Clinical Presentations and Treatment of Early Detected Patent Ductus Arteriosus in Very Low Birth Weight Neonates

Abstract

Background: The aim of this study was to evaluate patent ductus arteriosus (PDA) in very low birth weight (VLBW, birth weight ＜ 1500 g) infants. Materials and Methods: Medical records of 68 VLBW infants with a diagnosis of PDA born from January 2001 through August 2007 at Mackay Memorial Hospital were retrospectively reviewed. Morbidity after treatment using surgery alone, medication alone, or both was compared in an early group of neonates (n = 33) in whom PDA was diagnosed during the first 3 days of life versus a late group (n = 35) diagnosed after 3 days after birth. Results: The groups did not differ by gestational age, birth weight, or Neonatal Therapeutic Intervention Score on admission. In the early group, 42% (14/33) did not have a murmur; PDA was diagnosed on echocardiography performed because of cardiopulmonary instability. Necrotizing enterocolitis was more common in the late group (5/35, 14% vs. 2/33, 6%, P=0.05), but the incidence of other morbidities did not differ significantly. Ten infants in the early group and six in the late group underwent immediate surgical ligation. The remainder responded either to indomethacin alone or had late ligation after indomethacin failed. Two infants in each group died, but there were no deaths directly attributed to surgery. Conclusions: Echocardiographic evaluation because of cardiopulmonary dysfunction may lead to early diagnosis of PDA in VLBW infants without audible murmur. Such cardiopulmonary dysfunction includes hypotension requiring inotropics, increasing ventilator settings or heart failure signs. Early surgical ligation is safe and effective if indicated by the clinical condition. Otherwise, a trial using indomethacin is reasonable.