| Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus. | |
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MedLine Citation:
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PMID: 22795222 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andrea C Wickremasinghe; Elizabeth E Rogers; Robert E Piecuch; Bridget C Johnson; Suzanne Golden; Anita J Moon-Grady; Ronald I Clyman |
Publication Detail:
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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:
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Title: The Journal of pediatrics Volume: 161 ISSN: 1097-6833 ISO Abbreviation: J. Pediatr. Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-22 Completed Date: 2013-01-22 Revised Date: 2013-04-16 |
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: 1065-72 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0544, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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HL109199/HL/NHLBI NIH HHS; HL46691/HL/NHLBI NIH HHS; R01 HL046691/HL/NHLBI NIH HHS; R01 HL109199/HL/NHLBI NIH HHS; UL1 RR024131/RR/NCRR NIH HHS; UL1 RR024131/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Cardiovascular Agents; 53-86-1/Indomethacin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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