St Georges University, London, UK
|Background:Whether to close a patent ductus arteriosus (PDA) and the timing of treatment are common clinical dilemmas for clinicians looking after preterm infants. Many clinicians are less willing to treat and wait for the PDA to close. However, there is a concern that if treatment is required, infants are being treated later in postnatal life which may be less effective.
1.To evaluate the impact of timing of treatment on the need for ligation and associated outcomes.
2.To determine the impact of gestational age on need for ligation.
3.To compare outcomes of infants requiring ligation with those where PDA closed medically.
Data for 112 babies with treated PDAs between 2007-2013 were collected from the St George’s neonatal database for: intervention used to close the PDA and timing of the intervention. Outcome data was identified for duration of treatment, chronic lung disease (CLD), respiratory support at 36 weeks corrected gestation, home oxygen, mortality, intraventricular hemorrhage, necrotising enterocolitis, and retinopathy of prematurity.
The likelihood of requiring surgical ligation was higher than medical closure only for infants born at 23 weeks gestation. Of those who underwent ligation, a greater proportion were ventilated at 36 weeks (35% vs 4%, p<0.001) and discharged on home oxygen (62% vs. 28%, p =0.01). Although the likelihood of medical closure was higher when medication was commenced in the first 3 weeks of life, mortality rates were higher the earlier treatment was commenced (numbers however were low). There were no other significant associations found between the interventions, gestational age, clinical outcomes and treatment timing.
The results support the current concerns expressed in the neonatal medical literature that treatment does little to alter clinical outcomes except in very few selected cases. A symptomatic ‘wait and watch’ approach before offering treatment is warranted.
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