Abstract
Objective. To identify factors affecting closure of patent ductus arteriosus (PDA) in newborn infants born at 22–27 weeks gestational age (GA) during pharmacological treatment with cyclooxygenase inhibitors. Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed. Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25 + 4 weeks versus 24 + 3 weeks; P = 0.047), and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s; P = 0.023). Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04; P = 0.049). Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.
Highlights
Infants born before 28 gestational weeks have a high incidence of patent ductus arteriosus (PDA) [1, 2]
Previous studies have identified low gestational age (GA), pregnancy-induced hypertension, antenatal indomethacin exposure, lack of antenatal glucocorticoid exposure, late indomethacin treatment, respiratory distress syndrome (RDS), use of high-frequency oscillatory ventilation (HFOV), large ductal diameter, and less ductal shunt velocity as independent risk factors for failure of pharmacological treatment of PDA [14,15,16,17,18]. Pulmonary factors such as prenatal steroid exposure and RDS appear to affect the closure of the ductus arteriosus, and parameters related to pulmonary circulation, for example, high PaO2 and low blood pressure within the ductus arteriosus, relate to physiological ductal constriction in animal studies [19]
Our study shows that higher gestational age and maximal shunt velocity is associated with successful pharmacological PDA treatment in infants born at 22–27 weeks GA
Summary
Infants born before 28 gestational weeks have a high incidence of patent ductus arteriosus (PDA) [1, 2]. Previous studies have identified low gestational age (GA), pregnancy-induced hypertension, antenatal indomethacin exposure, lack of antenatal glucocorticoid exposure, late indomethacin treatment, respiratory distress syndrome (RDS), use of high-frequency oscillatory ventilation (HFOV), large ductal diameter, and less ductal shunt velocity as independent risk factors for failure of pharmacological treatment of PDA [14,15,16,17,18] Pulmonary factors such as prenatal steroid exposure and RDS appear to affect the closure of the ductus arteriosus, and parameters related to pulmonary circulation, for example, high PaO2 and low blood pressure within the ductus arteriosus, relate to physiological ductal constriction in animal studies [19]. The objective of this retrospective study was to identify factors associated with closure of the ductus arteriosus during treatment with cyclooxygenase inhibitors in infants born at 22–27 weeks GA, with special focus on ventilatory and pulmonary circulatory factors
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