Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome
- 1 February 2009
- journal article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 123 (2), 674-681
- https://doi.org/10.1542/peds.2007-2781
Abstract
OBJECTIVE. The purpose of this work was to evaluate therapy for patent ductus arteriosus as a risk factor for death or neurodevelopmental impairment at 18 to 22 months, bronchopulmonary dysplasia, or necrotizing enterocolitis in extremely low birth weight infants. METHODS. We studied infants in the National Institute of Child Health and Human Development Neonatal Research Network Generic Data Base born between 2000 and 2004 at 23 to 28 weeks' gestation and at n = 2838) included 403 receiving supportive treatment only, 1525 treated with indomethacin only, 775 with indomethacin followed by secondary surgical closure, and 135 treated with primary surgery. Patients who received supportive therapy for patent ductus arteriosus did not differ from subjects treated with indomethacin only for any of the outcomes of interest. Compared with indomethacin treatment only, patients undergoing primary or secondary surgery were smaller and more premature. When compared with indomethacin alone, primary surgery was associated with increased adjusted odds for neurodevelopmental impairment and bronchopulmonary dysplasia in multivariable logistic regression. Secondary surgical closure was associated with increased odds for neurodevelopmental impairment and increased adjusted odds for bronchopulmonary dysplasia but decreased adjusted odds for death. Risk of necrotizing enterocolitis did not differ among treatments. Indomethacin prophylaxis did not significantly modify these results. CONCLUSIONS. Our results suggest that infants treated with primary or secondary surgery for patent ductus arteriosus may be at increased risk for poor short- and long-term outcomes compared with those treated with indomethacin. Prophylaxis with indomethacin in the first 24 hours of life did not modify the subsequent outcomes of patent ductus arteriosus therapy.Keywords
This publication has 39 references indexed in Scilit:
- Patent ductus arteriosus: lack of evidence for common treatmentsArchives of Disease in Childhood: Fetal & Neonatal, 2007
- Patent Ductus Arteriosus: Evidence for and against TreatmentThe Journal of Pediatrics, 2007
- Conservative treatment for patent ductus arteriosus in the pretermArchives of Disease in Childhood: Fetal & Neonatal, 2007
- Indomethacin responsiveness of patent ductus arteriosus and renal abnormalities in preterm infants treated with indomethacinThe Journal of Pediatrics, 2003
- Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or lessThe Journal of Pediatrics, 1996
- Changing trends in the epidemiology and pathogenesis of neonatal chronic lung diseaseThe Journal of Pediatrics, 1995
- “Silent” patent ductus arteriosus and bronchopulmonary dysplasia in low birth weight infantsjpme, 1995
- Effects of indomethacin in premature infants with patent ductus arteriosus: Results of a national collaborative studyThe Journal of Pediatrics, 1983
- Early closure of the patent ductus arteriosus in very low-birth-weight infants: A controlled trialThe Journal of Pediatrics, 1981
- Medical management of small preterm infants with symptomatic patient ductus arteriosusThe Journal of Pediatrics, 1978