title: Decline in health status of extremely premature neonates with patent ductus arteriosus after second course of medical therapy.
abstract: BACKGROUND
  Many neonatal centers offer surgical ligation of patent ductus arteriosus (PDA) after two failed courses of pharmacologic therapy. This study compares health status of extremely premature (< 28 weeks gestation) neonates who failed medical therapy at the time of their second course of medical treatment versus operation.
  
  
  METHODS
  A retrospective chart review was performed on neonates born at less than 28 weeks gestation who underwent PDA ligation after two rounds of medical therapy over a 7.5-year period. Measurements of health status at the time of the second course of medical therapy and the time of operation were compared.
  
  
  RESULTS
  Neonates (n = 34) required less fraction of inspired oxygen (33.5 ± 12.9% vs. 48.5 ± 24%, p < 0.0001), had lower mean airway pressure (7.5 ± 1.9 vs. 9.1 ± 2.4 mm Hg, p < 0.0001), and were less likely to require vasopressor support (16.7 vs. 60%, p = 0.0126) at the time of the start of second course than at surgery.
  
  
  CONCLUSIONS
  Our study suggests that extremely premature neonates show a decline in cardiopulmonary reserve between a second course of medical therapy and surgical intervention.
authors.affiliation: Department of Surgery, Carilion Clinic, Roanoke, Virginia 24014, United States. knottdoc@gmail.com
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Alvaro
authors.initials: A
authors.lastname: Zamora
authors.forename: Clinton
authors.initials: C
authors.lastname: Cavett
authors.forename: Terri-Ann
authors.initials: TA
authors.lastname: Wattsman
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D004374:Ductus Arteriosus, Patent / Q000601:surgery / Q000628:therapy*; D006304:Health Status; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery / Q000628:therapy*; D008026:Ligation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin