title: Failure of a repeat course of cyclooxygenase inhibitor to close a PDA is a risk factor for developing chronic lung disease in ELBW infants.
abstract: BACKGROUND
  The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. This study was aimed at evaluating the failure rate of a cyclooxygenase (COX) inhibitor (COI) for PDA closure and to determine the incidence of a PDA requiring ligation in ELBW infants. We examined the clinical characteristics and risk factors that may predict the clinical consequences of failure of PDA closure by COI.
  
  
  METHODS
  Medical information on 138 infants with birth weight (BW) < 1000 gm who survived for > 48 hours was retrieved. Clinical characteristics and outcomes of patients whose PDAs closed with COI were compared with those who did not close.
  
  
  RESULTS
  Of the 138 patients, 112 survived to discharge. Eighty (71.4%) of those who survived received 1-3 courses of COI treatment for a symptomatic PDA. A total of 32 (40%) failed COI treatment and underwent PDA ligation. Multivariable logistic regression analysis suggests that the observed differences in the outcomes in infants with or without symptomatic PDA can be explained by the babies with symptomatic PDA being more immature and sicker. No significant difference was seen in the incidence of chronic lung disease (CLD) in infants whose PDA was treated medically versus those who failed medical treatment and then underwent ligation. However, after adjusting for disease severity and other known risk factors, the odds ratio of developing CLD for surviving babies with a persistent PDA compared to those whose PDA was successfully closed with 1-2 courses of COI is 3.24 (1.07-9.81; p = 0.038).
  
  
  CONCLUSIONS
  When successfully treated, PDA in ELBW infants did not contribute significantly to the adverse outcomes such as CLD, retinopathy of prematurity (ROP) and age at discharge. This suggests that it is beneficial for a hemodynamically significant PDA to be closed. The failure of a repeat course of COI to close a PDA is a major risk factor for developing CLD in ELBW infants.
authors.affiliation: Mount Sinai Kravis Children's Hospital and Department of Pediatrics, Mount Sinai School of Medicine, One Gustave L, Levy Place, New York, NY 10029-6574, USA.
authors.forename: Lynda
authors.initials: L
authors.lastname: Adrouche-Amrani
authors.forename: Robert S
authors.initials: RS
authors.lastname: Green
authors.forename: Karen M
authors.initials: KM
authors.lastname: Gluck
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
mesh_terms: D002908:Chronic Disease; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007213:Indomethacin / Q000627:therapeutic use*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D008026:Ligation; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D007213:Indomethacin