Document Detail


Management of patent ductus arteriosus in term or near-term neonates with respiratory distress.
MedLine Citation:
PMID:  20675240     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Respiratory distress and patent ductus arteriosus (PDA) in neonates are mutually perpetuating. Contrary to the situation in premature infants, the recognition, clinical relevance and optimal management of PDA in full-term neonates are unclear. The present study aimed to identify PDA as a possible cause of respiratory distress in term and near-term neonates, and to examine the clinical responsiveness of PDA to different treatment modalities in mature-gestational-age neonates. METHODS: Patients with gestational ages of over 34 weeks were included in this retrospective chart review; they had PDA as the sole recognizable cause of respiratory distress and were free of all other diseases. Clinical responsiveness to different regimens, including conservative treatment, drug therapy with preload reduction and inotropic agent with or without the addition of indomethacin, and surgical intervention were analyzed. RESULTS: Forty-four neonates qualified for this study. Six received no treatment and their cardiorespiratory symptoms resolved within 1 week (regimen A). Symptoms in 11 neonates were relieved after use of diuretic and inotropic agents (regimen B). Twelve neonates became asymptomatic without further intervention after indomethacin treatment in addition to preload reduction and inotropes (regimen C). A total of 15 of the 44 infants underwent PDA ligation (regimen D) due to persistent heart failure following regimens B or C, but had speedy resolution of respiratory symptoms following surgery. There were significant differences in birth body weight and hemodynamic variation based on left atrium to aortic root dimensional ratio between the treatment (regimens B, C and D) and non-treatment (regimen A) groups (p < 0.05). CONCLUSION: PDA plays an important role in prolonging respiratory distress in term or near-term neonates. Although most infants respond to noninvasive medical treatment, surgical ligation during the neonatal period is warranted in certain mature infants. Surgical treatment should be considered in patients with smaller birth body weights and those with increased left atrium to aortic root dimensional ratios.
Authors:
Yu-Chen Lin; Hsuan-Rong Huang; Reyin Lien; Pen-Hong Yang; Wen-Jen Su; Hung-Tao Chung; Te-Jen Chen; Won-Hsiung Liu
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics and neonatology     Volume:  51     ISSN:  1875-9572     ISO Abbreviation:  Pediatr Neonatol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-08-02     Completed Date:  2010-09-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101484755     Medline TA:  Pediatr Neonatol     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  160-5     Citation Subset:  IM    
Copyright Information:
2010 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department of Pediatrics, Chi Mei Medical Center, Liouying Campus, Tainan, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cardiac Surgical Procedures
Cardiotonic Agents / therapeutic use
Cardiovascular Agents / therapeutic use
Diuretics / therapeutic use
Ductus Arteriosus, Patent / complications*,  therapy*
Female
Gestational Age
Humans
Indomethacin / therapeutic use
Infant, Newborn
Male
Respiratory Distress Syndrome, Newborn / etiology*,  therapy*
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Cardiovascular Agents; 0/Diuretics; 53-86-1/Indomethacin
Comments/Corrections
Comment In:
Pediatr Neonatol. 2010 Jun;51(3):141-2   [PMID:  20675236 ]

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