POPULATION CHARACTERISTIC AND FOLLOW UP OF PRETERM INFANTS AFTER LIGATION OF PATENT DUCTUS ARTERIOSUS

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

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Neurodevelopmental Outcomes of Preterm Infants Treated with Oral Paracetamol Versus Ibuprofen for Patent Ductus Arteriosus

American Journal of Perinatology ◽

10.1055/s-0037-1601564 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1185-1189 ◽

Cited By ~ 11

Author(s):

Zeynep Eras ◽

Nurdan Uras ◽

Fuat Canpolat ◽

Omer Erdeve ◽

Serife Oguz ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Infant Development ◽

Controlled Trial ◽

Ductus Arteriosus ◽

Neurodevelopmental Outcomes ◽

Significant Difference ◽

Oral Ibuprofen ◽

Patent Ductus

Objective This study aims to determine the effects of paracetamol versus ibuprofen treatment given to preterm infants for the pharmacological closure of patent ductus arteriosus (PDA) on neurodevelopmental outcomes at 18 to 24 months' corrected age. Method A follow-up study was conducted to evaluate the neurodevelopmental outcomes of preterm infants (gestational age ≤ 30 weeks) enrolled in a randomized controlled trial comparing oral paracetamol versus oral ibuprofen for the closure of PDA. The developmental assessment was done by using “Bayley Scales of Infant Development, Second Edition” at 18 to 24 months' corrected age. Results A total of 80 infants completed the trial protocol. Of the 75 infants eligible for follow-up, 61 infants (30 in the paracetamol group and 31 in the ibuprofen group) were evaluated. There was no significant difference in neurodevelopmental outcomes between the two groups. Conclusion The neurodevelopmental outcomes did not differ among the preterm infants who receive either paracetamol or ibuprofen at 18 to 24 months' corrected age.

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Neurodevelopmental (ND) Follow-Up at Three Years Corrected Age (CA) of Extremely Preterm Infants Treated with Prophylactic Indomethacin in the First 24 Hours of Life for the Prevention of Patent Ductus Arteriosus (PDA)

Pediatric Research ◽

10.1203/00006450-199904020-01138 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 191A-191A

Author(s):

R J Couser ◽

R E Hoekstra ◽

T B Ferrara ◽

G B Wright ◽

A K Cabalka

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

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Patent ductus arteriosus in preterm infants born before 30 weeks’ gestation: high rate of spontaneous closure after hospital discharge

Cardiology in the Young ◽

10.1017/s1047951118000641 ◽

2018 ◽

Vol 28 (8) ◽

pp. 995-1000 ◽

Cited By ~ 5

Author(s):

Vittorio Romagnoli ◽

Annalisa Pedini ◽

Monica Santoni ◽

Grazia Scutti ◽

Massimo Colaneri ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Hospital Discharge ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Spontaneous Closure ◽

High Rate ◽

Inclusion Criteria ◽

Surgical Ligation ◽

Patent Ductus

AbstractAimThe aim of this study was to determine the spontaneous closure rate of patent ductus arteriosus at a 2-year follow-up, following failed medical therapy and beyond initial hospital discharge, and to evaluate in-hospital spontaneous or pharmacological closure rates.Materials and methodsA retrospective evaluation was conducted in a cohort of preterm infants admitted to the Neonatal ICU of Ancona between January, 2004 and June, 2013. Inclusion criteria were gestational age between 24+0 and 29+6 weeks or birth weight <1250 g; admission within 48 hours from birth; and discharge alive from hospital. All infants received routine heart ultrasound between 48 and 72 hours of life. Haemodynamically significant patent ductus arteriosus was defined as a duct diameter >1.5 mm, a left atrium-to-aorta ratio >1.4, and/or reversal of end-diastolic flow in the aorta >30% of the anterograde. First-line treatment was intravenous ibuprofen. Intravenous indomethacin was used if ibuprofen failed. Surgical ligation was considered in haemodynamically significant patent ductus arteriosus after medical treatment.ResultsA total of 593 infants met the inclusion criteria, and patent ductus arteriosus was diagnosed in 317 (53.4%). Among them, 283 (89.3%) infants had haemodynamically significant patent ductus arteriosus, with pharmacological closure achieved in 228 (80.6%) infants and surgical ligation performed in 20 (7.1%). Follow-up at 24 months was available for 39 (81.3%) of 48 infants with patent ductus arteriosus at the hospital discharge: 36 (92.3%) underwent spontaneous closure, two (5.1%) underwent surgical ligation, and one (2.6%) had a patent ductus arteriosus.DiscussionA significant number of patent ductus arteriosus that fail pharmacological closure undergo spontaneous closure by the age of 2 years. This information should be taken into account when considering surgery or additional attempts of pharmacological closure.

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