8 ± 2.5 ） mm. We used the Amplatzer Duct Occluder with the type from 6 -8 mm to 12 - 14 ram, the delivery sheath from 6 French to 8 French. 24 hours after intervention, echocardiography demonstrated that there were 6 residual shunts in Group A while 22 in Group B. After 1 year, residual shunt existed in neither group. There were 4 patients whose femoral arteries pulsed weakly after intervention in Group A, while in Group B there were 3. They all recovered 24 hours after the application of urokinase. In Group A blood flow velocity in descending aorta increased in 5 infants, while in Group B there were 3. They all resumed in 6 - 12 months. Conclusions Transcatheter closure of PDA in infants is safe and technically feasible. However, indication should be strictly selected and the intervention should be performed by experienced physician.

Perpulmonary Device Closure of Patent Ductus Arteriosus with Minimum Diameter More Than 4 mm in Infants

Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.

Right-heart contrast echocardiography reveals missed patent ductus arteriosus in a postpartum woman with pulmonary embolism: A case report

BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and interpreted logically,RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.CASE SUMMARY A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress.Two years prior,she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography.While the latter showed no sign of pulmonary artery embolism,the former showed pulmonary artery hypertension,moderate insufficiency,and mild stenosis of the aortic valve.RHCE showed microbubbles appearing in the left ventricle,slightly delayed after rightheart filling with microbubbles;no microbubbles appeared in the left atrium and microbubbles’appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles.Conventional echocardiography was re-performed,and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles.The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.CONCLUSION RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.

New Nano-Film Single-Rivet Patent Ductus Arteriosus Occluders:A Prospective,Randomized and Double-blind Study

Nitinol alloy occluders are widely used in the transcatheter intervention treatment of congenital heart diseases like patent ductus arteriosus（PDA）.However,nitinol alloy contains high levels of nickel,which can lead to toxic effects in the immune and hematopoietic systems if released in sufficient quantities.A new type of single-rivet occluder coated with nano-film has been developed to limit the release of nickel.In total,23 patients were recruited and randomly assigned to the experimental group（n=12） with the new nano-film single-rivet occluders or the control group（n=11） with the traditional occluders.One case in the control group was lost to follow-up.The remaining 22 cases were followed up at 24 h,7 days,1 month,3 months,and 6 months after the procedure.There were no statistically significant differences in routine blood test,alanine aminotransferase,creatinine,and troponin between the experimental and control groups.Serum nickel concentration in both two groups increased at 24 h after the procedure,peaked at 1 month,and returned to preoperative levels at 6 months.Serum nickel levels in the experimental group were significantly lower than in the control group at 24 h,7 days,1 month,and 3 months after the procedure.These data suggested that the nano-film coating effectively prevented nickel release from the new occluders,and therefore has a preferable safety profile.

Analysis of two cases of patent ductus arteriosus ligation in preterm identical twins and literature review

Objective:To investigate the timing and effect of surgical ligation in the treatment of patent ductus arteriosus(PDA)in preterm identical twins.Methods:Retrospective analysis was made on the treatment of 2 cases of preterm twins with hemodynamic significant PDA(hsPDA)with corresponding clinical manifestation in our neonatology department,and literatures of PDA ligation for preterm twins were retrieved.Results:These 2 cases were naturally conceived monochorionic diamniotic twins,with gestational age 30+2 weeks,birth weight was 1510g and 780g for larger twin and smaller twin,with birth weight discordance 48.3%.They both developed hsPDA with corresponding clinical manifestation,series Echocardiography showed evidence of left to right shunting and cardiac insufficiency which were left atrial and ventricular enlargement,large PDA(2.8~3.5mm),failed two courses of ibuprofen,N-terminal pro-brain natriuretic peptide level increased significantly,finally received surgical ligation with significant clinical improvement and no related complications.12 cases were found from literature search,including our 2 cases,of these,2 died,9 were cured and 1 improved significantly.Among 6 cases whose detailed information were available,4 infants were identical twins,2 unknown.Conclusions:Preterm identical twins have the same genetic basis,the possibility of PDA ligation for both the larger twin and smaller twin should be alerted if the gestaional age is small and birth weight discordance is above 30%.If preterm twins have hsPDA who may fail ibuprofen treatment,surgical ligation should be considered early,and it is safe and effective.

