| 1. |
- Gavali, Hamid, et al.
(författare)
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Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction : A Nationwide Multicentre Study
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 62:6, s. 918-926
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study.Methods: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR.Results: Some 126 radically surgically treated AGI patients were identified – 102 graft infections and 24 endograft infections – treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p =.46), or long term five year survival (48.2% vs. 49.9%, p =.87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p =.56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 – 14.8), coronary artery disease (OR 4.2, CI 1.2 – 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 – 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 – 0.9).Conclusion: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.
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| 2. |
- Gavali, Hamid, et al.
(författare)
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Semi-Conservative Treatment Versus Radical Surgery in Abdominal Aortic Graft and Endograft Infections
- 2023
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 66:3, s. 397-406
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort.Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed to identify factors associated with mortality.Results: One hundred and sixty-nine patients with surgically treated abdominal AGI were identified, comprising 43 SC (14 endografts; 53% with a graft enteric fistula [GEF] in total) and 126 RS (26 endografts; 50% with a GEF in total). The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan -Meier estimated five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan -Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 -1.5).Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.
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| 3. |
- Hoffsten, Alice, et al.
(författare)
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Early Postnatal Comprehensive Biomarkers Cannot Identify Extremely Preterm Infants at Risk of Developing Necrotizing Enterocolitis.
- 2021
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Ingår i: Frontiers in pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Necrotizing enterocolitis (NEC) is a fatal disease where current diagnostic tools are insufficient for preventing NEC. Early predictive biomarkers could be beneficial in identifying infants at high risk of developing NEC. Objective: To explore early biomarkers for predicting NEC in extremely preterm infants (EPIs). Methods: Blood samples were collected on day 2 (median 1.7; range 1.5-2.0) from 40 EPI (median 25 gestational weeks; range 22-27): 11 developed NEC and 29 did not (controls). In each infant, 189 inflammatory, oncological, and vascular proteomic biomarkers were quantified through Proximity Extension Assay. Biomarker expression and clinical data were compared between the NEC group and Controls. Based on biomarker differences, controls were sorted automatically into three subgroups (1, 2, and 3) by a two-dimensional hierarchical clustering analysis. Results: None of the biomarkers differed in expression between all controls and the NEC group. Two biomarkers were higher in Control 1, and 16 biomarkers were lower in Control group 2 compared with the NEC group. No biomarker distinguished Control 3 from the NEC group. Perinatal data were similar in the whole population. Conclusions: Early postnatal comprehensive biomarkers do not identify EPIs at risk of developing NEC in our study. Future studies of predictors of NEC should include sequential analysis of comprehensive proteomic markers in large cohorts.
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| 4. |
- Markasz, Laszlo, et al.
(författare)
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Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity
- 2020
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Ingår i: Translational Vision Science & Technology. - : Association for Research in Vision and Ophthalmology (ARVO). - 2164-2591. ; 9:13
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Growth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP.Methods: In total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons.Results: Differences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively).Conclusions: Our data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development.Translational Relevance: Cluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.
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| 5. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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A High Ductal Flow Velocity is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22-27 Weeks Gestational Age
- 2012
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Ingår i: Critical Care Research and Practice. - : Hindawi Limited. - 2090-1305 .- 2090-1313. ; , s. 715265-
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To identify factors affecting closure of patent ductus arteriosus (PDA) in newborn infants born at 22-27 weeks gestational age (GA) during pharmacological treatment with cyclooxygenase inhibitors.Method:Infants born at 22-27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory and outcome parameters. Echocardiographic examinations during treatment were reviewed.Results:Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4 weeks vs. 24+3 weeks; P=0.047), and a higher pre-treatment left to right maximal ductal flow velocity (1.6 m/s vs. 1.1 m/s; P=0.023). Correcting for GA, preeclampsia, antenatal steroids, and age at treatment start, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04, p=0.049).Conclusion:Maximal ductal flow velocity was independently associated with success of PDA treatment.
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| 6. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants
- 2021
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Ingår i: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010-2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/-1 week) and time of birth (+/-1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24(+5) +/- 1(+3) weeks and 668 +/- 170 g) and the Control group (24(+5) +/- 1(+3) weeks and 704 +/- 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.
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| 7. |
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| 8. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Early Biochemical Markers Associated with Development of Necrotizing Enterocolitis
- 2017
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Ingår i: Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017).
