| Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. | |
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MedLine Citation:
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PMID: 20434168 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To examine whether a more conservative approach to treating patent ductus arteriosus (PDA) is associated with an increase or decrease in morbidity compared with an approach involving early PDA ligation. STUDY DESIGN: In January 2005, we changed our approach to infants born at age<or=27 weeks gestation who failed indomethacin treatment. We changed from an early surgical approach, in which feedings were stopped and all PDAs were ligated (period 1: January 1999 to December 2004; n=216) to a more conservative approach in which feedings continued and PDAs were ligated only if cardiopulmonary compromise developed (period 2: January 2005 to August 2009; n=180). All infants in both periods received prophylactic indomethacin therapy. RESULTS: The 2 periods had similar rates of perinatal/neonatal risk factors and indomethacin failure (24%), as well as ventilator management and feeding advance protocols. The conservative approach (period 2) was associated with decreased rates of duct ligation (72% vs 100%; P<.05). Even though infants subjected to this approach were exposed to larger PDA shunts for longer durations, the rates of bronchopulmonary dysplasia, sepsis, retinopathy of prematurity, neurologic injury, and death were similar to those in period 1. The overall rate of necrotizing enterocolitis was significantly lower in period 2 compared with period 1. CONCLUSIONS: These findings support the need for new controlled, randomized trials to reexamine the benefits and risks of different approaches to PDA treatment. |
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Authors:
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Nami Jhaveri; Anita Moon-Grady; Ronald I Clyman |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of pediatrics Volume: 157 ISSN: 1097-6833 ISO Abbreviation: J. Pediatr. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-23 Completed Date: 2010-09-23 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0375410 Medline TA: J Pediatr Country: United States |
Other Details:
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Languages: eng Pagination: 381-7, 387.e1 Citation Subset: AIM; IM |
Copyright Information:
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Copyright (c) 2010 Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Pediatrics, University of California, San Francisco, CA 94143-0544, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Ductus Arteriosus, Patent
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drug therapy*,
surgery* Female Humans Indomethacin / therapeutic use* Infant, Newborn Ligation Male Prospective Studies Time Factors Treatment Failure |
| Grant Support | |
ID/Acronym/Agency:
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HL46691/HL/NHLBI NIH HHS; R01 HL046691-16/HL/NHLBI NIH HHS; UL1 RR024131/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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53-86-1/Indomethacin |
| Comments/Corrections | |
Comment In:
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J Pediatr. 2011 Feb;158(2):343; author reply 383-4
[PMID:
21074182
]
J Pediatr. 2011 Jun;158(6):1037-8; author reply 1038-9 [PMID: 21349543 ] J Pediatr. 2010 Sep;157(3):355-7 [PMID: 20580017 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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