Patent Ductus Arteriosus in Very Low Birthweight Infants: Complications of Pharmacological and Surgical Treatment

J Perinat Med. 2001;29(4):327-34. doi: 10.1515/JPM.2001.047.

Abstract

Aims: To evaluate complications of surgical and pharmacological treatment of symptomatic patent ductus arteriosus (PDA) in very low birthweight (VLBW) infants.

Patients and methods: Of 931 VLBW infants consecutively admitted 1987-1998, a significant PDA prompted first-choice treatment by indomethacin in 101 infants, and surgery in 55 infants. PDA closed or became asymptomatic after indomethacin in 64 patients (63%), while 34 went on to surgery. PDA closure was achieved in all 61 infants after ligation and in 26 of 28 infants after clipping.

Results: Transient renal impairment after indomethacin treatment was recorded in 40 of 101 infants (40%), compared to renal impairment in 9 of 55 infants (16%) undergoing surgery without prior indomethacin. No differences in necrotizing enterocolitis and intracranial hemorrhage rates were seen. Air leak occurred in 6 of 89 infants after surgery, two of which had fatal tension pneumothorax. Intraoperative hemorrhage requiring emergency transfusion occurred in 2 infants, wound infection occurred in 2 infants and phrenic palsy in one infant. Based on an intention-to-treat analysis, the overall fatality rates were 16 of 101 (16%) for indomethacin and 14 of 55 (25%) for surgery.

Conclusions: Despite the short-comings inherent to retrospective analyses, we propose that surgery should be reserved for infants not responding to pharmacological PDA closure.

Publication types

  • Comparative Study

MeSH terms

  • Birth Weight
  • Blood Loss, Surgical
  • Ductus Arteriosus, Patent / drug therapy*
  • Ductus Arteriosus, Patent / mortality
  • Ductus Arteriosus, Patent / surgery*
  • Humans
  • Indomethacin / therapeutic use
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Intensive Care, Neonatal
  • Ligation
  • Surgical Wound Infection / epidemiology
  • Treatment Failure
  • Treatment Outcome

Substances

  • Indomethacin