Original ArticleEarly Surgical Ligation Versus a Conservative Approach for Management of Patent Ductus Arteriosus That Fails to Close after Indomethacin Treatment
Section snippets
Methods
This project design was approved by the University of California San Francisco's Institutional Review Board. Between January 1999 and July 2009, all infants ≤276/7 weeks gestation admitted to the William H. Tooley Nursery at University of California San Francisco were treated with a course of prophylactic indomethacin starting within 15 hours of birth provided that there were no contraindications. A full description of this approach has been published elsewhere.19 An echocardiogram was
Results
Infants who died ≤4 days before the first echocardiographic evaluation were excluded from the analysis (Figure). There were no differences between period 1 and period 2 in the percentages of infants that were excluded from the study (11% due to early death) or did not experience permanent PDA closure after prophylactic indomethacin treatment, were retreated with indomethacin, failed indomethacin retreatment, or were considered to have failed indomethacin treatment (24%) (Figure). There also
Discussion
This study spanning 2 consecutive time periods found no significant differences in the rates of BPD, sepsis, ROP, neurologic injury, or mortality between infants treated with early PDA surgery and those treated more conservatively (with surgical ligation only if the PDA was hemodynamically significant after failure of indomethacin treatment). We found a decreased risk of NEC in the more conservatively treated infants. Although the more conservative approach still resulted in eventual surgical
References (41)
- et al.
PDA treatment: Effects on pulmonary hemorrhage and pulmonary morbidity
J Pediatr
(2008) - et al.
Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants
J Pediatr
(1978) - et al.
The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial
J Pediatr
(2009) - et al.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight < 1500 grams
J Pediatr
(1978) - et al.
The use of a bedside assay for plasma B-type natriuretic peptide as a biomarker in the management of patent ductus arteriosus in premature neonates
J Pediatr
(2005) - et al.
Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of interatrial shunting
J Pediatr
(1994) - et al.
Improved lung compliance after ligation of patent ductus arteriosus in hyaline membrane disease
J Pediatr
(1978) - et al.
Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant
J Pediatr
(1994) - et al.
Patent ductus arteriosus: recent advances in diagnosis and management
Pediatr Clin North Am
(1982) - et al.
Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants
Cochrane Database Syst Rev
(2002)
Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial
Pediatrics
Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants
N Engl J Med
Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants
Pediatrics
Prevention and 18-month outcome of serious pulmonary hemorrhage in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms
Pediatrics
Prophylactic indomethacin reduces the incidence of pulmonary hemorrhage and patent ductus arteriosus in surfactant treated infants <1250 grams
Pediatr Res
Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome
Acta Paediatr Scand
Patent ductus arteriosus: lack of evidence for common treatments
Arch Dis Child Fetal Neonatal Ed
A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth
N Engl J Med
Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study
J Pediatr Gastroenterol Nutr
Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units
J Pediatr Gastroenterol Nutr
Cited by (0)
Supported in part by grants from the US Public Health Service (Grants NHLBI HL46691 and NIH/NCRR UCSF-CTSI UL1 RR024131) and a gift from the Jamie and Bobby Gates Foundation. R.C. received a research grant from Ovation Pharmaceuticals, Inc. The other authors declare no conflicts of interest.