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At least 1,423 records · Page 79Linked to original sources
PubMed2006

Renal impairment associated with indomethacin treatment for patent ductus arteriosus in extremely preterm neonates--is postnatal age at start of treatment important?

OBJECTIVE: To study serum creatinine (SCr) levels following indomethacin for patent ductus arteriosus (PDA) closure in extremely preterm neonates in relation to postnatal age at the start of treatment. METHODS: This was a retrospective (January 2000-December 2002) analysis of data on preterm neonates (gestation <29 weeks) who received indomethacin for PDA. Pre-existing renal malformation and/or impairment and high serum levels of nephrotoxic drugs were criteria for exclusion. RESULTS: Indomethacin was commenced at postnatal age <7 days and >or=7 days in 60 (group 1) and 30 (group 2) neonates, respectively. The median (Q1, Q3) gestational age and birth weight for group 1 and group 2 neonates were 25 (23, 27) vs. 25 (24, 26) weeks and 740 (620, 909) vs. 780 (663, 966) grams, respectively. Postnatal age <7 days at start of indomethacin was associated with higher baseline (0.083 (0.074, 0.090) vs. 0.073 (0.054, 0.083) mmol/L, p=0.001) and peak SCr levels (0.099 (0.089,0.109) vs. 0.090 (0.064, 0.104) mmol/L, p=0.015). Logistic regression analysis controlling for gestational age and baseline SCr level indicated that postnatal age >or=7 days was a risk factor for elevated SCr after indomethacin (OR=13.4, 95% CI: 3.8-46.6, p < 0.001). CONCLUSION: Postnatal age >or=7 days at the start of indomethacin is a predictor of a significant rise in SCr in extremely preterm neonates.

Age Factors↗
PubMed2004

Patent prosecution in structural proteomics.

This paper presents a brief overview of intellectual property rights and the various areas in proteomics to which intellectual property rights may be applicable. Technology transfer, including licensing and business agreements, are not covered in this paper. Instead, issues and complications related to national and overseas patent prosecution in this relatively new field will be discussed.

Intellectual Property↗
PubMed1976

Ligation of patent ductus arteriosus in premature infants.

Twenty-four neonates at 25-34 weeks' gestation with a weight range of 570-1530 g underwent ligation of patent ductus arteriosus (PDA). The infants had mild to severe respiratory distress syndrome at birth and later developed signs of heart failure as a result of left-to-right shunting through a PDA. Surgical closure of the PDA was performed within 2-31 days after birth. In the period before operation the heart rate was monitored constantly and the arterial blood-gases were assessed frequently. The trachea was intubated and respiration was controlled with a ventilator. Surgery was performed under controlled ventilation and no anaesthesia was used. Care was taken not to overventilate the lungs. Nine infants died. Death was associated with higher peak inspiratory ventilator pressures at the time of operation and with complications occurring during or after the operation. The most common complication was tension pneumomediastinum which appears to be related to excessive ventilator pressures during surgery.

Acidosis↗
PubMed2004

Interactions between patent medicine vendors and customers in urban and rural Nigeria.

Patent medicine vendors (PMVs) supply a large portion of the drugs used by the public in African countries to treat their illnesses. Little has been reported about what actually transpires between PMVs and their customers, but nevertheless, concerns have been raised about the potential for abuse of their position. This study conducted 720 observations of PMV-customer interaction in 444 medicine shops in both the metropolis of Ibadan and the rural town of Igbo-Ora in Oyo State, Nigeria. Each interaction lasted 2 minutes on average. A quarter of the customers shared their illness problems with the shop attendant, 9% presented a prescription and the majority simply requested items for purchase. Most customers (73%) were buying drugs for themselves, while the remainder had been sent to purchase for another person. The former were more likely to be adults, while the latter were more often children and adolescents. The most common PMV behaviours are: selling the requested medicine (69%), giving their own suggestions to the customer (30%), asking questions about the illness (19%) and providing instructions on how to take the medicine (21%). Only three referrals were observed. The large number of specific drug requests was evidence of a public that was actively involved in self-care, and thus the major role of the PMV appeared to be one of salesperson meeting that need. A second role became evident when the customer actually complained about his/her illness, a practice associated with the more active PMVs who asked questions, gave suggestions and provided information. These PMV roles can be enhanced through consumer education, PMV training and policy changes to standardize and legitimize PMV contributions to primary health care.

