Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?
Open Access
- 1 January 2014
- journal article
- review article
- Published by Medknow in Journal of Clinical Neonatology
- Vol. 3 (2), 67-75
- https://doi.org/10.4103/2249-4847.134670
Abstract
Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.Keywords
This publication has 91 references indexed in Scilit:
- Patent Ductus Arteriosus: Are Current Neonatal Treatment Options Better or Worse Than No Treatment at All?Seminars in Perinatology, 2012
- Attention-Deficit/Hyperactivity Disorder After Early Exposure to Procedures Requiring General AnesthesiaMayo Clinic Proceedings, 2012
- Cerebral Autoregulation in Neonates with a Hemodynamically Significant Patent Ductus ArteriosusThe Journal of Pediatrics, 2012
- Elevated Concentrations of Inflammation-Related Proteins in Postnatal Blood Predict Severe Developmental Delay at 2 Years of Age in Extremely Preterm InfantsThe Journal of Pediatrics, 2011
- Early Blood Gas Abnormalities and the Preterm BrainAmerican Journal of Epidemiology, 2010
- Early Surgical Ligation Versus a Conservative Approach for Management of Patent Ductus Arteriosus That Fails to Close after Indomethacin TreatmentThe Journal of Pediatrics, 2010
- Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infantsJournal of Perinatology, 2009
- The Role of Patent Ductus Arteriosus Ligation in Bronchopulmonary Dysplasia: Reexamining a Randomized Controlled TrialThe Journal of Pediatrics, 2009
- Intensive Care for Extreme Prematurity — Moving beyond Gestational AgeNew England Journal of Medicine, 2008
- Conservative treatment for patent ductus arteriosus in the pretermArchives of Disease in Childhood: Fetal & Neonatal, 2007