Patent ductus arteriosus in micropreemies and full-term infants: The relative merits of surgical ligation versus indomethacin treatment☆
Section snippets
Materials and methods
The medical records, X-rays, and echocardiograph reports of all newborns admitted to the neonatal intensive care unit with diagnosis of patent ductus arteriosus from June 1988 through March 2001 (154 months) were reviewed. No infants were excluded. Previous approval from the Texas A&M Institutional Review Board (IRB) had been obtained. Demographic as well as clinical data from these infants were collected and tabulated. A PDA was suspected based on a heart murmur, congestive heart failure,
General
Two hundred twelve newborns (101 boys and 111 girls) had patent ductus arteriosus diagnosed during the 154-month study period. Mean gestational age and birth weight were 26.5 weeks (22.0 to 38.0 weeks) and 836.0 g (447 to 2,863 g), respectively. One hundred forty-six infants (69%) were born with extremely low birth weight, defined as birth weight less than 1,000 g. Eighty-four percent of neonates received surfactant. Patent ductus arteriosus was suspected by new heart murmur (94%), pulmonary
Discussion
During intrauterine life, only 10% of the cardiac output passes through the lungs; the remaining 90% is shunted via the ductus to the aorta and systemic circulation. Shortly after birth, increased oxygen tension in the pulmonary artery and decreased responsiveness to prostaglandin type E provide a stimulus for the ductus to close. Failure of ductal closure leads to a persistent left to right shunt predisposing the newborn to decreasing cardiac performance, prolonged ventilatory support, and
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Cited by (90)
The Extremely Premature Infant (Micropremie) and Common Neonatal Emergencies
2019, A Practice of Anesthesia for Infants and ChildrenChanging patterns of patent ductus arteriosus surgical ligation in the United States
2018, Seminars in PerinatologyCitation Excerpt :Compared to pharmacological treatment, however, PDA SL results in definitive ductus closure, has an exceedingly low failure rate, and avoids the complications of NSAIDs. SL was favored over NSAID treatment in some nurseries,47–49 and in several centers SL has been the preferred first-line treatment for small preterm infants.15–22 Nevertheless, SL is typically reserved for medical treatment failures or cases where NSAIDs are contraindicated.
The Extremely Premature Infant (Micropremie) and Common Neonatal Emergencies
2018, A Practice of Anesthesia for Infants and ChildrenSurgical management of patent ductus arteriosus in the very preterm infant and postligation cardiac compromise
2018, Hemodynamics and Cardiology: Neonatology Questions and ControversiesSurgical ligation of patent ductus arteriosus in premature infants: Trends and practice variation
2016, Cardiology in the Young
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Address reprint requests to Danny C. Little, MD, Scott and White Hospital, 2401 South 31st St, Temple, TX 76508.