Adolescent↗
PubMed2005

Maternal and offspring MTHFR gene C677T polymorphism as predictors of congenital atrial septal defect and patent ductus arteriosus.

To observe the association of MTHFR gene C677T locus polymorphism with occurrence of congenital heart defects (CHDs), 21 patients with atrial septal defect (ASD), 35 patients with patent ductus arteriosus (PDA), one patient with both conditions combined, and their biological parents were collected as the case group. Another 104 normal individuals and their biological parents without a family history of birth defects were selected as the control group. MTHFR C677T genotypes of each sample were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results showed for the occurrence of ASD, the odds ratio (OR) of TT genotype was 4.08 [95% confidence interval (95% CI) = 1.28-13.24] compared with CT genotype. For the occurrence of PDA, the ORs of TT were 3.44 (95% CI = 0.89-16.13) and 2.38 (95% CI = 0.92-6.14) compared with CC and CT genotypes, respectively. Author as meant? Compared with CC + CT genotype combination, the ORs of TT were 3.95 (95% CI = 1.38-11.44) and 2.60 (95% CI = 1.02-6.36) for ASD and PSD respectively. The results also had sex differences and the statistical significance was only observed in male ASD and female PDA. The ORs of T allele carriers were 2.29 (95% CI = 1.08-4.92) and 1.88 (95% CI = 1.02-3.47) compared with C allele for the occurrences of ASD and PDA respectively. The analysis of parents genotype showed that the OR of TT mothers was 2.31 (95% CI = 0.96-5.59, P < 0.05) compared with (CC + CT) for the occurrence of PDA in offspring. So this study could give a clue that MTHFR C677T locus variation was related with occurrence of ASD and PDA, and the carriers of TT genotype and T allele had higher risk of diseases. The mother carrying TT genotype was associated with occurrence of PDA in offspring.

Adult↗
PubMed1978

Patent ductus arteriosus and ventricular septal defect: trends in reported frequency.

Nationwide secular increases in the reported frequency of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) are presented. Detailed examination of data from one locality, Metropolitan Atlanta, indicates that the increases were primarily the result of a rise in the reported frequency of these heart defects in isolated form (i.e., without other malformations). During the latter years of the study more Atlanta babies with isolated PDA were of low birth weight and short gestational age, and more cases were diagnosed in the infants' first week of life. The increase in VSD was not as consistent nor as dramatic as that of PDA. Neither were there any changes over time in the demographic characteristics of Atlanta infants affected by isolated VSD. At least part and perhaps all of the increase in PDA may be explained by an increased awareness on the part of physicians who take care of premature infants. While the increase in reported VSD may be explainable on the basis of awareness or secular shifts in diagnostic standards, the problem seems qualitatively different from that of PDA.

Black or African American↗
PubMed1997

Transcatheter closure of patent ductus arteriosus with the Rashkind occluder. Acute results and angiographic follow-up in adults.

We performed catheter closure of a patent ductus arteriosus with a Rashkind occluder in 51 adult patients (aged 14 to 76 years). The diameter of the ductus ranged from 2 to 13 mm (mean 4.5 +/- 2.0 mm), QP:QS from 1.0 to 2.6 (mean 1.6 +/- 0.3). The procedure was successful in 50/51 patients, in one of them at a second attempt. In one patient, the ductus could not be closed even with additional occluders. This patient was sent for surgery. In two patients with a large ductus, two Rashkind umbrellas were implanted simultaneously. Immediately after ductus closure, there was a residual shunt in 40/50 patients decreasing to 26/50 after 20 min. Two of the patients with a residual shunt suffered from haemolysis. In 16 patients, the residual shunt disappeared spontaneously within some months. In 15 patients, additional occluders (a second occluder in 12, a third occluder in one, and a fourth and fifth occluder in another) were implanted during the initial procedure or during follow-up. All patients were followed until angiography proved complete closure of the ductus. At the time of the last follow-up angiogram, the ductus was occluded in 49/50 patients; one patient refused a follow-up angiogram. Ductus occlusion with the Rashkind umbrella can be considered a technique with a high success rate and low rate of complications in adults. However, a residual shunt is not uncommon. Additional occluders have to be implanted in many patients.

