Conservative treatment for patent ductus arteriosus in the preterm.
BACKGROUND
A patent ductus arteriosus (PDA) is common among preterms, and prophylactic medical treatment has been advocated as the first-line approach. Conservative treatment may result in similar outcome, but without exposure to the harmful side effects of medication. A retrospective analysis revealed a ductal closure rate of 94% after conservative treatment with adjustment of ventilation (lowering the inspiratory time and increasing positive end expiratory pressure) and fluid restriction.


OBJECTIVE
To study prospectively over one year the rate of PDA closure, and morbidity and mortality following conservative treatment.


METHODS
Prospective study (1 January 2005 - 31 December 2005) including 30 newborns <or=30 weeks' gestation, all of whom were being ventilated and required surfactant. Echocardiography was performed 48-72 h after birth. Clinically important PDA was conservatively treated as described above. The percentage of children with PDA, ductal ligation and major complications was determined.


RESULTS
Ten neonates (33%) developed a clinical important PDA. Following conservative treatment the duct closed in all neonates (100%), and none required ductal ligation or medical treatment. The rates of major complications were no higher than those reported by the Vermont Oxford Network and in the literature.


CONCLUSIONS
The managed care plan resulted in an overall ductal closure rate of 100%. These results suggest that conservative treatment of PDA is a worthy alternative to prophylactic medical treatment.
Vanhaesebrouck
Sophie
S
Neonatal Intensive Care, Ziekenhuis Oost Limburg, Genk, Belgium.
Zonnenberg
Inge
I
Vandervoort
Piet
P
Bruneel
Els
E
Van Hoestenberghe
Marie-Rose
MR
Theyskens
Claire
C
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000628:therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D011663:Pulmonary Surfactants; D007052:Ibuprofen