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Relationship between Decrease in Urine Output following Treatment with Prostaglandin Inhibitors and PDA Closure
Malika Goel1, Sourabh Dutta1, Shiv Sajan Saini1
1Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Insights
A decrease in urine output (UO) following treatment for patent ductus arteriosus (PDA) with prostaglandin inhibitors indicates a higher likelihood of PDA closure. This finding suggests a link between renal and ductal tissue sensitivity to these medications in preterm infants.
Area of Science:
- Neonatal Physiology
- Pharmacology
- Pediatric Cardiology
Background:
- Prostaglandin inhibitors are standard treatment for patent ductus arteriosus (PDA) in preterm infants.
- These inhibitors can cause a transient decrease in urine output (UO) due to effects on renal vasculature.
- The relationship between this UO change and PDA closure efficacy is not well-established.
Purpose of the Study:
- To investigate the association between decreased urine output (UO) and successful closure of hemodynamically significant PDA (hsPDA).
- To determine if renal vascular sensitivity to prostaglandin inhibitors correlates with ductal tissue sensitivity.
- To identify if reduced UO predicts PDA closure in preterm neonates.
Main Methods:
- Prospective, proof-of-concept cohort study involving 40 preterm neonates with hsPDA treated with prostaglandin inhibitors.
- Daily measurement of urine output (UO) from baseline up to 72 hours.
- Daily echocardiography to assess PDA status; comparison of UO changes between PDA-closed and PDA-open groups.
Main Results:
- The PDA-closed group (n=28) exhibited a significantly greater percentage decrease in UO compared to the PDA-open group (n=12) at multiple time points (24-48h and 48-72h).
- The decrease in UO preceded PDA closure, and was associated with greater weight loss in the PDA-closed group.
- A decrease in UO of 27% (24-48h) and 17% (48-72h) best predicted PDA closure.
Conclusions:
- A reduction in urine output following prostaglandin inhibitor treatment for hsPDA is significantly associated with successful PDA closure.
- This suggests that the degree of UO reduction can serve as a predictive marker for treatment efficacy.
- Further research may elucidate the underlying mechanisms linking renal and ductal responses to prostaglandin inhibition.
Objective:
Prostaglandin inhibitors are used for the treatment of patent ductus arteriosus (PDA) and they often transiently decrease the urine output (UO) due to prostaglandin inhibition in the renal vasculature. We hypothesized that preterm infants whose renal vasculature shows greater sensitivity to prostaglandin inhibitors are likely to have ductal tissue with greater sensitivity to the same. Our objective was to determine whether the decrease in UO following treatment of PDA with a prostaglandin inhibitor is associated with a higher probability of PDA closure.
Study Design:
In a prospective, proof-of-concept, cohort study, we enrolled 40 preterm neonates with hemodynamically significant PDA (hsPDA), being treated with a prostaglandin inhibitor. The key predictor, UO, was measured at baseline and daily until 72 hours. We repeated echocardiography daily until PDA closure or the end of treatment. The key outcome was PDA closure. We compared "PDA-closed" (n = 28) and "PDA-open" (n = 12) groups for change in UO from baseline.
Results:
The median (Q1, Q3) percent decrease in UO (figures rounded off to integers) was greater in the "PDA-closed" versus "PDA-open" group: from baseline to 0 to 24 hours [-45% (-55%, +0.04%) vs. -15% (-28%, +49%)]; baseline to 24 to 48 hours [-41% (-53%, +14%) vs. -3% (-25%, +62%), p = 0.03] and baseline to 48 to 72 hours [-33% (-49%, +32%) vs. +21% (-7%, +98%), p = 0.02]. Decrease in UO preceded PDA closure. The "PDA-closed" group had significantly greater weight loss, despite a greater decrease in UO. A decrease in UO of 27 and 17% by 24 to 48 hours and 48 to 72 hours, respectively, best predicted PDA closure.
Conclusion:
A decrease in UO after treating hsPDA with a prostaglandin inhibitor is associated with successful closure of PDA.
Key Points:
· Prostaglandin inhibition causes both decrease in urine output and PDA closure following medical treatment. · The association between drug-induced decrease in urine output and PDA closure has been inadequately studied.. · Decrease in urine output after treatment with prostaglandin inhibitors increases the chances of PDA closure..
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