Blood pressure increase preceded spontaneous and paracetamol-induced, early ductal closure in very preterm infants
Ukkonen, Tiina; Härkin, Pia; Härmä, Antti; Leskinen, Markku; Valkama, Marita; Saarela, Timo; Hallman, Mikko; Aikio, Outi (2024-08-20)
Wiley-Blackwell
20.08.2024
Ukkonen T, Härkin P, Härmä A, Leskinen M, Valkama M, Saarela T, et al. Blood pressure increase preceded spontaneous and paracetamol-induced, early ductal closure in very preterm infants. Acta Paediatr. 2024; 113: 2619–2627. https://doi.org/10.1111/apa.17384.
https://creativecommons.org/licenses/by-nc-nd/4.0/
© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
https://creativecommons.org/licenses/by-nc-nd/4.0/
© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
https://creativecommons.org/licenses/by-nc-nd/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202408215519
https://urn.fi/URN:NBN:fi:oulu-202408215519
Tiivistelmä
Abstract
Aim:
To investigate the blood pressure (BP) and ductal calibre patterns associated with early ductal closure in very low gestational age (<32 weeks) infants.
Methods:
Blood pressure was continuously measured intra-arterially among 43 infants participating in a randomised, double-blind trial of 4 days prophylactic intravenous paracetamol. Early closure of the ductus was verified by daily ultrasound examinations. The BP recordings, before and after the verified ductal closure, were examined and compared to control infants without ductal closure. In the 24-h preceding the ultrasound-verified ductal closure, periods of increased BP were searched and identified as suggestive ductal closure time points. In control infants without ductal closure, BP trends were examined during the corresponding age.
Results:
Mean arterial BP increased significantly before ductal closure (p < 0.001) and stayed higher than in the control group. Mean BP during the 8 h preceding closure significantly predicted the ductal closure [OR 2.094 (95% CI 1.209–3.630), p = 0.008], and multiple potential confounders failed to abolish this association. A linear decrease pattern in ductal calibre was significantly associated with the ductal closure.
Conclusion:
Blood pressure increased and stabilised before the early ductal closure, offering potential implications on treatment strategies of very premature infants.
Aim:
To investigate the blood pressure (BP) and ductal calibre patterns associated with early ductal closure in very low gestational age (<32 weeks) infants.
Methods:
Blood pressure was continuously measured intra-arterially among 43 infants participating in a randomised, double-blind trial of 4 days prophylactic intravenous paracetamol. Early closure of the ductus was verified by daily ultrasound examinations. The BP recordings, before and after the verified ductal closure, were examined and compared to control infants without ductal closure. In the 24-h preceding the ultrasound-verified ductal closure, periods of increased BP were searched and identified as suggestive ductal closure time points. In control infants without ductal closure, BP trends were examined during the corresponding age.
Results:
Mean arterial BP increased significantly before ductal closure (p < 0.001) and stayed higher than in the control group. Mean BP during the 8 h preceding closure significantly predicted the ductal closure [OR 2.094 (95% CI 1.209–3.630), p = 0.008], and multiple potential confounders failed to abolish this association. A linear decrease pattern in ductal calibre was significantly associated with the ductal closure.
Conclusion:
Blood pressure increased and stabilised before the early ductal closure, offering potential implications on treatment strategies of very premature infants.
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