Adolescent↗
PubMed1990

Dissecting aneurysm of the pulmonary artery in a case of unoperated patent ductus arteriosus.

A 54-year-old woman with unoperated patent ductus arteriosus developed fatal cardiac tamponade due to a dissecting aneurysm of the pulmonary artery causing haemopericardium. Histology of the pulmonary artery showed the presence of cystic medial necrosis. Previous reports of this condition are reviewed and the role of pulmonary hypertension causing secondary cystic medial necrosis is discussed.

Adult↗
PubMed1995

Detection of residual flow by transesophageal echocardiography during video-assisted thoracoscopic patent ductus arteriosus interruption.

The purpose of this study is to examine prospectively the efficacy of intraoperative transesophageal echocardiography (TEE) monitoring in reducing the incidence of residual ductal flow during video-assisted thoracoscopic (VATS) patent ductus arteriosus (PDA) interruption. Thirty consecutive patients undergoing PDA interruption via the VATS procedure were monitored with an appropriately sized Hewlett-Packard color-Doppler TEE probe. All examinations were performed by the same individual and interpreted with a cardiologist. Real time TEE monitoring was used, but the results were not disclosed to the surgeon until he was prepared to close the wound. The mean age was 2.4 yr and the average weight 11.2 kg. Two patients had residual flow after placement of the vascular clip. One patient had residual flow detected intraoperatively after placement of the vascular clip and residual flow was quickly abolished by the placement of a second clip, thus avoiding a reintervention. A follow-up transthoracic echocardiography was performed on 18 patients 1 mo postoperatively. Three patients presented residual ductal flow. This study using a novel application of TEE, demonstrates that TEE monitoring during PDA interruption may improve the surgical result, thus avoiding reintervention and the complications associated with residual ductal flow. However, late recurrence due to recanalization may occur and may not be detected by intraoperative TEE monitoring.

Adolescent↗
PubMed1996

Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin.

OBJECTIVE: The authors evaluated the risk of necrotizing enterocolitis (NEC) in very low birth weight infants receiving indomethacin (INDO) to close patent ductus arteriosus (PDA). BACKGROUND DATA: Controversy exists regarding the best method of managing very low birth weight infants with PDA and whether to employ medical management using INDO or surgical ligation of the ductus. METHODS: Two hundred fifty-two premature infants with symptomatic PDA were given intravenously INDO 0.2 mg/kg every 12 hours x 3 in an attempt to close the ductus. Patients were evaluated for sex, birth weight, gestational age, ductus closure, occurrence of NEC, bowel perforation, and mortality. RESULTS: There were 135 boys and 117 girls. The PDA closed or became asymptomatic in 224 cases (89%), whereas 28 (11%) required surgical ligation. Ninety infants (35%) developed evidence of NEC after INDO therapy. Fifty-six were managed medically; surgical intervention was required in 34 of 90 cases (37.8%) or 13% of the entire PDA/INDO study group. Bowel perforation was noted in 27 cases (30%). Factors associated with the onset of NEC included gestational age < 28 weeks, birth weight < 1 kg, and prolonged ventilator support. The overall mortality rate was 25.5%, but was higher in infants with NEC versus those without. The highest mortality was noted in perforated NEC cases. The PDA/INDO patients were compared with a control group of 764 infants with similar sex distribution, birth weights, and gestational ages without PDA who did not receive INDO. Necrotizing enterocolitis occurred in 105 of 764 control patients (13.7%), including 13 (12.3%) with perforation. The overall mortality rate of controls was 25%, which was similar to the overall 25.5% mortality rate in the PDA/INDO study group. CONCLUSION: These data indicate that there is increased risk of NEC and bowel perforation in premature infants with PDA receiving INDO. Mortality was higher in the PDA/INDO group with NEC than those PDA/INDO infants without NEC.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Current therapy of the patent ductus arteriosus.

