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      Application of NPE in the assessment of a patent ductus arteriosus

      review-article
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , , on behalf of the European Special Interest Group “Neonatologist Performed Echocardiography” (NPE)
      Pediatric Research
      Nature Publishing Group US

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          Abstract

          In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.

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          Most cited references66

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          Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants.

          The prophylactic administration of indomethacin reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage in very-low-birth-weight infants (those with birth weights below 1500 g). Whether prophylaxis with indomethacin confers any long-term benefits that outweigh the risks of drug-induced reductions in renal, intestinal, and cerebral blood flow is not known. Soon after they were born, we randomly assigned 1202 infants with birth weights of 500 to 999 g (extremely low birth weight) to receive either indomethacin (0.1 mg per kilogram of body weight) or placebo intravenously once daily for three days. The primary outcome was a composite of death, cerebral palsy, cognitive delay, deafness, and blindness at a corrected age of 18 months. Secondary long-term outcomes were hydrocephalus necessitating the placement of a shunt, seizure disorder, and microcephaly within the same time frame. Secondary short-term outcomes were patent ductus arteriosus, pulmonary hemorrhage, chronic lung disease, ultrasonographic evidence of intracranial abnormalities, necrotizing enterocolitis, and retinopathy. Of the 574 infants with data on the primary outcome who were assigned to prophylaxis with indomethacin, 271 (47 percent) died or survived with impairments, as compared with 261 of the 569 infants (46 percent) assigned to placebo (odds ratio, 1.1; 95 percent confidence interval, 0.8 to 1.4; P=0.61). Indomethacin reduced the incidence of patent ductus arteriosus (24 percent vs. 50 percent in the placebo group; odds ratio, 0.3; P<0.001) and of severe periventricular and intraventricular hemorrhage (9 percent vs. 13 percent in the placebo group; odds ratio, 0.6; P=0.02). No other outcomes were altered by the prophylactic administration of indomethacin. In extremely-low-birth-weight infants, prophylaxis with indomethacin does not improve the rate of survival without neurosensory impairment at 18 months, despite the fact that it reduces the frequency of patent ductus arteriosus and severe periventricular and intraventricular hemorrhage.
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            Towards rational management of the patent ductus arteriosus: the need for disease staging.

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              Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less.

              Ductus arteriosus (DA) closure occurs within 96 hours in >95% of neonates >1500 g in birth weight (BW). The prevalence and postnatal age of spontaneous ductal closure in neonates 34% of ELBW neonates and is predicted by variables related to maturation, for example, EGA and an absence of HMD, whereas indomethacin failure could not be predicated.
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                Author and article information

