Conservative treatment for patent ductus arteriosus in the preterm

Abstract

Background: A patent ductus arteriosus (PDA) is common among preterms, and prophylactic medical treatment has been advocated as the first-line approach. Conservative treatment may result in similar outcome, but without exposure to the harmful side effects of medication. A retrospective analysis revealed a ductal closure rate of 94% after conservative treatment with adjustment of ventilation (lowering the inspiratory time and increasing positive end expiratory pressure) and fluid restriction. Objective: To study prospectively over one year the rate of PDA closure, and morbidity and mortality following conservative treatment. Method: Prospective study (1 January 2005 -31 December 2005) including 30 newborns (30 weeks' gestation, all of whom were being ventilated and required surfactant. Echocardiography was performed 48-72 h after birth. Clinically important PDA was conservatively treated as described above. The percentage of children with PDA, ductal ligation and major complications was determined. Results: Ten neonates (33%) developed a clinical important PDA. Following conservative treatment the duct closed in all neonates (100%), and none required ductal ligation or medical treatment. The rates of major complications were no higher than those reported by the Vermont Oxford Network and in the literature. Conclusion: The managed care plan resulted in an overall ductal closure rate of 100%. These results suggest that conservative treatment of PDA is a worthy alternative to prophylactic medical treatment.

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

“…The rate of ligation in the present study, in infants receiving more than one course of indomethacin, although higher than reported in recent cohort studies (6,8,(10)(11)(12), was still within the range reported in the literature (4,5,15,17,18). Koehne et al (4) reported an overall ligation rate of 57% and a 34% ligation rate in 101 babies who had indomethacin treatment.…”

Patent Ductus Arteriosus in Preterm Infants

“…Strategies avoiding use of indomethacin or ibuprofen yield outcomes comparable to contemporaneous external benchmarks. 51,52 Less frequent use of surgical ligation in infants with PDA after failure of indomethacin prophylaxis was associated with a lower rate of necrotizing enterocolitis and no increase in rates of other adverse outcomes. 53 Reduced use of indomethacin and ligation at 1 center was associated with an increased rate of the combined outcome of death or chronic lung disease but no increase in rates of individual morbidities or mortality.…”

What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?

“…Because of the paucity of published trials documenting outcomes in neonatal intensive care units (NICUs) where PDAs were not treated reflexively with cyclo-oxygenase inhibitors or LIGATE, [5][6][7] we adopted PDA management guidelines in 2008 that emphasized watchful waiting for spontaneous closure, modest fluid restriction and limited use of indomethacin (INDO) and LIGATE to only those infants who met certain cardiorespiratory distress criteria. The purpose of this manuscript is to describe our beforeafter observational study to determine whether our new PDA management guidelines were associated with improved, worsened or unusual NICU outcomes.…”