Forstner, P.J. Freiherr von (Philipp Jacob) (2019) Retrospective longitudinal observational study of two neonatal centres comparing treatment strategies of PDA with emphasis on gastrointestinal complications in preterm infants. thesis, Medicine.
Full text available on request.Abstract
A persistently patent ductus arteriosus (PDA) causes significant infant morbidity and mortality in preterm babies. This study aims to assess the association between hemodynamically significant (hs) PDA, COX- inhibitor therapy on gastrointestinal complications and identify possible influencing factors. Methods A total of 310 infants with detectable PDA and <36 weeks of gestational age (GA) and <1500g of birth weight (BW) were included from two level 1 neonatal clinics, Vivantes Klinikum Neukölln (VB) and Charité in Berlin (CB), from 2014 till 2017. Primary endpoints were defined as diagnosis of NEC, FIP, surgical ligation of PDA and death. Differences were tested with the Pearson chi-square (or Fisher’s exact test) or Kruskal-Wallis tests (>2 variables). Results Patient populations at each centre were comparable in GA (26 vs. 27, p=0,17), and BW (870 vs. 872, p=0,36). Only one patient without hsPDA had a gastrointestinal complication, whereas 23 hsPDA patients did (p=0,04). The differences in FIP incidence (8% vs. 3%, p=0,05) as well as NEC incidence (8% vs. 3%, p=0,05) were statistically significant. Despite VB treating fewer patients with COX-inhibitors (50% vs 72%, p=0,04), more NECs were reported. Yet, both centres treated comparable numbers of NEC patients with COXinhibitors (40% vs. 44%). FIP patients treated for arterial hypotonia received catecholamines earlier in VB than in CB (6 vs 15 Day of life, p=0,53) before FIP was diagnosed (16 vs 15 DOL, p=0,65). Patients in VB received significantly less breast milk in the first seven days than in CB and fewer probiotics (85% vs. 95%, p=0,05). Conclusion This study confirmed an association of PDA with gastrointestinal complications. It further established that COX-inhibitors are not affecting the incidence of NEC and FIP in premature infants. Additionally, breast milk compliance and probiotic use were identified as the most obvious influencing factors preventing NEC. Regarding FIP prevention, the focus should be on optimising the early hemodynamic adaptation to decrease incidences.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty Supervisor: and Bos, Prof. A. PhD |
| Supervisor name: | Secondary Supervisor: and Emeis Dr. M. and Institution of Research: and Vivantes Klinikum Neukölln, Berlin; Universitätsklinikum Cha and Berlin |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2448 |
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