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99nicu.org 99nicu.org

99nicu.org

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Blog Entries posted by 99nicu.org

  1. 99nicu.org
    Mortality rates of congenital heart disease has fallen dramatically over the years, nicely demonstrated by a cohort British study. The annual numbers of deaths decreased from 1460 in 1959 to 154 in 2009. Survival was especially improved in infancy. Infants comprised 63% of all CHD deaths during 1959-63, but only to 22% in 2004-08.
    Naturally, the development of pediatric cardiology, thoracic surgery and pediatric intensive care have been essential for this dramatic improvement.
    The improved situation for infants with congenital heart disease is quite similar and parallel to improved outcomes for preterm infants. Only a few decades ago, the majority of today's survivors would have had a poor prognosis.
    With this growing generation of "new survivors" comes new challenges. In neonatal and adult medicine we know little about aging individuals born preterm, and I believe the same applies to aging individuals born with congenital heart disease.
    Knowles RL, Bull C, Wren C, & Dezateux C (2012). Mortality with congenital heart defects in England and Wales, 1959-2009: exploring technological change through period and birth cohort analysis. Archives of disease in childhood, 97 (10), 861-5 PMID: 22753769
  2. 99nicu.org
    Platelets are probably involved in sealing and remodelling of the closing ductus arteriosus. And, it is easy to believe that thrombocytopenia is associated with PDA-problems in preterm infants. Or, even causally related!

    A conference abstract in 2011 (i.e. not peer-reviewed and published) fuelled this idea, reporting a association between trc-counts and PDA-risk. However, other small and published studies came to conflicting results.

    A large study from Germany is now available on line in Pediatrics, included 1350 babies with known data on trc-counts and PDA-status from echocardiography. Given the much better statistical power, the conclusions seem solid: mild, moderate or even severe thrombocytopenia was not associated with PDA risk.

    What should be done now? As the authors stress, thrombocytes are more than numbers and the functional state/capacity of the thrombocytes could be more important than the trc-count as such. And, regardless of the specific aims in future studies, platelet function needs to be considered when diving deeper into the question of platelets and the open duct.
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