[Patent ductus arteriosus in neonatal intensive care].
OBJECTIVE
In this study we evaluated the prevalence of symptomatic patent ductus arteriosus (PDA) in newborns, admitted to a neonatal intensive care unit (NICU), as well as the clinical features and the outcome of medical or surgical treatment.


METHODS
We carried out a retrospective medical chart review of 42 newborns admitted to an NICU between May 1996 and May 1998. Data regarding birth weight, sex, gestational age, prenatal corticotherapy and surfactant needs were gathered. Clinical evolution was assessed based on mechanical ventilation, morbidity and mortality. The therapeutic options and their results where analysed.


RESULTS
Of the 1,195 newborns admitted to an NICU, 42 had symptomatic PDA. The prevalence was higher in newborns with a low birth weight. There was no significant difference regarding the administration of steroids prenatally in the newborns with PDA compared to the remaining newborns without PDA. Surfactant therapy, mechanical ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis and intraventricular hemorrhage were found to be more frequent in patients with PDA, especially among those with a lower birth weight, with statistical significance for newborns weighing less than 2,500 g (p < 0.05). The therapy most frequently used was indomethacin, with a success rate of 22/23 (95.6%) and with two cases of acute renal failure as side effects. Only one infant required surgical ligation of PDA. Mortality was similar in both groups (PDA vs. no PDA).


CONCLUSIONS
PDA was probably underdiagnosed in our NICU. Morbidity, but not mortality, was higher in newborns with symptomatic PDA. We conclude that treatment with indomethacin is preferred to surgical ligation as an initial approach in those infants. Our data show the importance of early screening with echocardiogram for "silent" PDA in low birth weight neonates.
Baptista
M J
MJ
Departamento de Pediatria Faculdade de Medicina da Universidade do Porto e Hospital de São João Porto, Portugal.
Correia-Pinto
J
J
Areias
J C
JC
Guimarães
H
H
D001724:Birth Weight; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015995:Prevalence; D012189:Retrospective Studies