American Journal of Pediatrics

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Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants

Received: 26 November 2018    Accepted: 26 February 2019    Published: 21 March 2019
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Abstract

The persistence of hemodynamically significant patent ductus arteriosus (НPDA) has a great value on a short term and long term outcomes in preterm infant. There is no hesitation that PDA should be closed pharmacologically or surgically if present. The aim of the study was to establish the advisability, efficiency and safety of using different volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the НPDA closure. Retrospectively has been studied 91 preterm infants with gestational age 26-31 weeks, manifestations of respiratory distress syndrome, НPDA treated at the NICU. The research groups were representative for gestational age, gender and weight (1205.0 ± 435.0 grams). The therapy of PDA closure included using of different volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) in combination with COX inhibitors. COX inhibitors prescribed according to standard regimens: in the first 3 days - indomethacin orally in doses 0.2/0.1/0.1 mg/kg/day. If the preterm infant had symptoms of intestinal paresis (this prevented the oral administration of indomethacin). Ibuprofen administered in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in a rectal form. In all groups of preterm used a standard therapy of PDA closure. The volume of infusion therapy was restricted in the first group. Preemies received 53.5 ± 6.4 ml/kg/day on DOL1 and 2. From the third day increased urinary excretion, there was an increase in the amount of infusion therapy up to 63.6 ± 5.6 ml/kg/day, and at day 5 it was raised to 89.7 ± 6.8 ml/kg/day. In the second group there was no strict adherence to the restriction of the volume of infusion therapy (especially in the first 5 days), and delayed term for the PDA closure (on average at 14.55 ± 0.56 DOL) associated with that fact. In the first group the limit of the volume of infusion therapy observed more clearly in the first 5 days, and the closure of the arterial duct occurred exceptionally early (at 2.35 ± 0.48 DOL). With regard to the volume of infusion therapy in a more distant terms (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups, which suggests that the principle was the restriction of the infusion therapy in the first 5 days only.

DOI 10.11648/j.ajp.20190501.15
Published in American Journal of Pediatrics (Volume 5, Issue 1, March 2019)
Page(s) 22-27
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Рatent Ductus Arteriosus, Restrictive Infusion Therapy, Premature Newborns

References
[1] Knight D. B. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin Neonatol 2001; 6: 63–73.
[2] Evans N. Patent ductus arteriosus in the neonate. Current Paediatrics 2005; 15(5): 381–9.
[3] Hammerman C., Bin-Nun A., Markovitch E. et al. Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment. Pediatrics. 2011 Dec; 128(6):e1618-21. doi: 10.1542/peds.2011-0359. Epub 2011 Nov 7.
[4] Oncel M. Y., Yurttutan S., Degirmencioglu H. et al. Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants. Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey. 2009.
[5] D. Surkov, A. Obolonskiy, O. Kapustina, D. Volkov. Use of rectal ibuprofen for PDA closure in preterm neonates. Pediatric Anesthesia and Critical Care Journal 2014; 2(1):11-16.
[6] Surgical closure of patent ductus arteriosus in preterm low birth weight infants // Mandhan P., Brown S., Kukkady A. [et al.] // Congenit Heart Dis. – 2011. – Vol. 4(1). – P. 34 –37.
[7] Tsai E. Withholding and withdrawing artificial nutrition and hydration // Paediatr. Child. Health. – 2011. – Vol. 16(4). – P. 241-242.
[8] Nankervis C. A., Martin E. M., Crane M. L. Implementation of a multidisciplinary guideline-driven approach to the care of the extremely premature infant improved hospital outcomes // Acta Paediatr. – 2010. – Vol. 99. – P. 188–193.
[9] Dent C. L., Schwartz. SM. Postoperative care of the pediatric cardiac surgical patient. In: Cardiovascular Pediatric Critical Illness and Injury // London, United Kingdom: Springer. – 2010. – P. 169–179.
[10] Perioperative Fluid Management Strategies in Major Surgery: A Stratified Meta-Analysis // Tomas C., Julia E., Joy R. [et al.] Society of Critical Care Anesthesiologists. – 2012. – P. 640– 661.
[11] Edward F. B., Michael J. A. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants // Cochrane Database Syst Rev. – 2014. – CD000503.
[12] Soni N. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) // Cassandra’s view. Anaesthesia. – 2011. – Vol. 64. – P. 235– 8.
[13] Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery / Rahbari N. N., Zimmermann J. B., Schmidt T. [et al.] // Br. J. Surg. – 2011. – Vol. 96. – P. 331– 41.
[14] Nankervis CA, Martin EM, Crane ML. Implementation of a multidisciplinary guideline-driven approach to the care of the extremely premature infant improved hospital outcomes // Acta Paediatr. – 2010. – Vol. 99. – P. 188–193.
[15] Knight D. B. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin Neonatol 2001; 6: 63–73.
[16] Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed. 2007; 92(4):F244 –F247.
Author Information
  • Regional Children’s Hospital, Dnepr, Ukraine

