The impact of patent ductus arteriosus in neonates with late onset sepsis: a retrospective matched-case control study.
BACKGROUND
Late-onset sepsis (LOS) in neonates with patent ductus arteriosus (PDA) may predispose them to more complicated hospital courses. The objective of this study was to determine the incidence, the distribution of pathogens, and the clinical features of LOS in neonates with PDA and analyze their outcomes.


METHODS
The medical records were reviewed retrospectively of infants with PDA and LOS who were hospitalized in NICUs of Chang Gung Children's Hospital between January 2003 and December 2009. The clinical features of these infants were compared with a group of gestational age and birth body weight-matched neonates with LOS during the same period.


RESULTS
During this period, 224 neonates were found to have at least one event of blood-culture proven LOS and 79 (35.3%) were documented to have PDA. Although most LOS episodes (85/104, 81.7%) in neonates with PDA occurred after closure of PDA, neonates with PDA had a significantly higher rate of bronchopulmonary dysplasia (81.0% vs. 61.0%, p = 0.002) and a relatively higher rate of recurrent sepsis (25.3% vs. 15.2%, p = 0.079) than those without PDA. Longer durations of ventilator support and hospital stay were also noted in neonates with PDA as compared to those without (p = 0.001 and 0.005, respectively).


CONCLUSIONS
In neonates with LOS, the presence of PDA, even though it is aggressively treated with indomethacin or surgical intervention, may still contribute to the complexity of hospitalization. Close monitoring and aggressive treatments are warranted in these neonates with PDA.
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Pei-Jung
PJ
Chiang
Jen-Fu
JF
Hsu
Ming-Horng
MH
Tsai
Reyin
R
Lien
Ming-Chou
MC
Chiang
Hsuan-Rong
HR
Huang
Chiao-Ching
CC
Chiang
Hwey-Fang
HF
Liang
Shih-Ming
SM
Chu
D000367:Age Factors; D001997:Bronchopulmonary Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016022:Case-Control Studies; D016208:Databases, Factual; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008026:Ligation / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors
D007213:Indomethacin