Pediatrics and Neonatology最新文献

Background: The optimal management of patent ductus arteriosus (PDA) in premature infants remains controversial. This study compares in-hospital and neurodevelopmental outcomes of different PDA treatment strategies in preterm infants.

Methods: This retrospective study included infants with PDA born between 2017 and 2021, with a gestational age of 22 0/7 to 29 6/7 weeks or a birth weight of 401-1500 g. They were categorized into conservative treatment, medical treatment, or invasive closure with/without medication.

Results: Among the 130 infants analyzed, 76 had hemodynamically significant PDA (hsPDA), which was present in 96.0 % of the invasive closure group, 76.1 % of the medical treatment group, and 2.6 % of the conservative group. For infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of bronchopulmonary dysplasia (BPD) ≥ grade II, retinopathy of prematurity (ROP) ≥ stage 3 and cognitive impairment compared with medical treatment. Among infants with PDA, compared to the conservative treatment group, infants receiving medication had a higher risk of death or BPD ≥ grade II. Invasive closure was associated with a higher risk of BPD ≥ grade II. No significant difference in neurodevelopmental outcomes was found, except for better cognitive outcome at 2 years of corrected age in the medical treatment group.

Conclusion: For preterm infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of BPD ≥ grade II, ROP ≥ stage 3, and cognitive impairment compared to medical treatment. Among infants with PDA, despite a more turbulent postnatal course, neurodevelopmental outcomes for those receiving medication or invasive closure were comparable to those managed conservatively. Despite multiple statistical approaches, the limited sample size and potential reverse causality bias remain concerns. Further studies are needed to determine the optimal treatment strategy for PDA in preterm infants.

Background: Kasai portoenterostomy (KPE) is the key standard operation for biliary atresia (BA). Age at operation is an important factor that affects the outcome of KPE. The aim of the study is to evaluate the short-term outcome of KPE for biliary atresia infants in Upper Egypt.

Patients and methods: this was a cross-sectional, multicenter retrospective study done in three university hospitals in Upper Egypt. The data was collected from January 1, 2019 to September 30, 2021. All infants diagnosed with BA and managed by KPE were included in the study. The collected data were demographic data (age in months or days, sex, residence, parents' consanguinity, and parents' smoking status), history of present illness (the date of first symptoms, fecal color, skin itching, and associated anomalies), and general and abdominal examinations (liver size, skin, and sclera color).

Results: The total number of patients was 45 infants. Two-thirds of the cases were females. The mean age of KPE was 99 ± 13 days. The mean duration of jaundice clearance and resolution after surgery was 12.3 ± 5.5 weeks in 64.4 % of cases. During the five-year follow-up period, 26 (57.8 %) patients were still alive with native livers. Parental smoking, whether maternal or paternal, prenatal or postnatal, was present in 95.5 % of patients. A massive decrease in ALP level in the 1st postoperative week is an excellent predictor of a good outcome with a cutoff value of 560 U/L. Prophylaxis against developing cholangitis is important for the outcome.

Conclusion: Kasai portoenterostomy is an important operation for biliary atresia infants, whatever the age, under or above 4 months old. Kasai portoenterostomy increases the survival rate of native liver infants who suffer from BA. Jaundice clearance after KPE for BA can be predicted using postoperative AST, ALP, and GGT, as these enzymes decline dramatically at the end of the 3rd postoperative month. Unfortunately, the infants in this study had delayed diagnoses. To address this, targeted interventions such as continuing medical education for local doctors, improved transportation infrastructure, and financial support programs are needed to enhance early diagnosis. Despite the delay in the surgical intervention and the older infant's age, the results were good.

Clinicaltrials: gov Identifier: NCT05925543. Kasai portoenterostomy operation. in Biliary Atresia - Clinical Trials Registry - ICH GCP. The Registration Date was June 29, 2023.