Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?
The optimal approach to a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors reviewed the records of 82 ELBW premature infants who had surgical ligation of a PDA during a 2-year period. Thirty-one received indomethacin before ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilation, severe intraventricular hemorrhage (IVH) and lower birth weight (BW). Seventy-seven percent of the infants survived. Predictors of mortality were severe IVH, lower BW, and the occurrence of necrotizing enterocolitis (NEC). The indomethacin-treated infants had a lower incidence of NEC and IVH. Overall, 16% of the patients had perioperative morbidity, and 10% of the patients died. The study shows that a trial of indomethacin therapy is not associated with increased complications in ELBW infants with PDA.
Robie
D K
DK
Section of Pediatric Surgery, Cora and Webb Mading Department of Surgery, Texas Children's Hospital, Houston 77030, USA.
Waltrip
T
T
Garcia-Prats
J A
JA
Pokorny
W J
WJ
Jaksic
T
T
D001997:Bronchopulmonary Dysplasia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000150:complications; D002552:Cerebral Ventricles; D017024:Chemotherapy, Adjuvant; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015999:Multivariate Analysis; D011292:Premedication; D012189:Retrospective Studies; D012307:Risk Factors
D016861:Cyclooxygenase Inhibitors; D007213:Indomethacin