The patent ductus arteriosus (PDA) was the first congenital heart lesion to be treated surgically and also the first to be treated with nonsurgical catheter intervention. Surgical ligation and division of the ductus remains the gold standard for consistently achieving complete occlusion. Transaxillary muscle-sparing thoracotomy and video-assisted thoracoscopic ligation, however, have evolved as surgical alternatives with reduced trauma, shorter hospitalization, and excellent cosmetic result but are associated with a significant rate of residual or recurrent duct patency. With aggressive application of critical pathway methods, significant reduction in cost has been achieved for surgical PDA closure. Nonsurgical transcatheter closure nevertheless has gained widespread acceptance, mostly employing detachable or nondetachable stainless steel coils. Coils have superseded the previously popular Rashkind PDA occluder (USCI/Bard, Tewksbury, MA) because of significantly lower cost, less cumbersome handling, smaller delivery catheters, and superior occlusion rates. Various coil implantation techniques and detachment mechanisms have been devised. Large PDAs with smallest diameter greater than 5 mm, however, still are better treated surgically until appropriate devices become available.

Age Factors↗
PubMed1986

Inadvertent ligation of the left pulmonary artery instead of patent ductus arteriosus. Noninvasive diagnosis by pulmonary perfusion imaging.

Pulmonary perfusion scintigraphy was used to noninvasively evaluate a neonate four days after attempted surgical closure of a large patent ductus arteriosus (PDA). No perfusion to the left lung was seen, suggesting inadvertent ligation of the left pulmonary artery (PA). This was confirmed by cardiac catheterization and reoperation. Radionuclide pulmonary perfusion imaging is an ideal noninvasive technique for evaluating pulmonary perfusion in neonates after complicated thoracic surgery.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

The effect of tolazoline on right-to-left shunting via a patent ductus arteriosus in meconium aspiration syndrome.

Since arterial blood oxygen tensions are used in the evaluation of treatment of patients with meconium aspiration syndrome, it is important to recognize the occurrence of significant right-to-left shunting via a patent ductus arteriosus. The clinical findings, evidence of right-to-left ductus shunting, and outcome in eight patients with meconium aspiration syndrome are presented. Administration of tolazoline HCl and curare produced a beneficial effect on their PaO2 values.

Ductus Arteriosus, Patent↗
PubMed1981

Clinical evaluation of premature infants with patent ductus arteriosus: a scoring system with echocardiogram, acid-base, and blood gas correlations.

To provide a clinical assessment of cardiovascular dysfunction (CVD) in premature infants with patent ductus arteriosus (PDA), a scoring system (CVD score) was devised and correlated with blood gases, acid-base balance, and echocardiogram. The score consisted of evaluation of heart rate, quality of peripheral arterial pulsation, degree of precordial pulsation, duration of murmur and cardiothoracic ratio on chest roentgenogram. There were 116 observations made on 55 premature infants who had PDA and required medical or surgical treatment. Significant positive correlations were seen for CVD score with left atrial (LA)/aortic (Ao) ratio (p less than 0.001), left ventricular and diastolic dimension (DD) (p less than 0.001), blood pH (p less than 0.01), and blood PCO2 (p less than 0.01). The scoring system may by used as a clinical guide when echocardiogram or angiogram is not available.

Blood Gas Analysis↗
PubMed1985

Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant.

The systolic, diastolic, and pulse pressures of 34 infants weighing less than 1200 g, who required mechanical ventilation for hyaline membrane disease, were prospectively evaluated in the first week of life and related to the magnitude of ductal shunting. Seventeen infants developed a large patent ductus arteriosus (PDA) corresponding to significant left-to-right ductal shunting and requiring surgical ligation. By the second day of life these patients with large PDAs had significantly lower mean systolic and diastolic BPs than the non-PDA infants. There were no significant differences in pulse pressures between groups. Both systolic and diastolic BPs promptly returned to control values after ligation. A mean diastolic BP less than 28 mm Hg on the third day of life was significantly associated with a PDA in 93% of patients.

Blood Pressure↗
PubMed1986

Prostaglandins and echocardiography in the assessment of patent ductus arteriosus.

