ORIGINAL ARTICLE

Conservative treatment for patent ductus arteriosus in the preterm

Sophie Vanhaesebrouck¹, Inge Zonnenberg¹, Piet Vandervoort², Els Bruneel¹, Marie-Rose Van Hoestenberghe¹, Claire Theyskens¹

¹ Neonatal Intensive Care, Ziekenhuis Oost Limburg, Genk, Belgium
² Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium

Correspondence to:
Dr Claire Theyskens
Ziekenhuis Oost Limburg, Campus Sint-Jan, Schiepse Bos 6, B-3600 Genk, Belgium; claire.theyskens{at}zol.be

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.

Abbreviations: CLD, chronic lung disease; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PEEP, positive end expiratory pressure

Keywords: PDA; preterm; outcome; conservative treatment; ibuprofen prophylaxis

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