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Am J Perinatol 2013; 30(04): 289-296
DOI: 10.1055/s-0032-1324696
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early versus Conventional Treatment for Patent Ductus Arteriosus in Preterm Infants

Júlia Candel-Pau
1   Vall d'Hebron Research Institute, Barcelona, Spain
2   Neonatology Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
,
Ángeles Linde Sillo
2   Neonatology Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
,
Félix Castillo Salinas
2   Neonatology Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
,
Ermengol Coma Redon
3   Department of Epidemiology and Preventive Medicine, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
,
Queralt Ferrer Menduiña
4   Department of Pediatric Cardiology, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
,
Dimpna C. Albert
4   Department of Pediatric Cardiology, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
› Institutsangaben
Weitere Informationen

Publikationsverlauf

28. Oktober 2011

18. Mai 2012

Publikationsdatum:
23. August 2012 (online)

    Lizenzen und Reprints

Abstract

Objective After the introduction of a new protocol based on the early treatment with indomethacin for patent ductus arteriosus, the objective of this study was to assess the safety and efficacy of this new practice in comparison with the safety and efficacy of the conventional treatment in a high-risk population.

Study Design We conducted a retrospective cohort study including 154 newborns with an average gestational age of 26.4 weeks (1.37 standard deviation) and an average birth weight of 855 g (201.5 standard deviation). A statistically descriptive analysis was performed with SPSS Statistics Pack version 17.0.

Results and Conclusions We did not find any statistically significant differences in the clinical features of the two treatment groups, nor in the main efficacy, morbidity, and mortality results.

