Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?

Robie, Daniel K.; Waltrip, Todd; Garcia‐Prats, Joseph A.; Pokorny, William J.; Jaksic, Tom

doi:10.1016/s0022-3468(96)90102-5

Cited by 22 publications

(16 citation statements)

References 37 publications

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“…However, they have reported conflicting results (9, 10, 11, 12, 13). Moreover, these studies did not target extremely preterm infants at the limits of viability, although these infants undergo surgical ligation the most frequently and under the riskiest conditions.…”

Section: Discussionmentioning

confidence: 99%

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

et al. 2014

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The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17±12 vs 11±8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

et al. 2014

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“…13,27,28 Although none of them specifically investigated NEC as a complication, an association between indomethacin therapy and NEC was observed in some studies 13,27 but not in others. 28 In the largest of these reports, Koehne et al 28 retrospectively investigated complications of surgical ligation and indomethacin treatment for a PDA in 156 premature infants over a 10-year period (1987 to 1998), and observed no differences in the rate of NEC between infants who had their ductus closed, either with indomethacin (67 infants), surgical ligation (55 infants), or indomethacin followed by surgical ligation (34 infants).…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Enterocolitis and Gastrointestinal Complications After Indomethacin Therapy and Surgical Ligation in Premature Infants With Patent Ductus Arteriosus

et al. 2003

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BACKGROUND:Indomethacin is the most frequently used pharmacological agent for closure of a patent ductus arteriosus (PDA) in premature infants. However, reports of complications, particularly, necrotizing enterocolitis (NEC) and isolated gastrointestinal perforation have generated concerns about the use of this medication. OBJECTIVES:A retrospective study to compare the incidence of NEC, NEC-related gastrointestinal complications and isolated gastrointestinal perforation among premature infants treated for a PDA with either, indomethacin alone (I), surgical ligation alone (L), or indomethacin followed by surgical ligation (I-L). METHODS:The medical records of 224 infants that underwent treatment, either pharmacological or surgical, for a PDA, confirmed by echocardiography, over a 4-year period (1995 to 1998) were analyzed. Treatment history and gastrointestinal complications were reviewed. RESULTS:Of the 224 infants, 108 (48.2%) were treated with I, 50 (22.3%) by L, 66 (29.5%) with I-L. The clinical characteristics of the three treatment groups were similar and no differences in the incidence of NEC were observed between groups. NEC occurred in 14 (13%) of the I group, seven (14%) of the L group, and eight (12%) of the I-L group. The rate of NEC related gastrointestinal complications and isolated gastrointestinal perforation were also similar among groups. CONCLUSION:In this large retrospective study, indomethacin treatment for a significant PDA in premature infants was not associated with a greater risk for NEC or NEC-related gastrointestinal complications than surgical ligation.

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“…While usually effective, indomethacin is associated with serious side effects including oliguria, necrotizing enterocolitis (NEC), and intestinal perforation (IP) [1][2][3][4][5][6][7][8][9][10][11] . 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] .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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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.

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Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?

Cited by 22 publications

References 37 publications

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

Necrotizing Enterocolitis and Gastrointestinal Complications After Indomethacin Therapy and Surgical Ligation in Premature Infants With Patent Ductus Arteriosus

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

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