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Front. Pediatr. | doi: 10.3389/fped.2018.00041

Association between platelet counts before and during pharmacological therapy for patent ductus arteriosus and treatment failure in preterm infants

 Hannes Sallmon1*, Sven C. Weber2, Juliane Dirks1, Tamara Schiffer1, Tamara Klippstein1, Anja Stein3,  Ursula Felderhoff-Müser3, Boris Metze1, Georg Hansmann4,  Christoph Bührer1, Malte Cremer1 and Petra Koehne1
  • 1Neonatology, Charité Universitätsmedizin Berlin, Germany
  • 2Pediatrics/Neonatology and Pediatric Intensive Care Medicine, University of Greifswald, Germany
  • 3Neonatology, Universitätsklinikum Essen, Germany
  • 4Pediatric Cardiology and Critical Care, Hannover Medical School, Germany

Background: The role of platelets for mediating closure of the ductus arteriosus in human preterm infants is controversial. Especially, the effect of low platelet counts on pharmacological treatment failure is still unclear.
Methods: In this retrospective study of 471 preterm infants (< 1,500 g birth weight), who were treated for a patent ductus arteriosus (PDA) with indomethacin or ibuprofen, we investigated whether platelet counts before or during pharmacological treatment had an impact on the successful closure of a hemodynamically significant PDA. The effects of other factors, such as sepsis, preeclampsia, gestational age, birth weight, and gender were also evaluated.
Results: Platelet counts before initiation of pharmacological PDA treatment did not differ between infants with later treatment success or failure. However, we found significant associations between low platelet counts during pharmacological PDA therapy and treatment failure (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that platelet counts after the first, and before and after the second cyclooxygenase inhibitor cycle were significantly associated with treatment failure (area under the curve (AUC) of > 0.6). However, ROC curve analysis did not reveal a specific platelet cutoff-value that could predict PDA treatment failure. Multivariate logistic regression analysis showed that lower platelet counts, a lower birth weight, and preeclampsia were independently associated with COX inhibitor treatment failure.
Conclusion: We provide further evidence for an association between low platelet counts during pharmacological therapy for symptomatic PDA and treatment failure, while platelet counts before initiation of therapy did not affect treatment outcome.

Keywords: preterm infant, Ibuprofen, Indomethacin, patent ductus arteriosus, platelets, Ductal closure

Received: 07 Nov 2017; Accepted: 12 Feb 2018.

Edited by:

Eugene Dempsey, University College Cork, Ireland

Reviewed by:

Karel Allegaert, University Hospitals Leuven, Belgium
Joseph Ting, University of British Columbia, Canada  

Copyright: © 2018 Sallmon, Weber, Dirks, Schiffer, Klippstein, Stein, Felderhoff-Müser, Metze, Hansmann, Bührer, Cremer and Koehne. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Hannes Sallmon, Charité Universitätsmedizin Berlin, Neonatology, Berlin, Germany, hannes.sallmon@charite.de