Patent ductus arteriosus in micropreemies and full-term infants: The relative merits of surgical ligation versus indomethacin treatment

Little, Danny C.; Pratt, Theodore C.; Blalock, Shannon; Krauß, D.; Cooney, Donald R.; Custer, Monford D.

doi:10.1053/jpsu.2003.50086

Cited by 88 publications

(82 citation statements)

References 14 publications

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“…The rate of ligation in the present study, in infants receiving more than one course of indomethacin, although higher than reported in recent cohort studies (6,8,(10)(11)(12), was still within the range reported in the literature (4,5,15,17,18). Koehne et al (4) reported an overall ligation rate of 57% and a 34% ligation rate in 101 babies who had indomethacin treatment.…”

Section: Discussionsupporting

confidence: 61%

“…Assuming a 20% early (ie, <7 days) mortality rate in these 65 infants, an 80% rate of PDA diagnosis (3) and a subsequent treatment rate of 60% (13,14), approximately 25 infants per year will receive treatment for a PDA. The PDA will be unresponsive to the first course of indomethacin in 33% to 66% of cases (1,5,15), and up to 32% may receive a second course of indomethacin (5,16). Therefore, it was estimated that approximately nine of the 25 infants with a PDA would receive a second course of indomethacin.…”

Section: Sample Sizementioning

confidence: 99%

“…Previous publications (4,5,15,17,18) suggested that 15% to 98% of infants receiving a second indomethacin course had a surgical ligation performed. Due to this variability, it was estimated (based on local experience) that 75% of infants who received more than one indomethacin course undergo surgical ligation.…”

Section: Sample Sizementioning

confidence: 99%

See 2 more Smart Citations

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

Moore

Lawrence

Maharajh

et al. 2012

Paediatrics &Amp; Child Health

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Section: Discussionsupporting

confidence: 61%

Section: Sample Sizementioning

confidence: 99%

See 1 more Smart Citation

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

Moore

Lawrence

Maharajh

et al. 2012

Paediatrics &Amp; Child Health

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“…In a large group of studies, a comparative analysis of medical treatment with indomethacin or ibuprofen was performed (13). Neonates with body weights less than 1000 g are particularly at risk for the development of complications with pharmacologic therapy and significantly more often are resistant to that treatment method (18,19). In this group of patients, surgical treatment is recognized as the treatment of choice (14,15,17,18).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Macroscopic Lung Appearance in Premature Infants with Body Weights Less than 1000 G Undergoing Surgical Treatment for PDA

Wieteska¹,

Karolczak²

2007

Polish Journal of Surgery

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The aim of the study was to assess the relationship between intraoperatively observed macroscopic pathologic findings in the left lung and the chosen clinical factors. The factors analyzed in the study were the following: neonatal gestational age and body weight, the age of the neonate at the time of surgery, the history of intrauterine infection and/or presence of active infection in the neonate, the history of ibuprofen treatment, and intraoperative diameter of the arterial duct. Material and methods. The authors included a group of 126 preterm infants with body weight less than 1000 g undergoing surgical treatment for PDA in the 2 nd Department of Cardiac and General Pediatric Surgery between January 2000 and May 2006 and analyzed the macroscopic intraoperative left lung appearance. The average body weight of the neonates who participated in the study was 765.2 g, with the average gestational age 25.68 Hbd. According to the results of intraoperative macroscopic lung assessment, the neonates were classified into one of the following three groups: 0 -normal lungs or partially stiff lungs with emphysema focuses, 1 -limited macroscopic findings, focuses of limited atelectasis, lung congestion, 2 -severe pathologic findings in the pulmonary tissue, pulmonary hematomas, bleeding pulmonary surface, disseminated atelectasis, liver-like pulmonary tissue. In the study, the statistical analysis of the relationship between pathological pulmonary findings (groups 0, 1, 2) and investigated factors was performed by the comparison of mean values (or median) of the investigated factor in the analyzed groups. The Kruskal-Wallis and the Mann-Whitney tests were used dependent of the analyzed factor. Additionally, for chosen factors (the infection presence and PDA diameter), their relationship with the lung macroscopic appearance was assessed with the use of the Spearman test. Results. The pathological findings in the lungs were observed in the majority of the neonates (54%). The statistical analysis did not show any relationship between the pulmonary disorders and the majority of investigated factors. Conclusions. 1. The authors found that a duct diameter of ³ 4 mm correlates with the development of more severe disorders in the pulmonary tissue. 2. The authors emphasized the good results of surgical treatment of PDA and the lack of death in the perioperative period in that group of patients. Key words: PDA, ELBW, thoracotomy, lungs Patent ductus arteriosus (PDA) is observed in the majority of premature infants with extremely low body weight. The prevalence of PDA is higher with lower gestational age and lower body weight (1, 2). The relationship was demonstrated between the presence of PDA and not only the newborn gestational age but also the coexistence of respiratory distress and the general health condition of the newborn (3, 4). Significant left-to-right shunt through the arterial duct causes lung congestion, which can result in alveolar transudation. It can cause impaired alveolar ventilation, the development of atelectasis...

