Day case ligation of patent ductus arteriosus in preterm infants: a 10 year review.

Satur, C. R. M.; Walker, Duncan R.; Dickinson, D F

doi:10.1136/adc.66.4.477

Cited by 28 publications

(18 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Infants with PDA may be at increased risk for necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), or intraventricular hemorrhage (IVH) 3–7. The most premature infants are more likely to have a significant PDA, least likely to respond to indomethacin, and more likely to reopen the ductus 8–15…”

mentioning

confidence: 99%

Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome

et al. 2009

View full text Add to dashboard Cite

OBJECTIVE-The purpose of this work was to evaluate therapy for patent ductus arteri-osus as a risk factor for death or neurodevelopmental impairment at 18 to 22 months, bronchopulmonary dysplasia, or necrotizing enterocolitis in extremely low birth weight infants. METHODS-We studied infants in the National Institute of Child Health and Human DevelopmentNeonatal Research Network Generic Data Base born between 2000 and 2004 at 23 to 28 weeks' gestation and at <1000-g birth weight with patent ductus arteriosus. Patent ductus arteriosus therapy was evaluated as a risk factor for outcomes in bivariable and multivariable analyses.RESULTS-Treatment for subjects with patent ductus arteriosus (n = 2838) included 403 receiving supportive treatment only, 1525 treated with indomethacin only, 775 with indomethacin followed by secondary surgical closure, and 135 treated with primary surgery. Patients who received supportive therapy for patent ductus arteriosus did not differ from subjects treated with indomethacin only for any of the outcomes of interest. Compared with indomethacin treatment only, patients undergoing primary or secondary surgery were smaller and more premature. When compared with indomethacin alone, primary surgery was associated with increased adjusted odds for neurodevelopmental impairment and bronchopulmonary dysplasia in multivariable logistic regression. Secondary surgical closure was associated with increased odds for neurodevelopmental impairment and increased adjusted odds for bronchopulmonary dysplasia but decreased adjusted odds for death. Risk of necrotizing enterocolitis did not differ among treatments. Indomethacin prophylaxis did not significantly modify these results.CONCLUSIONS-Our results suggest that infants treated with primary or secondary surgery for patent ductus arteriosus may be at increased risk for poor short-and long-term outcomes compared with those treated with indomethacin. Prophylaxis with indomethacin in the first 24 hours of life did not modify the subsequent outcomes of patent ductus arteriosus therapy. What This Study AddsOur analysis of 2838 infants with PDA in the NRN GDB showed that those treated with indomethacin, when compared with those with supportive care, had similar outcomes, and those with surgical ligation had more complications.Clinically significant patent ductus arteriosus (PDA) occurs in ~49% of extremely low birth weight (ELBW) infants with weights of 501 to 750 g and 38% of infants with weights of 751 to 1000 g. 1,2 Infants with PDA may be at increased risk for necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), or intraventricular hemorrhage (IVH). [3][4][5][6][7] The most premature infants are more likely to have a significant PDA, least likely to respond to indomethacin, and more likely to reopen the ductus. [8][9][10][11][12][13][14][15] Optimal therapy for PDA remains controversial. The only direct comparison of primary medical versus surgical treatment did not include infants <29 weeks' gestation and was completed before the wi...

show abstract

mentioning

confidence: 99%

Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome

et al. 2009

View full text Add to dashboard Cite

show abstract

“…The risk of NEC associated with indomethacin has been variously reported as no increased risk to as high as 35% [9,[12][13][14] . Moreover, indomethacin may fail to achieve ductal closure, and very low birth weight (VLBW) infants with PDA have increased requirements for supplemental oxygen and mechanical ventilator support, and may be at increased risk for significant complications of prematurity including NEC, bronchopulmonary dysplasia, intraventricular hemorrhage (IVH) and renal impairment [2,6,7,[15][16][17][18] . Early definitive treatment of symptomatic PDA may reduce respiratory symptoms, risk of chronic lung disease and risk of IVH [16] .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, indomethacin may fail to achieve ductal closure, and very low birth weight (VLBW) infants with PDA have increased requirements for supplemental oxygen and mechanical ventilator support, and may be at increased risk for significant complications of prematurity including NEC, bronchopulmonary dysplasia, intraventricular hemorrhage (IVH) and renal impairment [2,6,7,[15][16][17][18] . Early definitive treatment of symptomatic PDA may reduce respiratory symptoms, risk of chronic lung disease and risk of IVH [16] . Attempts to identify predictors of failure of ductal closure or complications in indomethacin-exposed infants have used small cohorts or have not clearly defined the risk due to gestational age or illness severity at the time of PDA diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Ductal Closure and Intestinal Complications in Very Low Birth Weight Infants Treated with Indomethacin

