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Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants
Insights
Early surgical closure of a symptomatic patent ductus arteriosus (PDA) in preterm infants requiring mechanical ventilation benefits infants by reducing ventilation time and medication needs.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Cardiology
Background:
- A symptomatic patent ductus arteriosus (PDA) is a common complication in preterm infants.
- Mechanical ventilation is often required for these infants, increasing morbidity.
Purpose of the Study:
- To compare the outcomes of early surgical closure versus medical management for symptomatic PDA in preterm infants requiring mechanical ventilation.
Main Methods:
- Randomized assignment of 25 preterm infants (birth weight ≤1,500 gm) with symptomatic PDA to either early surgical closure (10 infants) or medical management (15 infants).
- All infants required mechanical ventilation at one week after birth; groups were similar in baseline characteristics.
Main Results:
- Infants undergoing surgical closure were weaned from mechanical ventilation sooner.
- Surgical closure led to decreased need for digoxin and furosemide, and faster achievement of gastrointestinal function.
- The surgical group experienced a smaller hospital bill compared to the medical management group.
Conclusions:
- Early surgical closure of PDA in preterm infants who still require mechanical ventilation at one week of age offers significant clinical and economic benefits.
- This approach improves recovery time and reduces the need for ongoing medical interventions.
Abstract:
As a result of randomized assignment, 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol, and ten according to an early surgical closure protocol. All infants required mechanical ventilation at the time of study entry, which was one week after birth. Birth weight, gestational age, age at onset of congestive failure, age at study entry, and the initial morbidity of members of the two groups were similar. The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner, had a decreased need for digoxin and furosemide, achieved gastrointestinal function sooner, and had a smaller hospital bill than the 12 survivors of the medical management group. These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation at one week after birth will benefit from surgical closure of the ductus at that time.