Keywords

patent ductus arteriosus - indomethacin - early treatment - preterm
 

  • References

  • 1 Golombek SG, Sola A, Baquero H , et al; Primer Grupo de Consenso Clínico SIBEN. [First SIBEN clinical consensus: diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns]. An Pediatr (Barc) 2008; 69: 454-481
    PubMedGoogle Scholar
  • 2 Ramirez CT, Cabrera PS, Jiménez MA, González HF. Sociedad Española de Cardiología Pediátrica. Ductus arterioso persistente en el prematuro. Protocolos diagnósticos y terapéuticos en cardiología pediátrica de la. February 2009; Capítulo 13
    PubMedGoogle Scholar
  • 3 Hermes-DeSantis ER, Clyman RI. Patent ductus arteriosus: pathophysiology and management. J Perinatol 2006; 26 (Suppl. 01) S14-S18 ; discussion S22–S23
    CrossrefPubMedGoogle Scholar
  • 4 Fujii AM, Brown E, Mirochnick M, O'Brien S, Kaufman G. Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus. J Perinatol 2002; 22: 535-540
    Google Scholar
  • 5 Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117: 1113-1121
    CrossrefPubMedGoogle Scholar
  • 6 Hammoud MS, Elsori HA, Hanafi EA, Shalabi AA, Fouda IA, Devarajan LV. Incidence and risk factors associated with the patency of ductus arteriosus in preterm infants with respiratory distress syndrome in Kuwait. Saudi Med J 2003; 24: 982-985
    PubMedGoogle Scholar
  • 7 Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000; 106: 659-671
    CrossrefPubMedGoogle Scholar
  • 8 Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol 2001; 18: 1-9
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Hamrick SEG, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125: 1020-1030
    CrossrefPubMedGoogle Scholar
  • 10 Cotton RB, Stahlman MT, Kovar I, Catterton WZ. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978; 92: 467-473
    CrossrefPubMedGoogle Scholar
  • 11 McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 2007; 92: F424-F427
    CrossrefPubMedGoogle Scholar
  • 12 Bose CL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed 2007; 92: F498-F502
    CrossrefPubMedGoogle Scholar
  • 13 Wyllie J. Treatment of patent ductus arteriosus. Semin Neonatol 2003; 8: 425-432
    CrossrefPubMedGoogle Scholar
  • 14 Natarajan G, Chawla S, Aggarwal S. Short-term outcomes of patent ductus arteriosus ligation in preterm neonates: reason for concern?. Am J Perinatol 2010; 27: 431-437
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Clyman R, Cassady G, Kirklin JK, Collins M, Philips III JB. The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial. J Pediatr 2009; 154: 873-876
    CrossrefPubMedGoogle Scholar
  • 16 Hoodbhoy SA, Cutting HA, Seddon JA, Campbell ME. Cerebral and splanchnic hemodynamics after duct ligation in very low birth weight infants. J Pediatr 2009; 154: 196-200
    PubMedGoogle Scholar
  • 17 Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2008; (1) CD003951 (Review)
    PubMedGoogle Scholar
  • 18 Benitz WE. Learning to live with patency of the ductus arteriosus in preterm infants. J Perinatol 2011; 31 (Suppl. 01) S42-S48
    CrossrefPubMedGoogle Scholar
  • 19 Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed 2007; 92: F244-F247
    CrossrefPubMedGoogle Scholar
  • 20 Knight DB, Laughon MM. Evidence for active closure of patent ductus arteriosus in very preterm infants. J Pediatr 2008; 152: 446-447 ; author reply 447–448
    PubMedGoogle Scholar
  • 21 Clyman RI, Chorne N. Patent ductus arteriosus: evidence for and against treatment. J Pediatr 2007; 150: 216-219 (editorial)
    CrossrefPubMedGoogle Scholar
  • 22 Van Overmeire B, Chemtob S. The pharmacologic closure of the patent ductus arteriosus. Semin Fetal Neonatal Med 2005; 10: 177-184
    CrossrefPubMedGoogle Scholar
  • 23 Bancalari E, Claure N, Gonzalez A. Patent ductus arteriosus and respiratory outcome in premature infants. Biol Neonate 2005; 88: 192-201
    CrossrefPubMedGoogle Scholar
  • 24 Van Overmeire B, Van de Broek H, Van Laer P, Weyler J, Vanhaesebrouck P. Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome. J Pediatr 2001; 138: 205-211
    CrossrefPubMedGoogle Scholar
  • 25 Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2003; (2) CD003745
    PubMedGoogle Scholar
  • 26 Fowlie PW, Davis PG. Prophylactic indomethacin for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2003; 88: F464-F466
    CrossrefPubMedGoogle Scholar
  • 27 Clyman RI. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. J Pediatr 1996; 128 (5 Pt 1) 601-607
    CrossrefPubMedGoogle Scholar
  • 28 Cordero L, Nankervis CA, Delooze D, Giannone PJ. Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?. J Perinatol 2007; 27: 158-163
    CrossrefPubMedGoogle Scholar
  • 29 Schmidt B, Roberts RS, Fanaroff A , et al; TIPP Investigators. Indomethacin prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in Preterms (TIPP). J Pediatr 2006; 148: 730-734
    CrossrefPubMedGoogle Scholar
  • 30 Schmidt B, Davis P, Moddemann D , et al; Trial of Indomethacin Prophylaxis in Preterms Investigators. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 2001; 344: 1966-1972
    CrossrefPubMedGoogle Scholar
  • 31 Cassady G, Crouse DT, Kirklin JW , et al. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000.  g or less at birth. N Engl J Med 1989; 320: 1511-1516
    CrossrefPubMedGoogle Scholar
  • 32 Jhaveri N, Moon-Grady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr 2010; 157: 381-387 , 387.e1
    CrossrefPubMedGoogle Scholar
  • 33 Herrera C, Holberton J, Davis P. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2007; (2) CD003480
    PubMedGoogle Scholar
  • 34 Attridge JT, Clark R, Walker MW, Gordon PV. New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006; 26: 93-99
    CrossrefPubMedGoogle Scholar
  • 35 Chorne N, Jegatheesan P, Lin E, Shi R, Clyman RI. Risk factors for persistent ductus arteriosus patency during indomethacin treatment. J Pediatr 2007; 151: 629-634
    CrossrefPubMedGoogle Scholar
  • 36 Shorter NA, Liu JY, Mooney DP, Harmon BJ. Indomethacin-associated bowel perforations: a study of possible risk factors. J Pediatr Surg 1999; 34: 442-444
    CrossrefPubMedGoogle Scholar
  • 37 O'Donovan DJ, Baetiong A, Adams K , et al. Necrotizing enterocolitis and gastrointestinal complications after indomethacin therapy and surgical ligation in premature infants with patent ductus arteriosus. J Perinatol 2003; 23: 286-290
    CrossrefPubMedGoogle Scholar
  • 38 Watterberg KL, Gerdes JS, Cole CH , et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 2004; 114: 1649-1657
    Google Scholar
  • 39 Stark AR, Carlo WAC, Tyson JE , et al; National Institute of Child Health and Human Development Neonatal Research Network. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. N Engl J Med 2001; 344: 95-101
    CrossrefPubMedGoogle Scholar
  • 40 Doyle LW, Ehrenkranz RA, Halliday HL. Dexamethasone treatment after the first week of life for bronchopulmonary dysplasia in preterm infants: a systematic review. Neonatology 2010; 98: 289-296
    CrossrefPubMedGoogle Scholar
  • 41 Paquette L, Friedlich P, Ramanathan R, Seri I. Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates. J Perinatol 2006; 26: 486-492
    CrossrefPubMedGoogle Scholar
  • 42 Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr 2005; 40: 184-188
    CrossrefPubMedGoogle Scholar
  • 43 Grosfeld JL, Chaet M, Molinari F , et al. Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin. Ann Surg 1996; 224: 350-355 ; discussion 355–357
    CrossrefPubMedGoogle Scholar
  • 44 Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3) CD004454 (Review)
    PubMedGoogle Scholar