Ibuprofen treatment for patent ductus arteriosus in preterm infants:a retrospective cohort study in a leading Chinese center

Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus(PDA)as to how and when to treat.We aimed to clarify this issue in very preterm infants(VPIs;<32 weeks).Methods:This retrospective study included 1659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system(the CVD scoring).The VPIs were classified into six groups(A1,A2,A3,B1,B2,and B3)based on CVD scores(A,<3,and B,≥3),and treatment with ibuprofen for PDA(1,conservational management;2,early ibuprofen treatment;and 3,late ibuprofen treatment).Treatment was stopped when PDA was closed,CVD score was zero or PDA needed ligation.Results:VPIs with CVD scores<3 had most PDA closure without surgery,and early ibuprofen treatment did not significantly affect PDA closure.VPIs with CVD scores≥3 had some PDA closure after 2 courses of treatment,but closure rates decreased linearly with ibuprofen course(1^(st)75.2%,2^(nd)62.3%,3^(rd)50.0%,P<0.0001),and early ibuprofen treatment(group B2)did not increase PDA closure compared to late ibuprofen treatment(group B3).In these same infants,the longer they were in CVD scores≥3,the more the complications of preterm were increased(retinopathy of prematurity ROP 1^(st)16.5%,2^(nd)23.8%,3^(rd)29.6%,P=0.016;bronchopulmonary dysplasia BPD 1^(st)15.5%,2^(nd)26.7%,3^(rd)33.8%,P<0.0001;intraventricular hemorrhage IVH 1^(st)20.4%,2^(nd)32.4%,3^(rd)23.8%,P=0.015).Conclusion:Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score≥3.

The Changes of Left Ventricular Form and Function After Closure of Moderate-to Large-sized Patent Ductus Arteriosus Using Domestic-made Occluder

Objectives To evaluate the changes of the left ventricular form and function after closure of moderate- to large-sized patent ductus arteriosus （PDA） using domestic-made occluder. Methods 22 patients with PDA underwent procedure successfuly using the domestic-made occluder. The mean PDA minimal （pulmonary end） diameter by aortography was 8.01±2.47 mm （range 4 to 15.5mm）. All patients underwent transthoracic echocardiography （TTE） study before the procedure and the following 48 hours, 3 months after procedure. Results All patients had been implanted the domestic-made occluders successfully with no haematolysis, infective endocarditis, recanalization and other complications. At 3 months, mean LVED was decreased to 50.05±6.55 mm, compared to the pre-procedure （55.67 ±8.48 mm）, P 〈 0.01. After 48 hours of the procedure, mean LVEDD and LVESD decreased significantly （156.22± 51.40 mL vs. 121.28±35.73ml, 57.16±32.07 mL vs. 45.88±15.97 mL）, P〈 0.05. At 3 months, LVEDD decreased to 110.93 ±15.08ml, LVSV reached 73.50± 9.19 mL, compared to the pre-procedure, P 〈 0.01. LVESD decreased to 37.43±10.44 mL at 3 months, P〈 0.05. Conclusions Closuring of moderate- to largesized PDA using domestic-made occluder is effective and safe. After procedure, left ventricular form and function improved.

Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors

Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.

Protective strategies to prevent patent ductus arteriosus

Ductus arteriosus is the communication between the proximal aorta and the pulmonary artery which diverts well oxygenated blood from the placenta to the systemic circulation bypassing the fluid filled lung in the fetal circulation. Therefore it is very essential for fetal survival. After birth, in term infants the ductus usually closes within the first day of life, starting with functional closure followed by anatomical closure by vascular remodeling.

A Retrospective Study of 1526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus

Background： Patent ductus arteriosus （PDA） is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices. Methods： One thousand five hundred and twenty-six patients （537 boys, 989 girls） with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications. Results： Median age and median weight were 4.0 years （range： 0.3 5-2.0 years old） and 15.3 kg （range： 4.5-91.0 kg）, respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 ram, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I （ADO I, 1280, 85.8%）, Cook detachable coils （116, 7.8%）, ADO II （ADO II, 68, 4.6%）, muscular VSD occluder （12, 0.8%）, and Amplatzer vascular plug （16, 1.0%）. Conclusions： Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults： immediate and two-year follow-up results

Background Transcatheter closure of patent ductus arteriosus （PDA） is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension （PAH） in adults.