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Konferensbidrag (refereegranskat)abstract
- Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR), European Society for Neonatology (ESN), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI)ORGANIZING COMMITTEELuc Zimmermann (President of ESPR), Morten Breindahl (President of ESN), Manuel Sánchez Luna (President of UENPS), Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNI)SCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair), Pierre Gressens (Past Scientific President), Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Neonatal Gastrointestinal Physiology and NEC"ABS 1. DETRIMENTAL MUCOSAL EFFECT OF IBUPROFEN IN THE IMMATURE HUMAN INTESTINE • E. Tremblay, E. Ferretti, M.-P. Thibault, D. Grynspan, K.M. Burghardt, M. Bettolli, C. Babakissa, E. Levy, J.-F. Beaulieu; Research Consortium on Child Intestinal InflammationABS 2. CORRELATION BETWEEN CALPROTECTIN LEVELS IN MECONIUM AND VITAMIN D STATUS IN CORD BLOOD: ASSOCIATION WITH INTESTINAL DISTRESS DURING NEONATAL PERIOD • S.H. Park, W.H. Kim, Y.M. LeeABS 3. COMPARISON OF FECAL CALPROTECTIN LEVELS ACCORDING TO FEEDING KINDS IN VERY PRETERM INFANTS • J.H. Park, N.H. Lee, S.Y. Shin, C.S. Kim, S.L. Lee, W.M. LeeABS 4. NEONATAL MORBIDITY OF EXTREME PRETERM INFANTS BEFORE AND AFTER THE INTRODUCTION OF A DONOR HUMAN MILK BANK AT THE PERINATAL CENTER GROßHADERN • V. Lieftüchter, M. Kujawa, A. Schuze, A.W. Flemmer, S. Herber-JonatABS 5. IS NEAR INFRARED SPECTROSCOPY A RELIABLE TECHNIQUE TO MEASURE GUT PERFUSION IN PRETERM INFANTS? • J. Banerjee, T.S. Leung, N. AladangadyABS 6. EARLY BIOCHEMICAL MARKERS ASSOCIATED WITH DEVELOPMENT OF NECROTIZING ENTEROCOLITIS • K.W. Olsson, R. SindelarABS 7. OPTICAL PROPERTIES OF EARLY STOOL FROM PRETERM INFANTS: IMPORTANT TO CONSIDER FOR ABDOMINAL OXIMETRY BASED ON NEAR-INFRARED SPECTROSCOPY • H. Isler, D. Schenk, J. Bernhard, F. Scholkmann, S. Kleiser, D. Ostojic, D. Bassler, M. Wolf, T. KarenABS 8. STOOLING PATTERN AND GASTRIC RESIDUALS ARE NOT USEFUL TOOLS FOR EARLY DIAGNOSIS OF NECROTISING ENTEROCOLITIS IN PRETERM INFANTS • S. Carlsson, M. Domellöf, A. ElfvinABS 9. REFERENCE VALUES OF ZONULIN IN TERM NEONATES • A. Tarko, A. Suchojad, A. Jarosz-Lesz, M. Majcherczyk, M. Michalec, I. Maruniak-ChudekABS 10. DETERMINANTS OF THE NEED FOR TREATMENT IN PREMATURE INFANTS WITH SUSPECTED NECROTISING ENTEROCOLITIS • N. Bussmann, A. El-Khuffash, D. CorcoranABS 11. EFFECT OF ANTIBIOTIC PROPHYLAXIS DURING REMOVAL OF A CENTRAL VENOUS CATHETER ON DEVELOPMENT OF THE NEONATAL INTESTINAL MICROBIOTA • E. d’Haens, R. Zwittink, C. Belzer, M. Hemels, R. van Lingen, I. Renes, J. Knol, D. van Zoeren-GrobbenABS 12. NEWBORNS WITH ULTRASOUND FINDING OF GAS IN HEPATIC PORTAL VENOUS SYSTEM: ANALYSIS OF RISK FACTORS, CLINICAL AND LABORATORY FINDINGS AND DEVELOPMENT OF ALLERGY • J. Lozar Krivec, A. Nyasha Zimani, N. Zupančič, D. Paro-PanjanABS 13. NEONATAL FECAL BIOMARKERS OF NECROTIZING ENTEROCOLITIS • I. Tofé, M.V. Rodriguez-Benitez, C. Hernandez-Chirlaque, M. Gil-Campos, M.D. Ruiz-Gonzalez, A. MartinezABS 14. THE OPEN ABDOMEN: A CHALLENGE FOR NEONATOLOGISTS AND NEONATAL SURGEONS. THE KAROLINSKA EXPERIENCE • M. Bartocci, E. Palleri, A. Svenningsson, T. WesterABS 15. ANOGENITAL STIMULATION IN RATS DOES NOT INCREASE GASTRIC EMPTYING • C.H. Ferreira, J. BelikABS 16. THE PRETERM INFANT GASTRIC EMPTYING RATE IS DEPENDENT ON THE FEED VOLUME AND