Patent Ductus Arteriosus Closure: Experience From a Tertiary Referral Center

Abstract

Objective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital. Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored. Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001). Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.

Surgery of Patent Ductus Arteriosus in Soavinandriana Hospital: Our Experience

“…In our study, 14% of children were born prematurely. The prematurity rate in our study was close to that in the Faim DR study (11%) [15]. However, other studies have shown a higher rate of premature births, such as Tort's study [13].…”

Indomethacin Prophylaxis in Preterm Infants: Changes over Time

“…8 Similarly, in a large retrospective study, pharmacological closure (with either indomethacin or ibuprofen) was the method of choice prior to surgical ligation. 32 This suggests that infants who received indomethacin may have experienced pharmacologic benefits for hsPDA, with a correspondingly lower rate of surgical intervention.…”

“…A retrospective cohort study, showed PDAs were less common in infants who were treated with indomethacin after the first day of life, compared to infants who were not treated with indomethacin (21% vs. 36.1%, p<0.001) 8 . Similarly, in a large retrospective study, pharmacological closure (with either indomethacin or ibuprofen) was the method of choice prior to surgical ligation 32 . This suggests that infants who received indomethacin may have experienced pharmacologic benefit for hsPDA, with a correspondingly lower rate of surgical intervention.…”

The Effect of Oral Acetaminophen on Open Arterial Duct Closure in Premature Infants Less Than 32 Weeks

“…Treatment options include fluid restriction, pharmacological intervention with nonsteroidal antiinflammatory drugs (NSAIDs) or paracetamol, or closing the duct by surgical ligation or heart catheterization. [5] PDA closure, regardless of the type of method, also comes with risks. There is not always a consensus as to what gives the best prognosis for newborns, whether to wait or to close the PDA.…”

“…It was considered to be beneficial to use only one drug for both purposes. [5] Several studies have shown that acetaminophen has an efficacy similar to that of ibuprofen [8] but with a lower incidence of acute renal failure, oliguria, [9] platelet dysfunction, gastrointestinal bleeding, hyperbilirubinemia, [10] and necrotizing enterocolitis. [11] Therefore, the present study was conducted to evaluate the effect of oral acetaminophen in the closure of PDA in preterm neonates Noor Mohammad Noori 1 , Alireza Teimouri 1 , Abdollah Dehvari 1 , Somayeh Bagheie 1 , Hossein Ansari 1…”