title: Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants.
abstract: OBJECTIVE
  Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants ≤28 weeks or 1250 g.
  
  
  METHODS
  This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl(-1) and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and χ (2). Significance was set at P<0.05.
  
  
  RESULTS
  PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA.
  
  
  CONCLUSIONS
  A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.
authors.affiliation: Division of Neonatal-Perinatal Medicine, BC Children's Hospital, Vancouver, BC, Canada. yolpesa@hotmail.com
authors.forename: Y P
authors.initials: YP
authors.lastname: Saldeño
authors.forename: V
authors.initials: V
authors.lastname: Favareto
authors.forename: J
authors.initials: J
authors.lastname: Mirpuri
mesh_terms: D000704:Analysis of Variance; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000379:methods; D016022:Case-Control Studies; D015897:Comorbidity; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D015995:Prevalence; D012178:Retinopathy of Prematurity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007213:Indomethacin