Journal of Perinatal Medicine
Official Journal of the World Association of Perinatal Medicine
Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.
Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica
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Patent ductus arteriosus in very low birthweight infants: complications of pharmacological and surgical treatment
Aims: To evaluate complications of surgical and pharmacological treatment of symptomatic patent ductus arteriosus (PDA) in very low birthweight (VLBW) infants.
Patients and methods: Of 931 VLBW infants consecutively admitted 1987–1998, a significant PDA prompted first-choice treatment by indomethacin in 101 infants, and surgery in 55 infants. PDA closed or became asymptomatic after indomethacin in 64 patients (63 %), while 34 went on to surgery. PDA closure was achieved in all 61 infants after ligation and in 26 of 28 infants after clipping.
Results: Transient renal impairment after indomethacin treatment was recorded in 40 of 101 infants (40 %), compared to renal impairment in 9 of 55 infants (16 %) undergoing surgery without prior indomethacin. No differences in necrotizing enterocolitis and intracranial hemorrhage rates were seen. Air leak occurred in 6 of 89 infants after surgery, two of which had fatal tension pneumothorax. Intraoperative hemorrhage requiring emergency transfusion occurred in 2 infants, wound infection occurred in 2 infants and phrenic palsy in one infant. Based on an intention-to-treat analysis, the overall fatality rates were 16 of 101 (16 %) for indomethacin and 14 of 55 (25 %) for surgery.
Conclusions: Despite the short-comings inherent to retrospective analyses, we propose that surgery should be reserved for infants not responding to pharmacological PDA closure.
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