Abstract
BackgroundThe optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. This study was aimed at evaluating the failure rate of a cyclooxygenase (COX) inhibitor (COI) for PDA closure and to determine the incidence of a PDA requiring ligation in ELBW infants. We examined the clinical characteristics and risk factors that may predict the clinical consequences of failure of PDA closure by COI.MethodsMedical information on 138 infants with birth weight (BW) < 1000 gm who survived for > 48 hours was retrieved. Clinical characteristics and outcomes of patients whose PDAs closed with COI were compared with those who did not close.ResultsOf the 138 patients, 112 survived to discharge. Eighty (71.4%) of those who survived received 1-3 courses of COI treatment for a symptomatic PDA. A total of 32 (40%) failed COI treatment and underwent PDA ligation. Multivariable logistic regression analysis suggests that the observed differences in the outcomes in infants with or without symptomatic PDA can be explained by the babies with symptomatic PDA being more immature and sicker. No significant difference was seen in the incidence of chronic lung disease (CLD) in infants whose PDA was treated medically versus those who failed medical treatment and then underwent ligation. However, after adjusting for disease severity and other known risk factors, the odds ratio of developing CLD for surviving babies with a persistent PDA compared to those whose PDA was successfully closed with 1-2 courses of COI is 3.24 (1.07-9.81; p = 0.038).ConclusionsWhen successfully treated, PDA in ELBW infants did not contribute significantly to the adverse outcomes such as CLD, retinopathy of prematurity (ROP) and age at discharge. This suggests that it is beneficial for a hemodynamically significant PDA to be closed. The failure of a repeat course of COI to close a PDA is a major risk factor for developing CLD in ELBW infants.
Highlights
The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established
In conclusion, 71.4% of ELBW infants who survived to discharge were diagnosed with hemodynamically significant PDA and received treatment
The adjusted odds of having chronic lung disease (CLD) for surviving babies with persistent hemodynamically significant PDA is greater than three times that of babies whose PDA was successfully closed with either one or 2 courses of cyclooxygenase inhibitor (COI)
Summary
The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. A significant left-to-right shunt through the PDA may increase morbidity and contribute to mortality in premature infants. The increased pulmonary blood flow due to a left to right shunt through a PDA can lead to deterioration of the respiratory status of premature infants and may contribute to the development of bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) [4]. A patent ductus arteriosus (PDA) with a significant left-to-right shunt may increase the risk for renal insufficiency, reduced brain perfusion [5] and possible necrotizing enterocolitis (NEC) [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
