Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes
Open Access
- 25 January 2007
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Perinatology
- Vol. 27 (3), 164-170
- https://doi.org/10.1038/sj.jp.7211662
Abstract
To describe the current use of treatments to prevent or treat patent ductus arteriosus (PDA) in preterm infants, examine the association between different treatment strategies and neonatal outcomes and review the variation in these practices between centers. Cohort study of infants born between 23 and 30 weeks gestation managed by the Pediatrix Medical Group from 1997 to 2004. We collected data on demographics, indomethacin and ligation, and outcomes of the following five groups: prophylactic indomethacin treatment: infants treated with indomethacin on day of life (DOL) 0 or 1; indicated indomethacin treatment: infants treated with indomethacin after DOL 1; PDA without treatment: infants with a PDA without report of treatment; ligation only: infants with a PDA ligation without use of indomethacin and no PDA: infants without a PDA and without treatment. There were 6189 (18%) patients who received prophylactic indomethacin, 5690 (16%) patients received indicated treatment, 3886 (11%) patients had a PDA without treatment, 702 (2%) patients received ligation only and 18 136 (52%) patients had no PDA. In multivariate analysis, mortality among survivors to 2 days of age was lower (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.5 to 0.7, PPPP<0.01, respectively) in the indicated treatment group compared with the PDA without treatment group. The proportion of infants receiving prophylactic indomethacin among all infants and infants receiving indicated treatment among neonates with a report of a PDA varied by site from 0 to 59% (median 9.5%) and 0 to 100% (median 62%), respectively. Indomethacin use for intraventricular hemorrhage prevention and/or treatment of a PDA is common, but the selection of infants for treatment, and the decision of when and how to treat vary widely between centers. Our findings suggest the need for randomized, placebo-controlled trials of the effect of treatment of the PDA in preterm infants.Keywords
This publication has 12 references indexed in Scilit:
- Reported Medication Use in the Neonatal Intensive Care Unit: Data From a Large National Data SetPediatrics, 2006
- Empiric Use of Ampicillin and Cefotaxime, Compared With Ampicillin and Gentamicin, for Neonates at Risk for Sepsis Is Associated With an Increased Risk of Neonatal DeathPublished by American Academy of Pediatrics (AAP) ,2006
- New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposureJournal of Perinatology, 2005
- Prophylaxis of Early Adrenal Insufficiency to Prevent Bronchopulmonary Dysplasia: A Multicenter TrialPediatrics, 2004
- Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated?Current Opinion in Pediatrics, 2004
- Long-Term Effects of Indomethacin Prophylaxis in Extremely-Low-Birth-Weight InfantsNew England Journal of Medicine, 2001
- Adverse Effects of Early Dexamethasone Treatment in Extremely-Low-Birth-Weight InfantsNew England Journal of Medicine, 2001
- Prophylactic indomethacin: Factors determining permanent ductus arteriosus closureThe Journal of Pediatrics, 2000
- Incidence of vocal fold paralysis in infants undergoing ligation of patent ductus arteriosusThe Annals of Thoracic Surgery, 1996
- Changing trends in the epidemiology and pathogenesis of neonatal chronic lung diseaseThe Journal of Pediatrics, 1995