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Am J Perinatol 2020; 37(11): 1123-1129
DOI: 10.1055/s-0039-1692389
Original Article

Do Calcium and Potassium Levels Influence Ductal Patency in Preterm Infants?

Ufuk Cakir 
1   Division of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity, Education and Research Hospital, Ankara, Turkey
,
Cuneyt Tayman
1   Division of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity, Education and Research Hospital, Ankara, Turkey
,
Mehmet Buyuktiryaki 
1   Division of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity, Education and Research Hospital, Ankara, Turkey
,
Handan Unsal
2   Department of Pediatric Cardiology, Health Sciences University, Zekai Tahir Burak Maternity, Education, and Research Hospital, Ankara, Turkey
,
Buse Ozer Bekmez
1   Division of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity, Education and Research Hospital, Ankara, Turkey
› Author Affiliations Funding None.
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Abstract

Objective We investigated the relationship of serum potassium (K+) and ionized calcium (iCa2+) levels with the persistence of ductus arteriosus.

Study Design This retrospective cohort study included infants with birth weight < 1,500 g and gestational age < 32 weeks. Serum K+ and iCa2+ levels at the 1st and 48th hour of life were measured from samples. The difference between the two levels was calculated for both serum K+ (ΔK+) and iCa2+ (ΔCa2+). These values were compared between hemodynamically significant patent ductus arteriosus (hsPDA) and non-hsPDA.

Results Of 1,322 hospitalized preterm nonates, 1,196 were included in the study. Mean serum K+ levels at the 1st and 48th hour were higher and iCa2+ levels at the 1st and 48th hour were lower in hsPDA and non-hsPDA, respectively (p < 0.001). Ionized ΔCa2+ (–0.06 ± 0.13 vs. –0.02 ± 0.12 mmol/L) was higher in hsPDA (p < 0.001).

Conclusion We demonstrated that serum K+ and iCa2+ level might play a role in ductal constriction.

Keywords

serum potassium - ionized calcium - patent ductus arteriosus - infants - premature - very low birth weight