NOT ON POSTNATAL AGE • C.H. Ferreira, F.E. Martinez, G.C. Crott, J. BelikABS 17. NECROTIZING ENTEROCOLITIS IN A NEONATAL INTENSIVE CARE UNIT • M. Branco, I. Falcão, T. Lopes, E. Proença, A. Almeida, C. Carvalho, L. PinhoABS 18. SPONTANEOUS INTESTINAL PERFORATION: A DIAGNOSTIC CHALLENGE IN THE NEWBORN • M. Branco, T. Lopes, I. Falcão, L. Pinho, C. Enes, A. Almeida, C. Carvalho, E. ProençaABS 19. OUTCOMES OF EXTREMELY LOW BIRTH WEIGHT BABIES RECEIVING SURGICAL TREATMENT FOR NECROTISING ENTEROCOLITIS • J. Ashton, C. Charlesworth, P. YajamanyamABS 20. ASSESSMENT OF ENZYMOTHERAPY EFFICACY IN CASE OF LACTASE INSUFFICIENCY IN PRETERM INFANTS • O. Vlasova, L. KoliubakinaABS 21. THE NORWEGIAN PRETERM INFANT GUT (PINGU) STUDY: A METAGENOMIC APPROACH TO GUT MICROBIOTA COMPOSITION AND RESISTOME IN INFANTS SUPPLEMENTED WITH PROBIOTICS • E. Esaiassen, E. Hjerde, P. Cavanagh, T. Pedersen, J. Andresen, S. Rettedal, R. Støen, B. Nakstad, N.P. Willassen, C. KlingenbergABS 22. NECROTIZING ENTEROCOLITIS: WHAT ASPECTS IN 2017? • H. Ben Salem, I. Kasraoui, M.T. Lamouchi, E.D. Bouaicha, N. Kasdallah, S. Blibech, M. DoagiABS 23. ROUTINE PROBIOTICS FOR PRETERM NEONATES: EXPERIENCE IN A TERTIARY AUSTRALIAN NEONATAL INTENSIVE CARE UNIT • G. Deshpande, V. Shingde, L. Downe, J. Xiao, M. TaberABS 24. MATERNAL RISK FACTORS FOR NEC IN PREMATURES INFANTS WITH GA UNDER 28 WEEKS • L. Olariu, G. Olariu, S. OlariuKeywords 2nd Congress of joint European Neonatal Societies; jENS 2017; Venice; 2017; Session “Neonatal Gastrointestinal Physiology and NEC” Full Text: PDF Number of abstract views: 1475 Number of PDF views/downloads: 2487
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| 9. |
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| 10. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants
- 2019
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 108:9, s. 1590-1956
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Tidskriftsartikel (refereegranskat)abstract
- AimWe assessed whether early haemodynamically significant patent ductus arteriosus (hsPDA) predicted persistent patent ductus arteriosus (PDA) in extremely preterm infants.MethodsThis prospective observational study of 60 infants born at 22–27 weeks of gestational age (GA) without any major congenital anomalies or heart defects was conducted at Uppsala University Children's Hospital from November 2012 to May 2015. Respiratory and systemic circulatory parameters were continuously recorded, and echocardiographic examinations performed daily during the first three days of life. Pharmacological treatment was initiated if hsPDA was found on days two to seven. Persistent PDA was diagnosed if hsPDA remained after pharmacological treatment or pharmacological treatment was contraindicated.ResultsThe infants (56% male) had a median GA of 25 + 2 weeks and 50% received pharmacological treatment. PDA was persistent in 30% and ultimately closed or insignificant in 70%. hsPDA on days two to seven was not associated with future persistent PDA (p = 1.000). Mechanical ventilation (p = 0.025), high mean airway pressure (p = 0.020) and low ductal maximal flow velocity (Vmax) (p = 0.024) on day two were associated with future persistent PDA.ConclusionEarly hsPDA did not predict persistent PDA, but the early need for assisted ventilation and low ductal Vmax were associated with future persistent PDA in these extremely preterm infants.
