Left vocal cord paralysis after patent ductus arteriosus ligation: A systematic review

The management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment.

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus.

The ductus arteriosus connects the pulmonary artery and the descending aorta in the foetus. In normal neonatal transition, the ductus closes soon after birth. If the duct remains significantly open after birth, it may complicate the recovery of a very preterm infant. Present treatments of patent ductus arteriosus (PDA) are either medical (ibuprofen or indomethacin) or surgical (ligation). However, these treatments can have serious side effects, especially in the most immature infants. This doctoral thesis studied the potential role of intravenous paracetamol for PDA treatment in very preterm infants born before 32 weeks of gestation. Consequences of the PDA treatments in an epidemiological birth cohort were also studied. In retrospective Study I stated that treatments of PDA decreased after the introduction of IV paracetamol for early pain management in preterm infants. Study II showed in a randomised clinical trial for the first time that paracetamol has a biological effect on the ductus arteriosus in preterm infants soon after birth. The ductus closed significantly earlier in the paracetamol group than in the placebo group. The epidemiological cohort Study III showed evidence that both medical and surgical treatment of PDA associated with severe bronchopulmonary dysplasia in infants born very preterm. Additionally, surgical PDA ligation was associated with increased risk of necrotising enterocolitis and intraventricular haemorrhage. Study IV showed that treatment of PDA was not associated with increased mortality, even in the most immature preterm infants born before 28 weeks of gestation.

/pdf/closure-of-patent-ductus-arteriosus-in-very-preterm-infants-2ztesbokqo.pdf

Closure of patent ductus arteriosus in very preterm infants : potential role of paracetamol and consequences of current treatments

The optimal timing of surgical ligation of patent ductus arteriosus in preterm or very-low-birth-weight infants: A systematic review and meta-analysis.

Objective We aimed to investigate the feasibility and safety of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus (PDA) without the use of X-ray equipment. Methods From January to December 2015, we performed stand-alone transthoracic echocardiography-guided percutaneous PDA occlusion using an occluder delivered via a delivery sheath introduced via femoral vein access without the use of X-ray equipment in 12 PDA patients. Results PDA occlusion was successfully performed in all 12 patients. The procedure duration ranged from 30 to 110 min (50.4±22.8 min), and the size of the implanted occluder ranged from 12 to 20 mm (15.2±2.8 mm). No occluder migration, residual shunt, or thrombotic complications were observed in the perioperative period. There was no clinical death, hemolysis, infection, or embolism during patients' hospitalization and the follow-up period. Conclusion Stand-alone transthoracic echocardiography-guided percutaneous PDA occlusion without the use of X-ray equipment is a safe and effective procedure.

Clinical study of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus.

Outcomes of Early Ligation of Patent Ductus Arteriosus in Preterms, Multicenter Experience.

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Outcomes of Early Ligation of Patent Ductus Arteriosus in Preterms, Multicenter Experience.