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“…If the ductus fails to close after the initial course of indomethacin, surgical ligation of PDA and additional indomethacin treatment are two available options for the management of persistent PDA [20,24]. It is not clear whether surgical ligation or multiple courses of indo-methacin should be the preferred treatment of PDA that fails to close after the initial short course of indomethacin [7,19,25]. The medical literature suggests that additional indomethacin treatment is unlikely to produce ductus closure for premature infants, if there is persistent Doppler evidence of ductal flow within 24 h after completion of the initial short course of indomethacin [17].…”

mentioning

confidence: 99%

Multiple Courses of Indomethacin and Neonatal Outcomes in Premature Infants

2007

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The objective of this retrospective cohort study was to determine patent ductus arteriosus (PDA) closure rate with multiple short courses (three doses) of postnatal indomethacin and compare neonatal outcomes in infants who received two versus three courses of indomethacin for PDA closure. Infants <34 weeks' gestational age born between January 2000 and December 2004 at the University of Maryland Medical Center and who received two or more short courses of indomethacin were included. Outcome measures were ductal closure rate and neonatal outcomes. Of 61 infants who were identified to have received two or more courses of indomethacin, 26 infants closed their ductus after the second course (response rate, 42%). Of the 35 infants who failed ductal closure after two courses, 11 infants had their ductus ligated and 23 received a third course of indomethacin. Of 23 who received a third course, 10 closed their ductus (response rate, 43%). There was no significant difference in the incidence of chronic lung disease, severe retinopathy of prematurity, necrotizing enterocolitis, renal function, or mortality between infants who received two and those who received three courses of indomethacin. Infants exposed to three courses of indo-methacin had a statistically nonsignificant increased incidence of periventricular leukomalacia (p = 0.08; adjusted odds ratio = 4.8; 95% CI, 0.8-30) and remained in the hospital for a longer duration (p = 0.02) compared to infants exposed to two courses of indomethacin. We conclude that multiple courses of indomethacin may be associated with a ductal closure. However, the requirement for a third course may be associated with an increased risk of periventricular leukomalacia. Indomethacin, a potent inhibitor of prostaglandin synthesis, has been routinely used to treat patent ductus arteriosus (PDA) in premature infants [10,28]. However, approximately 20%-40% of premature infants have residual luminal flow or fail to close after the initial short course (three doses given every 12 h) of indomethacin [4,12,15,28]. If the ductus fails to close after the initial course of indomethacin, surgical ligation of PDA and additional indomethacin treatment are two available options for the management of persistent PDA [20,24]. It is not clear whether surgical ligation or multiple courses of indo-methacin should be the preferred treatment of PDA that fails to close after the initial short course of indomethacin [7,19,25]. The medical literature suggests that additional indomethacin treatment is unlikely to produce ductus closure for premature infants, if there is persistent Doppler evidence of ductal flow within 24 h after completion of the initial short course of indomethacin [17]. Contrary to this limited evidence, a recent survey of Neonatal Fellowship Program Directors in the United States reported that multiple courses of indomethacin, up to three, are commonly used for persistent PDA, after the initial course of indo-methacin [1]. This survey also reported that there is wide variation in the ma...

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Patent ductus arteriosus in micropreemies and full-term infants: The relative merits of surgical ligation versus indomethacin treatment

Cited by 88 publications

References 14 publications

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

Intraoperative Macroscopic Lung Appearance in Premature Infants with Body Weights Less than 1000 G Undergoing Surgical Treatment for PDA

Multiple Courses of Indomethacin and Neonatal Outcomes in Premature Infants

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