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[Patent ductus arteriosus. A common clinical problem in extremely premature infants]
A K Edstedt-Bonamy1, S Johansson, J Milerad
1Länssjukhuset Gävle-Sandviken.
Insights
Symptomatic patent ductus arteriosus (PDA) affected nearly half of preterm infants studied. Treatment increasingly involved active therapies like indomethacin or surgery, associated with low birthweight, sepsis, and ventilation needs.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Pediatrics
Context:
- Focuses on symptomatic patent ductus arteriosus (PDA) in preterm infants within a level three intensive care unit.
- Analyzes treatment regimens and incidence from 1997-1999, a period of evolving therapeutic approaches.
- Examines 95 preterm infants, with 47 (49%) diagnosed with PDA.
Purpose:
- To investigate the incidence and evolving treatment strategies for symptomatic PDA in a neonatal intensive care setting.
- To identify factors associated with the presence of PDA in preterm infants.
Summary:
- Conservative management (fluid restriction, diuretics) was used in 17 infants.
- Active therapies, including indomethacin (13 infants) and surgical ligation (10 infants), were employed. Seven infants received a combination of indomethacin and surgery.
- The utilization of active therapies (indomethacin and/or surgery) increased significantly from 50% in 1997 to 85% in 1999.
- Low birthweight, septicemia, and the need for mechanical ventilation were independently associated with PDA.
Impact:
- Highlights a trend towards more aggressive treatment for symptomatic PDA in preterm neonates.
- Identifies key risk factors (low birthweight, sepsis, mechanical ventilation) that warrant close monitoring in preterm infants.
- Provides insights into clinical decision-making and therapeutic shifts in neonatal intensive care over a defined period.
Abstract:
An analysis was made of the incidence and treatment regimen of symptomatic patent ductus arteriosus (PDA) in 95 preterm infants treated 1997-1999 in a level three intensive care unit in Stockholm. 47 infants (49 percent) had PDA. Of these 17 infants were managed conservatively (fluid restriction and diuretics), 13 were treated with indomethacin, 10 underwent primary surgical ligation and 7 were treated with indomethacin first and surgery later on. The proportion of infants given "active" therapy (surgery and/or indomethacin) rose from 50 percent in 1997 to 85 percent in 1999. In a stepwise multiple regression analysis low birthweight, septicaemia and need for mechanical ventilation were all independently associated with PDA.