Determinants of surgical repair of patent ductus arteriosus in low-birth-weight infants.

Abstract

To identify risk factors related to the failure of indomethacin therapy and the need for surgical repair in patent ductus arteriosus (PDA) in extremely low-birth-weight (<1000g) infants (ELBWI). Study subjects were 36 ELBWI with PDA born at a single tertiary perinatal center. They were classified into those who required surgery due to failure of indomethacin treatment (surgical group, n=21) and those with effective indomethacin treatment (non-surgical group, n=15). The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the relationship between selected risk factors and surgical treatment of PDA were calculated. Gestational age of <28weeks and diameter of PDA of 2mm or more were independent and significant determinants of the need for surgical repair of PDA (adjusted ORs [95% CIs]=9.91 [1.16-84.48] and 24.80 [2.72-225.74], respectively). The need for surgical repair of PDA did not correlate with sex, birth weight, 1-min Apgar score, left atrium diameter/aortic diameter (LA/Ao), left ventricular internal dimension at end-diastole, prophylaxes with indomethacin, and total dosage of indomethacin. Gestational age at birth of <28weeks and diameter of PDA of 2mm or more are determinants of failure of indomethacin treatment for PDA and the need for surgical repair.