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Am J Perinatol 2022; 39(13): 1426-1432
DOI: 10.1055/s-0040-1722649
Original Article

Fresh Frozen Plasma Transfusion: An Independent Risk Factor for Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Chun-Pin Huang
1   Department of Pediatrics, Cathay General Hospital, Hsinchu Branch, Hsinchu, Taiwan
2   Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
,
Yi-Li Hung
2   Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
,
Wu-Shiun Hsieh
2   Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
3   Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
,
Chung-Min Shen
2   Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
4   School of Medical, Fu-Jen Catholic University, Taipei, Taiwan
› Institutsangaben Funding None.
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Abstract

Objective The incidence of patent ductus arteriosus (PDA), a major complication of prematurity, may be reduced by restricting fluid administration. Prophylactic fresh frozen plasma (FFP) transfusion may reduce the incidence of intraventricular hemorrhage in these infants, but risks transfusion-related volume overload. We conducted a retrospective study to investigate whether FFP transfusion is a risk factor for hemodynamically significant PDA (hsPDA) in very low birth weight (BW) premature infants.

Study Design From January 2009 to December 2014, 102 premature infants with gestational age (GA) less than or equal to 30 weeks were admitted to a level III neonatal intensive care unit, and 88 patients were enrolled. Patients were further divided into non-hsPDA (n = 29) and hsPDA groups (n = 59). We retrospectively reviewed demographic characteristics and various perinatal and postnatal variables. Univariate and multivariable analyses were performed to identify risk factors for hsPDA.

Results Compared with non-hsPDA patients, hsPDA patients had lower mean BW and GA, a higher incidence of severe respiratory distress symptoms, perinatal infection, use of surfactant, and need for FFP transfusion. However, multivariable logistic regression analysis showed that only FFP transfusion remained an independent risk factor for hsPDA (adjusted odds ratio = 3.880, 95% confidence interval: 1.214–12.402, p = 0.022) after adjusting for confounding factors.

Conclusion FFP transfusion is a significant risk factor for the subsequent development of hsPDA in our study population. FFP transfusion may complicate the fluid management of premature infants and increase the risk of hsPDA.

Key Points

  • Hemodynamic significant PDA is an important complication of preterm infant.

  • FFP transfusion may complicate the fluid management of premature infants.

  • FFP transfusion is an independent risk factor for hsPDA in very low birth weight premature infants.

Keywords

FFP transfusion - premature infants - hemodynamically significant PDA - intraventricular hemorrhage


