Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

Frontiers in Pediatrics

Yogen Singh¹  Georg Hansmann²  Sven C. Weber³  Natalie Timme³  Hannes Sallmon⁴  Elaine L. Shelton⁵  Ömer Erdeve⁶  Begüm Atasay⁶ 

[1] Department of Neonatology and Pediatric Cardiology, Cambridge University Hospitals, Cambridge, United Kingdom;University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom;Department of Pediatric Cardiology and Intensive Care Medicine, Medizinische Hochschule Hannover, Hanover, Germany;Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany;Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany;Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany;Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States;Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States;Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey;

关键词: platelets;    thrombocytopenia;    very low birth weight;    patent ductus arteriosus;    hemodynamics;   

DOI  :  10.3389/fped.2021.612242

来源: Frontiers

【 摘 要 】

Platelets are critically involved in murine patent ductus arteriosus (PDA) closure. To date, the clinical significance of these findings in human preterm infants with PDA is still controversial. We discuss the available study data on the role of platelets for PDA closure in preterm infants: Several mostly retrospective studies have yielded conflicting results on whether thrombocytopenia contributes to failed spontaneous ductal closure. The same applies to investigations on the role of thrombocytopenia as a risk factor for unsuccessful ductus arteriosus closure by pharmacological treatment with cyclooxygenase inhibitors. Nonetheless, recent meta-analyses have concluded that thrombocytopenia constitutes an independent risk factor for both failed spontaneous and pharmacological PDA closure in preterm infants. However, the available investigations differ in regard to patient characteristics, diagnostic strategies, and treatment protocols. Several studies suggest that impaired platelet function rather than platelet number is critically involved in failure of ductus arteriosus closure in the preterm infant. A recent randomized-controlled trial on platelet transfusions in preterm infants with PDA failed to show any benefit for liberal vs. restrictive transfusion thresholds on PDA closure rates. Importantly, liberal transfusions were associated with an increased rate of intraventricular hemorrhage, and thus should be avoided. In conclusion, the available evidence suggests that thrombocytopenia and platelet dysfunction contribute to failure of spontaneous and pharmacological PDA closure in preterm infants. However, these platelet effects on PDA seem to be of only moderate clinical significance. Furthermore, platelet transfusions in thrombocytopenic preterm infants in order to facilitate PDA closure appear to cause more harm than good.

【 授权许可】

CC BY