Outcome in neonates with necrotizing enterocolitis and patent ductus arteriosus

Background:There is no agreement of the influence of patent ductus arteriosus(PDA)on outcomes in patients with necrotizing enterocolitis(NEC).In this study,we assessed the infl uence of PDA on NEC outcomes.Methods:A retrospective study of 131 infants with established NEC was performed.Outcomes(death,disease severity,need for surgery,hospitalization duration),as well as multiple clinical parameters were compared between NEC patients with no congenital heart disease(n=102)and those with isolated PDA(n=29).Univariate,multivariate and stepwise logistic regression analyses were performed.Results:Birth weight and gestational age were significantly lower in patients with PDA[median(95%CI):1120 g(1009-1562 g),28.4 wk(27.8-30.5 wk)]than in those without PDA[median(95%CI):1580 g(1593-1905 g),32.4 wk(31.8-33.5 wk);P<0.05].The risk of NEC-attributable fatality was higher in NEC patients with PDA(35%)than in NEC patients without PDA(14%)[univariate odds ratio(OR)=3.3,95%CI:1.8-8.6,P<0.05;multivariate OR=2.4,95%CI:0.82-2.39,P=0.111].Significant independent predictors for nonsurvival within the entire cohort were advanced disease severity stage III(OR=27.9,95%CI:7.4-105,P<0.001)and birth weight below 1100 g(OR=5.7,95%CI:1.7-19.4,P<0.01).Conclusions:In patients with NEC,the presence of PDA is associated with an increased risk of death.However,when important differences between the two study groups are controlled,only birth weight and disease severity may independently predict mortality.

Different approaches for patent ductus arteriosus in premature infants using acetaminophen

Background Acetaminophen use for pharmacological treatment of hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants is becoming more popular with emerging evidence that it is effective as well as safe alternative for other agents used to close hsPDA.Data sources We performed a narrative review of literature about pharmacological treatment of PDA using acetaminophen.Results Acetaminophen was used as a prophylaxis,symptomatic,targeted,and a rescue approach.Conclusions It appears that acetaminophen could be used in different approaches to close the hsPDA.Long-term outcomes of acetaminophen exposure early in life still lack certainty.

Is early patent ductus arteriosus ligation helpful in premature neonates? A 10-year retrospective study

Background To compare short and long outcomes between early(≤28 days)(EL)and late ligation(LL)groups.To explore factors predicting early extubation(≤7 days)after patent ductus arteriosus(PDA)ligation.Methods We conducted a single center,retrospective cohort study of preterm infants<32 weeks who underwent surgical ligation over a 10-year period(2009-2019).Results A total of 133 infants underwent PDA ligation,in the study period.Both groups had similar short-term outcome such as bronchopulmonary dysplasia(BPD)or death(96%vs.98%,P=0.64)and long-term clinical outcomes including Bayley's assessment at 2 years corrected age.Fewer infants in the EL group developed severe BPD(63%vs.81%,P=0.02).Age at ligation had adjusted odds ratio of 1.04 with over lapping confidence interval(95%CI 1.0-1.1,P=0.02)for severe BPD/death.There was no difference in day of extubation between the EL and LL group(8 days vs.7 days,P=0.85).Left atrium/aortic root ratio of ≥1.75 would give sensitivity of 41% and 80% specificity for early extubation(area under the curve of 0.61).There was marginal reduction of hospital stay in the EL group[113(105-121)days vs.115(107-123)days;log rank P=0.026].Conclusion EL can be delivered safely with a clinically important lower incidenee of severe BPD and shorter duration of hospital stay compared to LL.

Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation

In the presence of a large patent ductus arteriosus(PDA),aortic co-arctation(CoA)cannot be diagnosed clinically because PDA masks the clinical features.This condition impedes the identification of CoA by transthoracic echcocardiography.However,the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure.In this article,a case of PDA was presented,in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery.