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Symptomatic patent ductus arteriosus in very-low-birth-weight infants: 1987-1989
A I Mouzinho1, C R Rosenfeld, R Risser
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Insights
Symptomatic patent ductus arteriosus (sPDA) remains a concern in very-low-birth-weight infants. Judicious fluid management is key, with over 80% of infants showing spontaneous closure.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Perinatology
Background:
- Symptomatic patent ductus arteriosus (sPDA) affects up to 50% of very-low-birth-weight (VLBW) infants.
- Previous studies highlighted the importance of early fluid management in reducing sPDA incidence.
- Increased survival rates in VLBW infants necessitate re-evaluation of sPDA trends.
Purpose of the Study:
- To determine if the incidence, morbidity, treatment, or risk factors for sPDA have changed in VLBW infants.
- To compare sPDA cases with matched controls.
- To assess the effectiveness of current management strategies.
Main Methods:
- Retrospective analysis of VLBW infants with sPDA surviving >72 hours between 1987-1989.
- Comparison of 119 sPDA cases with 70 matched controls.
- Statistical analysis including logistic regression to identify risk factors.
Main Results:
- The incidence of sPDA was 19%, with onset around 10 days of life.
- sPDA incidence varied significantly by birth weight, increasing in lower birth weight categories.
- sPDA was associated with increased chronic lung disease and intracranial hemorrhage.
- Medical management and indomethacin had limited success; 43% required surgical ligation.
Conclusions:
- Despite increased VLBW survival, sPDA incidence remains low with judicious fluid management.
- Over 80% of VLBW infants experienced spontaneous closure of sPDA.
- Predictive models for sPDA were not accurately developed.
- Effective management strategies for sPDA require further investigation.
Abstract:
Symptomatic patent ductus arteriosus (sPDA) may occur in up to 50% of very-low-birth-weight (VLBW, less than or equal to 1500 g) infants. We reported a 16% incidence in 1979-1980 in a totally inborn population, demonstrating the importance of early fluid management. Although survival of VLBW infants, especially those less than 1000 g, has increased, sPDA has not been carefully re-examined. Therefore, we sought to determine if the incidence, morbidity, treatment, or risk factors for sPDA had changed in this population. Between January 1, 1987 and December 31, 1989 all VLBW infants with sPDA surviving greater than 72 h (119/636) were identified and compared to matched controls (n = 70). Incidence and onset of sPDA were 19% and 10 +/- 6 days (+/- S.D.), respectively, the former increasing from 8% to 33% between 1251-1500 g and 500-750 g, respectively (P less than 0.001). Fluid and colloid administration were similar in sPDA and control infants. sPDA was associated with the occurrence of chronic lung disease (18% vs 7%, P = 0.005) and intracranial hemorrhage (53% vs 21%, P less than 0.001). Using stepwise logistic regression analysis we were unable to create a model that accurately predicted sPDA. Medical management and indomethacin were unsuccessful in 66% and 25%, respectively, of infants so treated; 43% required surgical ligation. Although survival of VLBW infants has increased, our incidence of sPDA remains low, with greater than 80% of infants demonstrating spontaneous closure when fluid and colloid administration are judiciously used.