107 Hemodynamic effects of low dose dexamethasone on patent ductus arteriosus in preterm neonates
Bibliographic record
Abstract
Abstract Background Patent ductus arteriosus (PDA) is common cardiovascular morbidity in preterm neonates. Pharmacological treatment of the PDA works primarily by inhibiting prostaglandins leading to ductal constriction. Anecdotal reports suggest that steroids may cause suppression of prostaglandin levels or decrease the sensitivity ductal muscles to prostaglandin promoting PDA constriction. Low dose dexamethasone (Dex) is a steroid that commonly used for prevention and treatment of Bronchopulmonary dysplasia (BPD) in preterm neonates , but its effects on PDA closure and associated hemodynamic changes in preterm infants remains underexplored. Objectives To investigate the effects of Dex on PDA hemodynamics and explore its dose dependent effect on PDA hemodynamic scores. Design/Methods This was a secondary analysis of prospective cohort study that investigated the cardiac effects of low dose Dex for prevention of BPD in neonates <29 weeks gestational age, at a level III NICU between April 2019 and July 2022 using serial echocardiography. For this study, PDA related echocardiographic parameters prior to initiation of Dex and after completion of Dex were analyzed. Two Dex dosing regimens were used during the study period - < 1mg/kg and > 1mg/kg cumulative dose- which were compared to determine any dose-response effects . Institutional ethical approval was obtained ( WREM124259). Results Out of 30 neonates included in the original cohort, 15 neonates with mean GA (SD) of 24.5 (1.06) weeks and mean birth weight (SD) 637.33(96.03) grams, had a PDA prior to Dex initiation (Table 1). PDA presence decreased to 66.7% after Dex completion. There was a significant decrease in both mean PDA size (SD) from 1.57 (0.51) mm to 1.01 (0.78) mm (p=0.010), and the hemodynamic significance score(SD) from 9.4 (3.78) to 6.13 (6.19) (p=0.021) respectively (Table 2). In a subset analysis, 50% of infants treated with lower-dose Dex experienced PDA closure, compared to 14.3% in the higher-dose group, although the difference was not statistically significant (p=0.282) Conclusion Echohocardiographic assessment before and after dexamethasone therapy demonstrate smaller ductal size and lower PDA hemodynamic significance score post treatment . Higher dose did not potentiate the effect in this cohort Whether this is a causal or temporal relationship remains to be seen in larger prospective cohorts
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".