  • Department of Pediatrics Dnepropetrovsk Medical Academy, Dnepr, Ukraine

  • Regional Children’s Hospital, Dnepr, Ukraine

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    Aleksii Obolonskyi, Olha Obolonska, Kateryna Dereza. (2019). Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants. American Journal of Pediatrics, 5(1), 22-27. https://doi.org/10.11648/j.ajp.20190501.15

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    Aleksii Obolonskyi; Olha Obolonska; Kateryna Dereza. Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants. Am. J. Pediatr. 2019, 5(1), 22-27. doi: 10.11648/j.ajp.20190501.15

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    AMA Style

    Aleksii Obolonskyi, Olha Obolonska, Kateryna Dereza. Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants. Am J Pediatr. 2019;5(1):22-27. doi: 10.11648/j.ajp.20190501.15

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  • @article{10.11648/j.ajp.20190501.15,
      author = {Aleksii Obolonskyi and Olha Obolonska and Kateryna Dereza},
      title = {Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {1},
      pages = {22-27},
      doi = {10.11648/j.ajp.20190501.15},
      url = {https://doi.org/10.11648/j.ajp.20190501.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20190501.15},
      abstract = {The persistence of hemodynamically significant patent ductus arteriosus (НPDA) has a great value on a short term and long term outcomes in preterm infant. There is no hesitation that PDA should be closed pharmacologically or surgically if present. The aim of the study was to establish the advisability, efficiency and safety of using different volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the НPDA closure. Retrospectively has been studied 91 preterm infants with gestational age 26-31 weeks, manifestations of respiratory distress syndrome, НPDA treated at the NICU. The research groups were representative for gestational age, gender and weight (1205.0 ± 435.0 grams). The therapy of PDA closure included using of different volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) in combination with COX inhibitors. COX inhibitors prescribed according to standard regimens: in the first 3 days - indomethacin orally in doses 0.2/0.1/0.1 mg/kg/day. If the preterm infant had symptoms of intestinal paresis (this prevented the oral administration of indomethacin). Ibuprofen administered in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in a rectal form. In all groups of preterm used a standard therapy of PDA closure. The volume of infusion therapy was restricted in the first group. Preemies received 53.5 ± 6.4 ml/kg/day on DOL1 and 2. From the third day increased urinary excretion, there was an increase in the amount of infusion therapy up to 63.6 ± 5.6 ml/kg/day, and at day 5 it was raised to 89.7 ± 6.8 ml/kg/day. In the second group there was no strict adherence to the restriction of the volume of infusion therapy (especially in the first 5 days), and delayed term for the PDA closure (on average at 14.55 ± 0.56 DOL) associated with that fact. In the first group the limit of the volume of infusion therapy observed more clearly in the first 5 days, and the closure of the arterial duct occurred exceptionally early (at 2.35 ± 0.48 DOL). With regard to the volume of infusion therapy in a more distant terms (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups, which suggests that the principle was the restriction of the infusion therapy in the first 5 days only.},
     year = {2019}
    }
    

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    AU  - Aleksii Obolonskyi
    AU  - Olha Obolonska
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    AB  - The persistence of hemodynamically significant patent ductus arteriosus (НPDA) has a great value on a short term and long term outcomes in preterm infant. There is no hesitation that PDA should be closed pharmacologically or surgically if present. The aim of the study was to establish the advisability, efficiency and safety of using different volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the НPDA closure. Retrospectively has been studied 91 preterm infants with gestational age 26-31 weeks, manifestations of respiratory distress syndrome, НPDA treated at the NICU. The research groups were representative for gestational age, gender and weight (1205.0 ± 435.0 grams). The therapy of PDA closure included using of different volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) in combination with COX inhibitors. COX inhibitors prescribed according to standard regimens: in the first 3 days - indomethacin orally in doses 0.2/0.1/0.1 mg/kg/day. If the preterm infant had symptoms of intestinal paresis (this prevented the oral administration of indomethacin). Ibuprofen administered in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in a rectal form. In all groups of preterm used a standard therapy of PDA closure. The volume of infusion therapy was restricted in the first group. Preemies received 53.5 ± 6.4 ml/kg/day on DOL1 and 2. From the third day increased urinary excretion, there was an increase in the amount of infusion therapy up to 63.6 ± 5.6 ml/kg/day, and at day 5 it was raised to 89.7 ± 6.8 ml/kg/day. In the second group there was no strict adherence to the restriction of the volume of infusion therapy (especially in the first 5 days), and delayed term for the PDA closure (on average at 14.55 ± 0.56 DOL) associated with that fact. In the first group the limit of the volume of infusion therapy observed more clearly in the first 5 days, and the closure of the arterial duct occurred exceptionally early (at 2.35 ± 0.48 DOL). With regard to the volume of infusion therapy in a more distant terms (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups, which suggests that the principle was the restriction of the infusion therapy in the first 5 days only.
    VL  - 5
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