Early screening and treatment of "silent" patent ductus arteriosus in prematures with RDS.
From January 1987 to December 1989, prematures with RDS weighing 1750 g or less admitted to the Neonatal Intensive Care Unite (NICU) were submitted from the third postnatal day to serial two-dimensional and pulsed Doppler (ATL MK 600) echocardiographic evaluation for "silent" patent ductus arteriosus (PDA). PDA was diagnosed in 36/175 prematures with RDS (20.5%). Thirty patients had indomethacin treatment and the PDA closed completely in 27 (90%); five needed a second course of indomethacin, that was effective in two (40%). Four RDS patients (4/36-11%) already weaned from the respirator, needed supplemental oxygen. The three non-responders and six other prematures with counterindications to the drug underwent surgical ligation (25%). As historical control, we retrospectively evaluated the population of preterm infants with RDS weighing less than or equal to 1750 g treated for hemodynamically significant PDA during three previous years before the screening protocol; in this group the echocardiographic and Doppler evaluations were done when congestive heart failure and pulmonary edema were clinically evident. In comparison, we found a reduced incidence of prematures with RDS treated for PDA, 7/120 (5.8%) a higher age at medical treatment (9 +/- 1.4 vs 4.4 - 2.3 days) and a larger prevalence of patients underwent ductal ligation (71.4%). These data show that early screening and treatment of "silent" PDA may result advantageous to improve the efficacy (90%) of indomethacin, in a critical time for the recovery of RDS, and furthermore decreasing the need of surgical ligation.
Zanardo
V
V
Department of Pediatrics, University of Padova, Italy.
Milanesi
O
O
Trevisanuto
D
D
Rizzo
M
M
Ronconi
M
M
Stellin
G
G
Cantarutti
F
F
D001724:Birth Weight; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000000981:diagnostic imaging*; D013997:Time Factors
D007213:Indomethacin