title: Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus.
abstract: OBJECTIVE
  To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD.
  
  
  METHODS
  This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV.
  
  
  RESULTS
  death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks.
  
  
  METHODS
  Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant.
  
  
  RESULTS
  1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks.
  
  
  CONCLUSIONS
  The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Electronic address: liliansadeck@uol.com.br.
authors.forename: Lilian S R
authors.initials: LS
authors.lastname: Sadeck
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Cléa R
authors.initials: CR
authors.lastname: Leone
authors.affiliation: Department of Pediatrics and Child Care, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Renato S
authors.initials: RS
authors.lastname: Procianoy
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.affiliation: Department of Pediatrics, Faculdade Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Sergio T M
authors.initials: ST
authors.lastname: Marba
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
authors.forename: Francisco E
authors.initials: FE
authors.lastname: Martinez
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
authors.forename: Ligia M S S
authors.initials: LM
authors.lastname: Rugolo
authors.affiliation: Department of Neonatology, Fundação Oswaldo Cruz (FIOCRUZ), Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil.
authors.forename: M Elisabeth L
authors.initials: ME
authors.lastname: Moreira
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil.
authors.forename: Renato M
authors.initials: RM
authors.lastname: Fiori
authors.affiliation: Faculdade de Medicina, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil.
authors.forename: Ligia L
authors.initials: LL
authors.lastname: Ferrari
authors.affiliation: Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil.
authors.forename: Jucille A
authors.initials: JA
authors.lastname: Menezes
authors.affiliation: Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
authors.forename: Paulyne S
authors.initials: PS
authors.lastname: Venzon
authors.affiliation: Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil.
authors.forename: Vânia Q S
authors.initials: VQ
authors.lastname: Abdallah
authors.affiliation: Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
authors.forename: José Luiz M B
authors.initials: JL
authors.lastname: Duarte
authors.affiliation: Universidade Federal do Maranhão (UFMA), São Luiz, MA, Brazil.
authors.forename: Marynea V
authors.initials: MV
authors.lastname: Nunes
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Leni M
authors.initials: LM
authors.lastname: Anchieta
authors.affiliation: Faculdade de Ciências Médicas de Minas Gerais (CMMG), Belo Horizonte, MG, Brazil.
authors.forename: Navantino
authors.initials: N
authors.lastname: Alves Filho
mesh_terms: D001034:Apgar Score; D001938:Brazil / Q000453:epidemiology; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000628:therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D008026:Ligation / Q000379:methods; D008297:Male; D011247:Pregnancy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Canal arterial; Ligadura cirúrgica; Ligation; Muito baixo peso; PDA management; Prematuridade; Preterm; Very low birth weight