et al. 2008

View full text Add to dashboard Cite

Objective: To describe factors associated with failure of patent ductus arteriosus closure and development of gastrointestinal complications in subjects treated with indomethacin. Study Design: Infants ≤30 weeks and <1,500 g delivered between 1997–2003 with patent ductus arteriosus treated with indomethacin were included in this single-center retrospective study. Risk factors for failed ductal closure rates and gastrointestinal complications were identified with uni- and multivariable analyses. Results: Among 210 subjects treated with indomethacin, ductal closure increased from 43% at 23 weeks to 87% at 27 weeks (OR 1.51 per week gestation, 95% CI 1.14–2.01, p = 0.004) and was unchanged thereafter. Gastrointestinal complications decreased with increasing gestational age (OR 0.67/week, 95% CI 0.52–0.84) but increased with male gender (OR 2.41, 95% CI 1.07–5.45). SNAP-II (Score for Neonatal Acute Physiology-II) scores at birth and at the time of first indomethacin therapy were not associated with likelihood of closure or with gastrointestinal complications. Duration of ductal patency was not associated with risk of necrotizing enterocolitis or intestinal perforation after adjusting for gestational age and gender. Conclusions: Ductal closure with indomethacin is linearly associated with gestational age in infants ≤27 weeks. Illness severity at the time of treatment is not predictive of treatment outcome or gastrointestinal complications. The duration of ductal patency is not associated with an increase in adjusted risk of necrotizing enterocolitis or intestinal perforation in patients treated with indomethacin.

show abstract

“…One study (13) suggested that a PDA is less likely to close with indomethacin if the PDA is associated with a large left atrium/aorta ratio on echocardiography and that surgical ligation may be the better option. However, surgery can be associated with significant shortand long-term complications including pneumothorax, hemodynamic instability, intraoperative bleeding, phrenic nerve palsy, wound infection and vocal cord paralysis (10,12,(14)(15)(16).…”

Section: Surgical Closure Of a Pdamentioning

confidence: 99%

Patent ductus arteriosus in premature infants: A never-closing act

Thébaud

Lacaze-Mazmonteil

2010

Paediatrics &Amp; Child Health

View full text Add to dashboard Cite

Part a: EvidEncE-basEd answEr and summary The ductus arteriosus (DA) is an important structure in fetal life. The DA connects the pulmonary artery to the aorta and serves to shunt blood away from the lungs into the umbilical placental circulation where gas exchange takes place. At birth, closure of the DA is an essential part of postnatal adaptation. Closure of the DA is initiated by an increase in oxygen and changes in pulmonary and systemic blood pressure (1). In full-term newborns, the DA routinely closes within one to five days after delivery (2). In preterm infants, failure of DA closure after birth can be associated with an increased incidence of chronic lung disease (CLD), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). Clinicians may choose to treat the patent DA (PDA) in an attempt to minimize the risk of these complications. However, although there is a statistical association between PDA and these complications, no formal causal relationship has been demonstrated. Prostaglandin inhibition -using indomethacin or ibuprofen -is the standard strategy to close the DA. Surgical closure of the DA is an alternative option.Experimental studies in the clinically relevant chronically ventilated preterm baboon model of CLD have provided some insights into the physiological effects and hemodynamic consequences of a pathological DA, the reversibility of these effects on ductal closure and the relationship of these changes to important neonatal morbidities. Although the PDA results in diminished cardiac function and increases ventilatory requirements, surgical ligation on day 6 has no effect on lung histology (3). Conversely, early indomethacin treatment versus placebo improves pulmonary mechanics and minimizes lung injury by limiting pulmonary blood flow and the consequences of increased pulmonary/systemic blood flow (4). A moderate PDA shunt also limits the increase in postprandial mesenteric blood flow velocity and may contribute to feeding intolerance (5).In the clinical setting, two strategies are usually used to close the DA to avoid PDA-associated complications: prophylactic (within 24 h of life, whether the DA is patent or not) and therapeutic (within seven days of life to infants who display clinical symptoms or echocardiographic signs of PDA) closure of a PDA. When pharmacological therapy fails, surgical ligation of the PDA is often proposed. The effectiveness and safety of these strategies have been evaluated in meta-analyses. Prophylactic closure of a Pda in preterm infantsProphylactic indomethacin results in favourable intermediate outcomes such as reduction of significant PDA, need for surgical ligation, severe IVH and serious pulmonary hemorrhage (6). No evidence of short-term gastrointestinal or renal adverse effects was detected. There was no significant difference between indomethacin and control groups with respect to the important long-term outcome of death, CLD or severe neurosensory impairment. The lack of long-term neurosensory benefit despite the reduction in rate of se...

show abstract

Day case ligation of patent ductus arteriosus in preterm infants: a 10 year review.

Cited by 28 publications

References 19 publications

Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome

Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome

Predictors of Ductal Closure and Intestinal Complications in Very Low Birth Weight Infants Treated with Indomethacin

Patent ductus arteriosus in premature infants: A never-closing act

Contact Info

Product

Resources

About