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| 11. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Exploration of potential biochemical markers for persistence of patent ductus arteriosus in preterm infants at 22–27 weeks’ gestation
- 2019
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86, s. 333-338
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants.MethodsInfants born at 22–27 weeks’ gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen.ResultsHigh levels of B-type natriuretic peptide, interleukin-6, -8, -10, and -12, growth differentiation factor 15 and monocyte chemotactic protein 1 were associated with persistent PDA, as were low levels of platelet-derived growth factor. High levels of erythropoietin were associated with both persistent PDA and failure to close PDA within 24 h of the last dose of ibuprofen.ConclusionsHigh levels of inflammatory markers were associated with the persistence of PDA. High levels of erythropoietin were associated with both the persistence of PDA and failure to respond to pharmacological treatment.
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| 12. |
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| 13. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Low Ductal Peak Flow Velocity Prior to Pharmacological Patent Ductus Arteriosus Treatment Predicts Treatment Failure in Extremely Preterm Infants
- 2010
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Konferensbidrag (refereegranskat)abstract
- BACKGROUNDPatent ductus arteriosus (PDA) is frequent in preterm infants and associated with increased mortality and morbidity. Low gestational ages (GA), sepsis and lack of prenatal steroid exposure are previously identified predictors of pharmacological PDA treatment failure.OBJECTIVETo identify early factors affecting ductal closure during pharmacological treatment in extremely preterm infants, with special focus on pulmonary circulation.DESIGN/METHODSNewborn infants, born at 22-27 gestational weeks between January 2006 and December 2008 at Uppsala University Children's Hospital and pharmacologically treated for PDA, were retrospectively identified (Figure 1). Medical charts were assessed for the first day of life, for the days of echocardiographic examination and for the days of treatment. Perinatal factors, vital parameters, ventilatory settings, treatments, fluid intake, complications and outcomes were registered and pre-treatment echocardiography was reviewed. Follow-up echocardiography defined successful or failed ductal closure. RESULTSThirty-two infants were identified (Figure 1). Prophylactic treatment was initiated 3 days after birth (range 1-8) in both groups (P=0.952) with one single course of 3-5 doses indomethacin (n=28) or ibuprofen (n=3).Infants who failed closure had lower GA (23+6 weeks vs. 25+6 weeks, P=0.048), higher median heart rate during first day of life (155 bpm vs. 145 bpm, P=0.027), were on ventilator 20%, P=0.004), and required longer total time of ventilatory support during hospital stay (28 days vs. 4 days, P=0.013). Other perinatal factors, vital parameters, treatments and fluid intake and incidences of BPD, IVH, NEC and ROP were similar between groups.Pre-treatment echocardiography revealed lower left to right ductal peak flow velocity in infants that failed closure (P=0.009, Figure 2). When adjusted for ductal diameter, low peak flow velocity was still associated with pharmacological treatment failure (P=0.017), indicating that higher pulmonary arterial pressure might oppose ductal constriction after birth (Figure 3). CONCLUSIONSLow ductal peak flow velocity is an early predictor of pharmacological PDA treatment failure in extremely preterm infants, possibly reflecting the influence of pulmonary arterial pressure on ductus constriction.
