title: Optimal management of patent ductus arteriosus in the neonate weighing less than 800 g.
abstract: Between January 1988 and December 1990, 132 neonates weighing < 800 g were admitted to our neonatal intensive care unit. Of the 76 who survived initial resuscitation, 42 had developed a hemodynamically significant patent ductus arteriosus (PDA) (mean +/- SD): gestational age 25.3 +/- 1.9 weeks, birth weight 650 +/- 93 g. Two infants were referred for primary surgical ligation because of contraindications to indomethacin. Forty infants were initially treated with indomethacin. Seventeen of 40 (43%) were subsequently referred for surgical ligation because of indomethacin failure. Infants requiring surgical duct closure were a lower gestational age (24.6 +/- 1.3 v 25.7 +/- 2.0 weeks, P = 0.49) and had a greater left atrial-aortic (LA/Ao) ratio on echocardiography (1.71 +/- 0.28 v 1.46 +/- 0.26, P = .04) compared with those treated successfully with indomethacin. There were 6 deaths (15%), all of which occurred in infants receiving indomethacin (5 indomethacin alone, 1 indomethacin+ligation). Indomethacin was directly associated with intestinal perforation in 3 patients, and acute renal failure in 1; all 4 died. Surgery was associated with minimal morbidity (intraoperative transfusion in 1, postoperative pneumothorax requiring chest tube in 1). These data suggest that in the extremely premature neonate with a hemodynamically significant PDA: (1) indomethacin therapy is associated with a high failure rate and significant complications; (2) PDA associated with a large LA/Ao ratio is unlikely to close with indomethacin therapy; and (3) surgical duct closure is associated with minimal morbidity. We conclude that primary surgical ligation may provide the optimal management for PDA in carefully selected patients.
authors.affiliation: Department of Surgery, McMaster University Medical Center, Hamilton, Ontario.
authors.forename: T
authors.initials: T
authors.lastname: Trus
authors.forename: A L
authors.initials: AL
authors.lastname: Winthrop
authors.forename: S
authors.initials: S
authors.lastname: Pipe
authors.forename: J
authors.initials: J
authors.lastname: Shah
authors.forename: J C
authors.initials: JC
authors.lastname: Langer
authors.forename: G Y
authors.initials: GY
authors.lastname: Lau
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy*; D008026:Ligation; D012189:Retrospective Studies
chemical_list: D007213:Indomethacin