Publication History

Received: 08 April 2019

Accepted: 29 April 2019

Article published online:
05 June 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Oncel MY, Erdeve O. Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus. World J Clin Pediatr 2016; 5 (01) 75-81
    CrossrefPubMedSearch in Google Scholar
  • 2 Prescott S, Keim-Malpass J. Patent ductus arteriosus in the preterm infant: diagnostic and treatment options. Adv Neonatal Care 2017; 17 (01) 10-18
    Search in Google Scholar
  • 3 Nemri AM. Patent ductus arteriosus in preterm infant: basic pathology and when to treat. Sudan J Paediatr 2014; 14 (01) 25-30
    PubMedSearch in Google Scholar
  • 4 Bhat R, Das UG. Management of patent ductus arteriosus in premature infants. Indian J Pediatr 2015; 82 (01) 53-60
    CrossrefPubMedSearch in Google Scholar
  • 5 Hajj H, Dagle JM. Genetics of patent ductus arteriosus susceptibility and treatment. Semin Perinatol 2012; 36 (02) 98-104
    CrossrefPubMedSearch in Google Scholar
  • 6 Oncel MY, Yurttutan S, Erdeve O. , et al. Oral paracetamol versus oral ibuprofen in the management of patent ductus arteriosus in preterm infants: a randomized controlled trial. J Pediatr 2014; 164 (03) 510-514
    Search in Google Scholar
  • 7 Kahvecioglu D, Erdeve O, Akduman H. , et al. Influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in the prematurity. Pediatr Neonatol 2018; 59 (01) 53-57
    CrossrefPubMedSearch in Google Scholar
  • 8 Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125 (05) 1020-1030
    CrossrefPubMedSearch in Google Scholar
  • 9 Hung YC, Yeh JL, Hsu JH. Molecular mechanisms for regulating postnatal ductus arteriosus closure. Int J Mol Sci 2018; 19 (07) E1861
    CrossrefPubMedSearch in Google Scholar
  • 10 Halil H, Tayman C, Cakır U, Buyuktiryaki M, Serkant U, Oğuz SS. Serum endocan level as a predictive marker for hemodynamically significant patent ductus arteriosus in very low birth weight infants. Am J Perinatol 2017; 34 (13) 1312-1317
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Cakir U, Tayman C. A mystery of patent ductus arteriosus and serum osmolality in preterm infants. Am J Perinatol 2019; 36 (06) 641-646
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Özer Bekmez B, Tayman C, Büyüktiryaki M, Çetinkaya AK, Çakır U, Derme T. A promising, novel index in the diagnosis and follow-up of patent ductus arteriosus: red cell distribution width-to-platelet ratio. J Clin Lab Anal 2018; 32 (09) e22616
    CrossrefPubMedSearch in Google Scholar
  • 13 McGuirl J, Arzuaga B, Lee BH. Antenatal calcium channel blocker exposure and subsequent patent ductus arteriosus in extremely low-birth-weight infants. Pediatr Cardiol 2012; 33 (01) 60-64
    CrossrefPubMedSearch in Google Scholar
  • 14 Hong Z, Hong F, Olschewski A. , et al. Role of store-operated calcium channels and calcium sensitization in normoxic contraction of the ductus arteriosus. Circulation 2006; 114 (13) 1372-1379
    CrossrefPubMedSearch in Google Scholar
  • 15 Thébaud B, Wu XC, Kajimoto H. , et al. Developmental absence of the O2 sensitivity of L-type calcium channels in preterm ductus arteriosus smooth muscle cells impairs O2 constriction contributing to patent ductus arteriosus. Pediatr Res 2008; 63 (02) 176-181
    CrossrefPubMedSearch in Google Scholar
  • 16 Posencheg MA, Evans JR. Acid-base, fluid and electrolyte management. 9th ed. In: Gleason CA, Devaskar SU. , eds. Avery’s Diseases of the Newborn. Philadelphia, PA: Elsevier Saunders; 2012: 367-389
    Search in Google Scholar
  • 17 Lapillonne A, Berleur MP, Brasseur Y, Calvez S. Safety of parenteral nutrition in newborns: results from a nationwide prospective cohort study. Clin Nutr 2018; 37 (02) 624-629
    CrossrefPubMedSearch in Google Scholar
  • 18 Mimouni FB, Mandel D, Lubetzky R, Senterre T. Calcium, phosphorus, magnesium and vitamin D requirements of the preterm infant. World Rev Nutr Diet 2014; 110: 140-151
    CrossrefPubMedSearch in Google Scholar
  • 19 Dargaville PA, Gerber A, Johansson S. , et al; Australian and New Zealand Neonatal Network. Incidence and outcome of CPAP failure in preterm infants. Pediatrics 2016; 138 (01) e20153985
    Search in Google Scholar
  • 20 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
    Search in Google Scholar
  • 21 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
    Search in Google Scholar
  • 22 Walsh MC, Wilson-Costello D, Zadell A, Newman N, Fanaroff A. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol 2003; 23 (06) 451-456
    Search in Google Scholar
  • 23 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
    CrossrefPubMedSearch in Google Scholar
  • 24 Lubchencho LO, Hansman C, Dressler M. Intrauterine growth as estimated from live birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963; 32: 791-800
    PubMedSearch in Google Scholar
  • 25 Evans N. Preterm patent ductus arteriosus: a continuing conundrum for the neonatologist?. Semin Fetal Neonatal Med 2015; 20 (04) 272-277
    CrossrefPubMedSearch in Google Scholar
  • 26 Li M, Jiang C, Ye L. , et al. The Role of Na+/Ca2+ exchanger 1 in maintaining ductus arteriosus patency. Sci Rep 2017; 7 (01) 9826
    CrossrefPubMedSearch in Google Scholar
  • 27 Hammerman C, Eidelman AI, Gartner LM. Hypocalcemia and the patent ductus arteriosus. J Pediatr 1979; 94 (06) 961-963
    CrossrefPubMedSearch in Google Scholar
  • 28 Waleh N, Reese J, Kajino H. , et al. Oxygen-induced tension in the sheep ductus arteriosus: effects of gestation on potassium and calcium channel regulation. Pediatr Res 2009; 65 (03) 285-290
    CrossrefPubMedSearch in Google Scholar
  • 29 Thébaud B, Michelakis ED, Wu XC. , et al. Oxygen-sensitive Kv channel gene transfer confers oxygen responsiveness to preterm rabbit and remodeled human ductus arteriosus: implications for infants with patent ductus arteriosus. Circulation 2004; 110 (11) 1372-1379
    CrossrefPubMedSearch in Google Scholar
  • 30 Weir EK, Obreztchikova M, Vargese A, Cabrera JA, Peterson DA, Hong Z. Mechanisms of oxygen sensing: a key to therapy of pulmonary hypertension and patent ductus arteriosus. Br J Pharmacol 2008; 155 (03) 300-307
    CrossrefPubMedSearch in Google Scholar
  • 31 Fan F, Ma A, Guan Y. , et al. Effect of PGE2 on DA tone by EP4 modulating Kv channels with different oxygen tension between preterm and term. Int J Cardiol 2011; 147 (01) 58-65
    CrossrefPubMedSearch in Google Scholar
  • 32 Toda N. Effects of calcium, sodium and potassium ions on contractility of isolated atria and their responses to noradrenaline. Br J Pharmacol 1969; 36 (02) 350-367
    CrossrefPubMedSearch in Google Scholar
  • 33 Rocha G, Ribeiro O, Guimarães H. Fluid and electrolyte balance during the first week of life and risk of bronchopulmonary dysplasia in the preterm neonate. Clinics (São Paulo) 2010; 65 (07) 663-674
    CrossrefPubMedSearch in Google Scholar
  • 34 Aggarwal R, Deorari AK, Paul VK. Fluid and electrolyte management in term and preterm neonates. Indian J Pediatr 2001; 68 (12) 1139-1142
    CrossrefPubMedSearch in Google Scholar
  • 35 Christmann V, de Grauw AM, Visser R, Matthijsse RP, van Goudoever JB, van Heijst AF. Early postnatal calcium and phosphorus metabolism in preterm infants. J Pediatr Gastroenterol Nutr 2014; 58 (04) 398-403
    CrossrefPubMedSearch in Google Scholar