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Conservative treatment for patent ductus arteriosus in the preterm.
  1. Sophie Vanhaesebrouck (sophie.vanhaesebrouck{at}uz.kuleuven.ac.be)
  1. Neonatology ZOL Genk, Belgium
    1. Inge Zonnenberg
    1. Neonatology ZOL Genk, Belgium
      1. Piet Vandervoort
      1. Cardiology ZOL Genk, Belgium
        1. Els Bruneel
        1. Neonatology ZOL Genk, Belgium
          1. Marie-Rose Van Hoestenberghe
          1. Neonatology ZOL Genk, Belgium
            1. Claire Theyskens
            1. Neonatology ZOL Genk, Belgium

              Abstract

              Background: Patent ductus arteriosus (PDA) remains common among preterms. Prophylactic medical treatment has been advocated as first-line approach. Conservative treatment may result in equal outcome, without exposition to harmful side-effects.

              We retrospectively observed a ductal closure rate of 94 % after conservative treatment with adapting ventilation (lowering inspiratory time and giving more positive end expiratory pressure) and fluid restriction.

              Objective: To study prospectively during one year the PDA closure rate, morbidity and mortality following conservative treatment.

              Study design:In a prospective study from January 1st 2005 till December 31st 2005, thirty newborns ¡Ü 30 weeks¡¯ gestation were included, all ventilated and requiring surfactant. Echocardiography was performed 48-72 hours after birth. Clinically significant PDA was conservatively treated as described above. Percentage of children with PDA, ductal ligation and major complications were determined.

              Results: Ten neonates (33 %) developed a clinical significant PDA. Following conservative treatment ductus closed in all neonates (100%). None required ductal ligation or medical treatment. No higher rates of major complications as compared to Vermont Oxford network and literature.

              Conclusion: 72 % of our preterm newborns did not develop symptomatic PDA. Early conservative treatment of clinically significant PDA resulted in ductal closure in 94%, which is similar to the rate reported with medical treatment (90%). Prophylactic treatment would have exposed these babies (94%) unnecessarily to medication. Applying our managed care plan prospectively resulted in an overall ductal closure rate of 100 %, postulating that conservative treatment of PDA is a worthy alternative to prophylactic medical treatment.

              • PDA
              • ibuprofen
              • outcome
              • preterm
              • prophylaxis

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