title: Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life.
abstract: OBJECTIVE
  To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates.
  
  
  METHODS
  The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) received non-surgical treatment. The parameters analyzed were birth weight, diameter of the ductus arteriosus (DAD), left atrial-to-aortic root diameter ratio (LA:Ao), the quotient of DAD² and birth weight (mm²/kg), and ductal shunting.
  
  
  RESULTS
  The study population comprised 58 males and 57 females. The average birth weight of group S (924 ± 224.3 g) was significantly (P=0.049) lower than that of group NS (1012.3 ± 242.8 g). The probability of the preterm neonates being submitted to surgical closure was 62.1% (P=0.006) when the DAD2/birth weight index was > 5 mm²/kg, 72.2% (P=0.001) when the LA:Ao ratio was > 1.5, and 61.2% when ductal shunting was high (P=0.025).
  
  
  CONCLUSIONS
  The parameters DAD²/birth weight index > 5 mm²/kg, LA:Ao ratio > 1.5 and high ductal shunting were statistically significant indicators (P<0.05) of the need for surgical closure of patent ductus arteriosus in low birth weight preterm neonates. Moreover, when an LA:Ao ratio > 1.5 was associated with the occurrence of shock, the probability of surgical closure increased to 78.4%.
authors.forename: Renato
authors.initials: R
authors.lastname: Braulio
authors.forename: Cláudio Léo
authors.initials: CL
authors.lastname: Gelape
authors.forename: Fátima Derlene da Rocha
authors.initials: FD
authors.lastname: Araújo
authors.forename: Kelly Nascimento
authors.initials: KN
authors.lastname: Brandão
authors.forename: Luciana Drummond Guimarães
authors.initials: LD
authors.lastname: Abreu
authors.forename: Paulo Henrique Nogueira
authors.initials: PH
authors.lastname: Costa
authors.forename: Flávio Diniz
authors.initials: FD
authors.lastname: Capanema
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001724:Birth Weight; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000473:pathology; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D047928:Premature Birth / Q000601:surgery*; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D014463:Ultrasonography