Prostaglandin (PG) levels and M-mode echocardiography were used to evaluate the severity of patent ductus arteriosus (PDA) in 19 premature infants. Mean 6-keto-PGF1 alpha levels in infants with more severe left-to-right shunting were significantly higher than those in infants with a moderate level of shunting (1335 +/- 763 vs. 504 +/- 348 pg/ml, respectively). Furthermore, there was a significant correlation between this elevation and a decrease in the left ventricular systolic time interval, suggesting that both reflect the severity of ductal shunting. Although other echocardiographic measurements of cardiovascular function generally showed some tendency to vary with 6-keto-PGF1 alpha levels, none was as closely correlated with the extent of PG elevation. Levels of PGE2 also seemed to vary with PDA severity; however, this correlation was not as significant.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Patent ductus arteriosus during high-frequency ventilation for hyaline membrane disease.

The cardiovascular effects of a patent ductus arteriosus (PDA) in a premature baboon model of hyaline membrane disease treated with conventional positive-pressure ventilation (CPPV) or high-frequency ventilation (HFV) were studied. Twenty-seven (84%) of 32 infant baboons delivered at 75% gestation had positive retrograde aortograms at one hour of life. Eleven (34%) of these infant baboons had persisting evidence for retrograde flow over the first 24 h by Doppler examination. Significantly higher fluid requirements and bicarbonate requirements were present in the animals with a persisting PDA. Mean aortic BP values were significantly lower in these same animals. No significant differences were found between groups when mean airway pressure, heart rate, urine output, or form of ventilation were compared. The only significant differences found between the conventional and high-frequency ventilated animals with PDA were higher peak airway pressures and lower PEEP levels in the conventionally ventilated infants. The premature baboons can be a useful primate model to study the PDA. There appears to be no significant difference regarding the clinical effects of HFV and CPPV on PDA.

Acidosis↗
PubMed2002

Effect of age and birth weight on indomethacin pharmacodynamics in neonates treated for patent ductus arteriosus.

OBJECTIVES: To determine patent ductus arteriosus (PDA) closure rates, and indomethacin (INDO) toxicity rates in neonates dosed with INDO using an individualized pharmacokinetic/pharmacodynamic (PK/PD) dosing approach. In addition, develop PD curves evaluating dose-response and concentration-response relationships for closure and renal toxicity, especially in select subgroups historically known as "poor responders" (<1000 g and > or = 10 days postnatal age). DESIGN: Prospective, cohort study. SETTING: Level III neonatal intensive care unit. SUBJECTS: One hundred thirty-nine patients receiving 151 courses of INDO for PDA closure were evaluated. INTERVENTIONS: Patients initially received 0.25 mg/kg of INDO, followed immediately by 1 mg/kg of furosemide. INDO concentrations were obtained 2 hrs and 8 hrs after the dose and were assayed using high-performance liquid chromatography. Individualized PK parameters were calculated with subsequent INDO dosing based on the individualized PK variables to increase trough serum concentrations by 0.3-0.5 mg/L. MEASUREMENTS AND MAIN RESULTS: Ductal closure was successful in 127 patients (91%). Renal toxicity occurred in 21 (15%) patients and was temporary and reversible. No significant differences in response rates based on treatment weight or postnatal age were observed. PD curves were similar for neonates <1000 g vs. > or = 1000 g. PD curves were also similar for neonates with postnatal age <10 days vs. > or = 10 days. Statistically significant differences were noted between neonates categorized for postnatal age <10 days vs. > or = 10 days in total days of therapy (1.8 vs. 2.3 days), total number of doses required to close PDA (3.5 vs. 5.6 doses), critical INDO dose (0.9 vs. 1.4 mg/kg), critical INDO concentration (1.9 vs. 1.4 mg/L), and critical dose/critical concentration ratio (0.52 vs. 2.2). CONCLUSIONS: These findings support the hypothesis that the poor PDA closure rates with INDO for neonates >10 days postnatal age are the result of pharmacokinetic differences only and that weight does not impact response rates. Individualized pharmacokinetic/pharmacodynamic dosing of INDO continues to achieve higher closure rate than current dosing standards. Patients historically known as poor responders significantly benefit from this dosing approach.

Age Factors↗