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| 14. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Outcomes after endovascular aortic intervention in patients with connective tissue disease
- 2023
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Ingår i: JAMA Surgery. - : American Medical Association (AMA). - 2168-6254 .- 2168-6262. ; 158:8, s. 832-839
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma.Objective: To assess the midterm outcomes of endovascular aortic repair in patients with CTD.Design, Setting, and Participants: For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022.Exposure: All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta.Main Outcomes and Measures: Short-term and midterm survival, rates of secondary procedures, and conversion to open repair.Results: In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions.Conclusions and Relevance: This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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| 15. |
- Olsson, Karl Wilhelm, 1985-
(författare)
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Persistent ductus arteriosus in extremely preterm infants
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patent ductus arteriosus (PDA) is common in infants born <28 weeks gestational age (GA) and associated with significant morbidity. Despite extensive research efforts, the indications for PDA treatment remain controversial. The aims of these studies were to gain knowledge of factors affecting ductal closure during the early postnatal period and provide better means for identification of preterm infants that may benefit from PDA treatment.In Paper I, infants born <28 weeks GA and pharmacologically treated for PDA were retrospectively identified and their echocardiographic examinations were reviewed. Twenty-nine (52%) infants successfully closed and 27 (48%) infants failed to close PDA during treatment. High maximal ductal flow velocity (Vmax) was independently associated with closure (OR 3.04, p=0.049).Paper II prospectively included infants born <28 weeks GA and assessed early respiratory, circulatory and echocardiographic parameters. PDA was persistent in 18 (30%) and ultimately closed or insignificant in 42 (70%) infants. Echocardiographic criteria for hemodynamically significant PDA on days 2-7 did not predict persistent PDA (p=1.000). Mechanical ventilation (p=0.025), high mean airway pressure (p=0.020) and low Vmax (p=0.024) during day two were associated with future persistent PDA.Blood samples were obtained during the second day of life from 47 of the infants in Paper II and serum markers previously associated with PDA or factors affecting PDA were analyzed for Paper III. Inflammatory markers and erythropoietin (EPO) were elevated in infants with future persistent PDA. EPO levels were also higher in infants that did not close PDA during pharmacological treatment.In Paper IV, 44 infants born <28 weeks GA with surgically ligated PDA were retrospectively compared to non-surgically treated controls. Ligated infants had larger ductal diameter prior to, and lack of diameter decrease after pharmacological treatment for PDA (p=0.048 and p=0.022 respectively), and higher incidence of severe bronchopulmonary dysplasia (p=0.025). Longer periods with invasive ventilation was independently associated with ligation (OR 1.04, p=0.018).In conclusion, early hsPDA do not predict persistence of ductus arteriosus in extremely preterm infants, but Vmax and EPO are promising early markers for prediction of persistence and should be subjects of future studies.
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| 16. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Pharmacological Ductus Arteriosus Treatment in Infants Born at 22-23 Gestational Weeks
- 2011
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Ingår i: Pediatric Research. - : Nature Publishing Group. ; , s. 268-268
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Konferensbidrag (refereegranskat)abstract
- Background: Improvements in neonatal care have increased survival rates for extremely premature infants. Patency of the ductus arteriosus is common among these infants and incidence relates inversely to gestational age. First-line treatment is COX-inhibitors, which is known to affect renal, pulmonary and cerebral blood flow and to increase risks of several morbidities. The efficacy of this treatment has not been confirmed in the very most preterm infants.Aim: To investigate the efficacy of pharmacological ductus arteriosus treatment in infants born at 22-23 weeks of gestation.Method: infants born at 22-23 weeks of gestation at Akademiska children's hospital between January 2006 and December 2010 were retrospectively identified and treatment and outcome parameters evaluated. Routine care for these infants included echocardiography during the first days of life and pharmacological treatment with indomethacin if echocardiographic or clinical signs of a hemodynamically significant ductus were present.Results: Fifty-three infants were born at 22-23 weeks gestation and 22 received pharmacological treatment for ductus arteriosus. Seven infants received ibuprofen due to shortage of indomethacin. Four (18%) infants obtained lasting ductal closure after pharmacological treatment. Four infants spontaneously closed their ductus later, three died, one received a second ibuprofen course, eight carried on to secondary surgical closure and two were discharged with a still patent ductus.Conclusion: Standard pharmacological treatment does not seem to effectively close ductus arteriosus in infants born at 22-23 gestational weeks.
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| 17. |
- Söderström, Fanny, et al.
(författare)
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Active versus restrictive ligation strategy for patent ductus arteriosus - A retrospective two-center study of extremely preterm infants born between 22+0 and 25+6 weeks of gestational age
- 2024
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Ingår i: EARLY HUMAN DEVELOPMENT. - : Elsevier. - 0378-3782 .- 1872-6232. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. Aims: To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. Study design: Retrospective, two-center, cohort study. Subjects: Infants born at 22(+0)-25(+6) weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). Main outcome measures: Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Results: Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub -group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. Conclusion: Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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