Patent ductus arteriosus in very low birthweight infants: complications of pharmacological and surgical treatment

Abstract

Despite the short-comings inherent to retrospective analyses, we propose that surgery should be reserved for infants not responding to pharmacological PDA closure.

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

“…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.…”

“…Koehne et al (4) reported an overall ligation rate of 57% and a 34% ligation rate in 101 babies who had indomethacin treatment. This cohort, comprised of patients treated between 1987 and 1998, was not restricted to infants <27 weeks' gestation.…”

“…Determination of the optimal timing of ligation warrants further research. Furthermore, although multiple studies confirm the efficacy of indomethacin, its potential side effects remain prominent (1,4,27). The timing and amount of indomethacin used may also have an impact on its side effects (16,(28)(29)(30), although others report that morbidity and mortality in extremely premature infants with a PDA is unrelated to prophylactic or repeated indomethacin exposure (26).…”

“…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.…”

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

“…9,12 Finally, indomethacin usage is not without potential adverse side effects. 13 Therefore, it is necessary to better characterize and define the ELBW population at-risk for developing an sPDA rather than to treat all ELBW neonates indiscriminately. To accomplish this, it is essential to develop a method that will accurately predict which ELBW neonates, if any, might benefit from early intervention.…”