Document Detail

Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment.
MedLine Citation:
PMID:  20434168     Owner:  NLM     Status:  MEDLINE    
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.
Nami Jhaveri; Anita Moon-Grady; Ronald I Clyman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  157     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  2010-09-23     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  381-7, 387.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
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MeSH Terms
Ductus Arteriosus, Patent / drug therapy*,  surgery*
Indomethacin / therapeutic use*
Infant, Newborn
Prospective Studies
Time Factors
Treatment Failure
Grant Support
Reg. No./Substance:
Comment In:
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 ]

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