Publikationsverlauf

Eingereicht: 18. September 2020

Angenommen: 09. Dezember 2020

Artikel online veröffentlicht:
24. Januar 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Deshpande P, Baczynski M, McNamara PJ, Jain A. Patent ductus arteriosus: the physiology of transition. Semin Fetal Neonatal Med 2018; 23 (04) 225-231
    CrossrefPubMedSuche in Google Scholar
  • 2 Mezu-Ndubuisi OJ, Agarwal G, Raghavan A, Pham JT, Ohler KH, Maheshwari A. Patent ductus arteriosus in premature neonates. Drugs 2012; 72 (07) 907-916
    CrossrefPubMedSuche in Google Scholar
  • 3 El-Khuffash A, Levy PT, Gorenflo M, Frantz III ID. The definition of a hemodynamically significant ductus arteriosus. Pediatr Res 2019; 85 (06) 740-741
    CrossrefPubMedSuche in Google Scholar
  • 4 Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants?. Congenit Heart Dis 2019; 14 (01) 21-26
    PubMedSuche in Google Scholar
  • 5 Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol 2018; 42 (04) 235-242
    CrossrefPubMedSuche in Google Scholar
  • 6 Schena F, Francescato G, Cappelleri A. et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr 2015; 166 (06) 1488-1492
    Suche in Google Scholar
  • 7 Fujii AM, Brown E, Mirochnick M, O'Brien S, Kaufman G. Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus. J Perinatol 2002; 22 (07) 535-540
    Suche in Google Scholar
  • 8 Velazquez DM, Reidy KJ, Sharma M, Kim M, Vega M, Havranek T. The effect of hemodynamically significant patent ductus arteriosus on acute kidney injury and systemic hypertension in extremely low gestational age newborns. J Matern Fetal Neonatal Med 2019; 32 (19) 3209-3214
    CrossrefPubMedSuche in Google Scholar
  • 9 Sellmer A, Bjerre JV, Schmidt MR. et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed 2013; 98 (06) F505-F510
    Suche in Google Scholar
  • 10 Rozé JC, Cambonie G, Marchand-Martin L. et al; Hemodynamic EPIPAGE 2 Study Group. Hemodynamic EPIPAGE 2 study group. Association between early screening for patent ductus arteriosus and in-hospital mortality among extremely preterm infants. JAMA 2015; 313 (24) 2441-2448
    CrossrefPubMedSuche in Google Scholar
  • 11 Ngo S, Profit J, Gould JB, Lee HC. Trends in patent ductus arteriosus diagnosis and management for very low birth weight infants. Pediatrics 2017; 139 (04) e20162390
    CrossrefPubMedSuche in Google Scholar
  • 12 Mitra S, Rønnestad A, Holmstrøm H. Management of patent ductus arteriosus in preterm infants--where do we stand?. Congenit Heart Dis 2013; 8 (06) 500-512
    CrossrefPubMedSuche in Google Scholar
  • 13 Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr 2015; 169 (09) 863-872
    CrossrefPubMedSuche in Google Scholar
  • 14 Chen YY, Wang HP, Chang JT, Chiou YH, Huang YF, Hsieh KS. Taiwan Premature Infant Development Collaborative Study Group. Perinatal factors in patent ductus arteriosus in very low-birthweight infants. Pediatr Int 2014; 56 (01) 72-76
    CrossrefPubMedSuche in Google Scholar
  • 15 Pourarian S, Farahbakhsh N, Sharma D, Cheriki S, Bijanzadeh F. Prevalence and risk factors associated with the patency of ductus arteriosus in premature neonates: a prospective observational study from Iran. J Matern Fetal Neonatal Med 2017; 30 (12) 1460-1464
    CrossrefPubMedSuche in Google Scholar
  • 16 Ognean ML, Boantă O, Kovacs S. et al. Persistent ductus arteriosus in critically ill preterm infants. J Crit Care Med (Targu Mures) 2016; 2 (04) 175-184
    CrossrefPubMedSuche in Google Scholar
  • 17 Du JF, Liu TT, Wu H. [Risk factors for patent ductus arteriosus in early preterm infants: a case-control study]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18 (01) 15-19
    PubMedSuche in Google Scholar
  • 18 Nizarali Z, Marques T, Costa C, Barroso R, Cunha M. Patent ductus arteriosus: perinatal risk factors. J Neonatal Biol 2012; 1: 3
    CrossrefPubMedSuche in Google Scholar
  • 19 Oh W. Fluid and electrolyte management of very low birth weight infants. Pediatr Neonatol 2012; 53 (06) 329-333
    CrossrefPubMedSuche in Google Scholar
  • 20 Stephens BE, Gargus RA, Walden RV. et al. Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 2008; 28 (02) 123-128
    CrossrefPubMedSuche in Google Scholar
  • 21 Stevenson JG. Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome. J Pediatr 1977; 90 (02) 257-261
    CrossrefPubMedSuche in Google Scholar
  • 22 Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med 1980; 302 (11) 598-604
    CrossrefPubMedSuche in Google Scholar
  • 23 Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2014; (12) CD000503
    PubMedSuche in Google Scholar
  • 24 Letshwiti JB, Semberova J, Pichova K, Dempsey EM, Franklin OM, Miletin J. A conservative treatment of patent ductus arteriosus in very low birth weight infants. Early Hum Dev 2017; 104: 45-49
    CrossrefPubMedSuche in Google Scholar
  • 25 Kuperman AA, Brenner B, Kenet G. Intraventricular hemorrhage in preterm infants and coagulation--ambivalent perspectives?. Thromb Res 2013; 131 (Suppl. 01) S35-S38
    CrossrefPubMedSuche in Google Scholar
  • 26 Kuperman AA, Kenet G, Papadakis E, Brenner B. Intraventricular hemorrhage in preterm infants: coagulation perspectives. Semin Thromb Hemost 2011; 37 (07) 730-736
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Dani C, Poggi C, Ceciarini F, Bertini G, Pratesi S, Rubaltelli FF. Coagulopathy screening and early plasma treatment for the prevention of intraventricular hemorrhage in preterm infants. Transfusion 2009; 49 (12) 2637-2644
    CrossrefPubMedSuche in Google Scholar
  • 28 Beverley DW, Pitts-Tucker TJ, Congdon PJ, Arthur RJ, Tate G. Prevention of intraventricular haemorrhage by fresh frozen plasma. Arch Dis Child 1985; 60 (08) 710-713
    CrossrefPubMedSuche in Google Scholar
  • 29 New HV, Berryman J, Bolton-Maggs PH. et al; British Committee for Standards in Haematology. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol 2016; 175 (05) 784-828
    CrossrefPubMedSuche in Google Scholar
  • 30 Northern Neonatal Nursing Initiative Trial Group. Randomised trial of prophylactic early fresh-frozen plasma or gelatin or glucose in preterm babies: outcome at 2 years. Lancet 1996; 348 (9022): 229-232
    CrossrefPubMedSuche in Google Scholar
  • 31 Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in very preterm infants. Cochrane Database Syst Rev 2004; (02) CD002055
    PubMedSuche in Google Scholar
  • 32 Keir AK, Stanworth SJ. Neonatal plasma transfusion: an evidence-based review. Transfus Med Rev 2016; 30 (04) 174-182
    CrossrefPubMedSuche in Google Scholar
  • 33 van Laere D, van Overmeire B, Gupta S. et al; European Special Interest Group ‘Neonatologist Performed Echocardiography’ (NPE). Application of NPE in the assessment of a patent ductus arteriosus. Pediatr Res 2018; 84 (Suppl. 01) 46-56
    CrossrefPubMedSuche in Google Scholar
  • 34 Kindler A, Seipolt B, Heilmann A, Range U, Rüdiger M, Hofmann SR. Development of a diagnostic clinical score for hemodynamically significant patent ductus arteriosus. Front Pediatr 2017; 5: 280
    CrossrefPubMedSuche in Google Scholar
  • 35 Benitz WE. Committee on fetus and newborn, American Academy of Pediatrics. Patent ductus arteriosus in preterm infants. Pediatrics 2016; 137: e20153730
    CrossrefPubMedSuche in Google Scholar
  • 36 De Buyst J, Rakza T, Pennaforte T, Johansson AB, Storme L. Hemodynamic effects of fluid restriction in preterm infants with significant patent ductus arteriosus. J Pediatr 2012; 161 (03) 404-408
    CrossrefPubMedSuche in Google Scholar
  • 37 Sehgal A, McNamara PJ. International perspective on management of a patent ductus arteriosus: lessons learned. Semin Fetal Neonatal Med 2018; 23 (04) 278-284
    CrossrefPubMedSuche in Google Scholar
  • 38 Vatcheva KP, Lee M, McCormick JB, Rahbar MH. Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology (Sunnyvale) 2016; 6 (02) 227
    CrossrefPubMedSuche in Google Scholar