The fate of ductus arteriosus in infants at 23–27 weeks of gestation: from spontaneous closure to ibuprofen resistance

Abstract

An important percentage of extremely preterm infants exhibited spontaneous closure of PDA. Among clinical characteristics lowest gestational ages predict PDA and ibuprofen-resistant PDA, while sepsis predicts only ibuprofen-resistant PDA.

Timing of Pharmacological Treatment for Patent Ductus Arteriosus and Risk of Secondary Surgery, Death or Bronchopulmonary Dysplasia: A Population-Based Cohort Study of Extremely Preterm Infants

“…Gestational age is strongly related to successful pharmacological PDA closure in previous studies [5,10]. Although we do not have echocardiographic data on PDA closure after pharmacological treatment in our cohort, we found gestational age to be the most important predictor of secondary PDA surgery or death.…”

“…Recent studies show a high spontaneous PDA closure rate [5,8,9,10,11] making clinicians more reluctant to start early PDA treatment. Speculations are that a deferred treatment strategy may increase the risk of PDA-related morbidities and reduce the chances of successful pharmacological closure, thus leading to an increased risk of PDA surgery [12].…”

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

“…131 Spontaneous closure rates, particularly after 7 days of age, may be underestimated, as the majority of infants included in these reports were treated by the second week after birth. In a prospective observational study of 65 very low birth weight (<1500 g) infants, Nemerofsky et al 132 found spontaneous ductal closure by 7 days of age in 31% of those with birth weights p1000 g and in 67% of those with birth weights >1000 g. For those with BWp1000 g, spontaneous closure without intervention occurred before discharge in 47% (at a median age of 56 days); one infant was treated with indomethacin in the first week and the remaining 16 had treatment initiated at a median age of 14 days.…”

A recurrent patent ductus arteriosus

“…Spontaneous [5,8], transcatheter [6], surgical closure [9] and pharmacological treatment [8,[10][11][12] have been reported. It has been reported that an important percentage of extremely preterm infants exhibited spontaneous closure of PDA and that lowest gestational ages predicts PDA and pharmacological-resistant PDA, while sepsis predicts only pharmacological-resistant PDA [8]. Larger PDA, lower birth weight and lower platelet count have been also reported as significant predictors of high failure of pharmacological treatment [10].…”