Korean J Pediatr.  2008 Oct;51(10):1065-1070. 10.3345/kjp.2008.51.10.1065.

Delayed closure effect in preterm infants with patent ductus arteriosus

• Lee HJ
• Sim GH
• Jung KE
• Lee JA
• Choi CW
• Kim EK
• Kim HS
• Kim BI
• Choi JH

• KMID: 2280313
• DOI: http://doi.org/10.3345/kjp.2008.51.10.1065

Abstract

PURPOSE: This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d).
METHODS
Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively.
RESULTS
The mean gestational age (GA) was 26+/-2 weeks (range, 23-32 wk), and the birth weight was 782+/-146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7+/-1.7 wk vs. 27.1+/-2.0 wk, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010)..
CONCLUSION
Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.

Keyword

Patent ductus arteriosus; Prematurity; Indomethacin; Surgical procedures; Treatment

MeSH Terms

Birth Weight
Bronchopulmonary Dysplasia
Ductus Arteriosus, Patent
Enteral Nutrition
Fertilization in Vitro
Gestational Age
Hemorrhage
Hospitalization
Humans
Incidence
Indomethacin
Infant
Infant, Newborn
Infant, Premature
Ligation
Parenteral Nutrition, Total
Pre-Eclampsia
Ventilators, Mechanical
Indomethacin