Patent ductus arteriosus in very low birthweight infants: complications of pharmacological and surgical treatment
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Petra S. Koehne
Abstract
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.
Copyright © 2001 by Walter de Gruyter GmbH & Co. KG
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- The first 40 years – a subjective review
- The effect of postnatal steroids on growth and development
- Mild maternal undernutrition in the first half of ovine pregnancy influences placental morphology but not fetal Doppler flow velocity waveforms and fetal heart size
- Longitudinal study of fatty acids in plasma and erythrocyte phospholipids during pregnancy
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- A role for the 72 kDa gelatinase (MMP-2) and its inhibitor (TIMP-2) in human parturition, premature rupture of membranes and intraamniotic infection
- The value of ultrasonographic examination of the uterine cervix in predicting post-term pregnancy
- Maternal complications associated with cesarean section
- Patent ductus arteriosus in very low birthweight infants: complications of pharmacological and surgical treatment
- Bedside functional imaging of the premature infant brain during passive motor activation
- Effects of selective inhibition of the Endothelin A and B receptors on hypoxic pulmonary vasoconstriction in newborn piglets
- Surfactant lavage and replacement in meconium aspiration syndrome with pulmonary hemorrhage
- Gelastic seizures in clusters in a case of West syndrome after perinatal hypothalamic hemorrhage
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