Document Detail


Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus.
MedLine Citation:
PMID:  22795222     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes.
STUDY DESIGN: In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224).
RESULTS: During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1.
CONCLUSION: A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months.
Authors:
Andrea C Wickremasinghe; Elizabeth E Rogers; Robert E Piecuch; Bridget C Johnson; Suzanne Golden; Anita J Moon-Grady; Ronald I Clyman
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-07-13
Journal Detail:
Title:  The Journal of pediatrics     Volume:  161     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-22     Completed Date:  2013-01-22     Revised Date:  2014-03-25    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1065-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Blindness / diagnosis,  etiology*
Cardiovascular Agents / therapeutic use
Cerebral Palsy / diagnosis,  etiology*
Child, Preschool
Combined Modality Therapy
Deafness / diagnosis,  etiology*
Developmental Disabilities / diagnosis,  etiology*
Ductus Arteriosus, Patent / complications,  drug therapy,  surgery,  therapy*
Female
Follow-Up Studies
Humans
Indomethacin / therapeutic use
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases* / drug therapy,  etiology,  surgery,  therapy
Ligation / methods
Logistic Models
Male
Multivariate Analysis
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HL109199/HL/NHLBI NIH HHS; HL46691/HL/NHLBI NIH HHS; R01 HL046691/HL/NHLBI NIH HHS; R01 HL109199/HL/NHLBI NIH HHS; T32 HD071860/HD/NICHD NIH HHS; UL1 RR024131/RR/NCRR NIH HHS; UL1 RR024131/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Cardiovascular Agents; XXE1CET956/Indomethacin
Comments/Corrections

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