                Contributors
                +31 24 36 14 430 , willem.deboode@radboudumc.nl
                Journal
                Pediatr Res
                Pediatr. Res
                Pediatric Research
                Nature Publishing Group US (New York )
                0031-3998
                1530-0447
                2 August 2018
                2 August 2018
                2018
                : 84
                : Suppl 1
                : 46-56
                Affiliations
                [1 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Department of Neonatal Intensive Care, , University Hospital Antwerp, ; Edegem, Belgium
                [2 ]Department of Neonatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
                [3 ]ISNI 0000 0004 0641 6648, GRID grid.412910.f, Neonatal Medicine, University Hospital of North Tees, Durham University, ; Stockton-on-Tees, United Kingdom
                [4 ]ISNI 0000 0004 0617 7587, GRID grid.416068.d, Department of Neonatology, , The Rotunda Hospital, ; Dublin, Ireland
                [5 ]ISNI 0000 0004 0488 7120, GRID grid.4912.e, Department of Paediatrics, , The Royal College of Surgeons in Ireland, ; Dublin, Ireland
                [6 ]Neonatal Intensive Care Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
                [7 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Departments of Pediatrics and Physiology, , University of Toronto, ; Toronto, Canada
                [8 ]GRID grid.488549.c, Department of Neonatology, , University Children’s Hospital, ; Tuebingen, Germany
                [9 ]GRID grid.461578.9, Department of Neonatology, , Radboud university medical center, Radboud Institute for Health Sciences, Amalia Children’s Hospital, ; Nijmegen, The Netherlands
                [10 ]ISNI 0000 0004 0392 0216, GRID grid.416047.0, Department of Neonatology, , Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, ; Cambridge, United Kingdom
                [11 ]Department of Neonatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
                [12 ]ISNI 0000 0000 8970 9163, GRID grid.81821.32, Department of Neonatology, , La Paz University Hospital, ; Madrid, Spain
                [13 ]Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
                [14 ]INFANT Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland
                [15 ]ISNI 0000 0004 0488 7120, GRID grid.4912.e, Department of Pediatrics, , The Royal College of Surgeons in Ireland, ; Dublin, Ireland
                [16 ]Division of Newborn Medicine, Mount Sinai Kravis Children’s Hospital, New York, NY USA
                [17 ]ISNI 0000 0004 0641 6648, GRID grid.412910.f, University Hospital of North Tees, Durham University, ; Stockton-on-Tees, United Kingdom
                [18 ]Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
                [19 ]ISNI 0000 0001 2355 7002, GRID grid.4367.6, Department of Pediatrics, , Washington University School of Medicine, ; Saint Louis, MO USA
                [20 ]GRID grid.429583.1, Department of Pediatrics, , Goryeb Children’s Hospital, ; Morristown, NJ USA
                [21 ]ISNI 0000 0001 2306 7492, GRID grid.8348.7, John Radcliffe Hospital, ; Oxford, United Kingdom
                [22 ]ISNI 0000 0004 1936 8921, GRID grid.5510.1, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, ; Oslo, Norway
                [23 ]ISNI 0000 0004 0389 8485, GRID grid.55325.34, Department of Cardiology and Center for Cardiological Innovation, , Oslo University Hospital, Rikshospitalet, ; Oslo, Norway
                [24 ]ISNI 0000 0004 0627 3659, GRID grid.417292.b, Department of Paediatrics, , Vestfold Hospital Trust, ; Tønsberg, Norway
                [25 ]ISNI 0000 0004 0386 2271, GRID grid.416259.d, The Royal Women’s Hospital, ; Parkville, VIC Australia
                [26 ]Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
                [27 ]GRID grid.411492.b, Azienda Ospedaliero-Universitaria S Maria della Misericordia, ; Udine, Italy
                [28 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Clinical Science, , Intervention and Technology, Karolinska Institutet, ; Stockholm, Sweden
                [29 ]GRID grid.488549.c, Department of Neonatology, , University Children’s Hospital of Tübingen, ; Tübingen, Germany
                [30 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Department of Pediatrics, , Monash University, ; Melbourne, Australia
                [31 ]ISNI 0000 0004 0622 5016, GRID grid.120073.7, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, ; Cambridge, United Kingdom
                [32 ]GRID grid.461578.9, Department of Paediatric Cardiology, , Radboudumc Amalia Children’s Hospital, ; Nijmegen, The Netherlands
                [33 ]ISNI 0000 0004 0511 3127, GRID grid.483296.2, Department of Pediatrics, , Clinique des Grangettes, ; Chêne Bougeries, Switzerland
                [34 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Department of Pediatrics, , Antwerp University Hospital UZA, ; Edegem, Belgium
                [35 ]ISNI 0000 0004 0626 3362, GRID grid.411326.3, Department of Neonatology, , University Hospital Brussels, ; Brussels, Belgium
                [36 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Department of Paediatrics & Child Health, , University of Stellenbosch, ; Cape Town, South Africa
                Article
                77
                10.1038/s41390-018-0077-x
                6257219
                30072803
                d5ac0132-6e97-41f0-8ab0-f80467e810aa
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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                © International Pediatric Research Foundation, Inc. 2018

                Pediatrics
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