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The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis

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Abstract

Patent ductus arteriosus (PDA), one of the most common disorders in newborns, is associated with many complications in premature infants such as respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). However, the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) is still an ongoing debate. The relationship between platelet parameters and hsPDA has been explored in many studies over the last decade, but there is still no definite conclusion. We aim to explain the relationship between platelet parameters and hsPDA through this meta-analysis. Therefore, we used PubMed, Embase, the Cochrane Library, and Web of Science databases as well as the Google Scholar to search for studies up to May 2020. Three reviewers independently screened the articles, evaluated the quality of the articles, and collected the data. The random-effects model and fixed-effects model were used to evaluate pooled results. We used the I-square (I2) test to examine heterogeneity and the funnel plot; Egger’s test and meta-regression analysis were used to test for publication bias. Influence analysis was also carried out in this study. Stata version 12.0 software was used for data analysis. Fourteen studies, which included 3330 newborns, were extracted from 986 studies. The weighted mean difference (WMD) of the platelet count was − 17.98 (p < 0.001), the platelet distribution width (PDW) was 0.27 (p = 0.266), the mean platelet volume (MPV) was 0.01 (p = 0.958), the plateletcrit (PCT) was − 0.03 (p < 0.001), and the platelet mass was − 150.10 (p = 0.001).

Conclusion: Platelet count, PCT, and platelet mass of the first 3 days of life are potentially helpful in identifying premature infants at risk of hsPDA. More prospective studies on the relationship between different degrees of thrombocytopenia and platelet function and hsPDA should be conducted.

What is Known:

• Platelets are involved in the formation of thrombi during closure of the arterial duct.

• The diagnosis of hsPDA by Doppler echocardiography and clinical signs is not precise enough.

What is New:

• Preterm newborns with hsPDA in the first week of life demonstrated a significant reduction in platelet count, platelet mass, and plateletcrit in the first 3 days of life.

• No significant difference was shown between hsPDA and non-hsPDA infants in platelet distribution width and mean platelet volume in the first 3 days of life.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

CI:

Confidence interval

COXI:

Cyclooxygenase inhibitor

DA:

Ductus arteriosus

hsPDA:

Hemodynamically significant PDA

I 2 :

I-square

IVH:

Intraventricular hemorrhage

MPV:

Mean platelet volume

NEC:

Necrotizing enterocolitis

PCT:

Plateletcrit

PDA:

Patent ductus arteriosus

PDGF:

Platelet-derived growth factor

PDW:

Platelet distribution width

PGE2 :

Prostaglandin E2

PRISMA:

The preferred reporting items for systematic reviews and meta-analyses

RDS:

Respiratory distress syndrome

ROP:

Retinopathy of prematurity

WMD:

Weighted mean difference

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Authors and Affiliations

  1. Department of NICU, Qingdao Women and Children’s Hospital, Qingdao University, Shibei District, Qingdao, 266000, Shandong province, China

    Ran Ding, Qianwei Zhang, Yi Duan, Daijing Wang, Qibin Sun & Ruobing Shan

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  1. Ran Ding
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Contributions

RD: Provided the idea, designed the strategy, co-wrote and revised the article, completed the statistical analysis, and processed pictures and tables.

QZ and YD: Participated in the inclusion and elimination of studies, conducted the data extraction and the quality assessment, co-wrote and revised the article.

DW: Participated in the inclusion and elimination of studies, conducted the quality assessment, and verified the data.

QS: Retrieved studies, co-wrote and revised the article.

RS: RS is the guarantor of the manuscript. Participated in the improvement of the research design, co-wrote and revised the article, checked all the processes of the article.

Corresponding author

Correspondence to Ruobing Shan.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Not applicable.

Systematic review registration

The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020186153).

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Communicated by Daniele De Luca

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Ding, R., Zhang, Q., Duan, Y. et al. The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. Eur J Pediatr 180, 699–708 (2021). https://doi.org/10.1007/s00431-020-03802-5

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