Patent ductus arteriosus in micropreemies and full-term infants

The relative merits of surgical ligation versus indomethacin treatment

Danny C. Little, Theodore C. Pratt, Shannon E. Blalock, Donald R. Krauss, Donald R. Cooney, Monford D. Custer

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background/Purpose: Treatment of ductus arteriosus is controversial. The merits and timing of ductus ligation versus indomethacin treatment were compared. Methods: Study parameters for infants with PDA (June 1988 through March 2001) included age, weight, physical findings, echocardiograph, success/complications of treatment, and length of stay (LOS). Statistical analysis was by descriptive univariate analysis. Results: Two hundred twelve infants were included. Median gestational age was 26 weeks (range, 22-38); weight, 836 g (447 to 2,863). Findings included murmur (94%), congestion (20%), cardiomegaly (15%), bounding pulses (6%), hyperdynamic precordium (4%), and CHF (2%). Echocardiographic measurements were left atrial diameter, 0.92 cm; posterior wall thickness, 0.26 cm; PDA diameter, 2.5 mm; septal thickness, 0.27 cm; aortic root diameter, 0.64 cm; ejection fraction, 39%; left ventricular internal diameter-diastole, 1.3 cm; left ventricular internal diameter-systole, 0.82 cm; right ventricular internal diameter-diastole, 0.51 cm. No measurement, except PDA diameter, was predictive of medical failure or need for reoperation. However, weight less than 1,000 g was highly predictive of medical failure. Additional cardiac anomalies included ASD (69%), VSD (3%), and aortic coarctation (1%). One hundred sixty-seven babies (79%) received indomethacin, closing the PDA in 88 cases (53%, recurrence = 47%). Indomethacin complications (73%) included thrombocytopenia (36%), BUN increase (31%), sepsis (30%), oliguria (25%), hyponatremia (25%), IVH (16%), pulmonary interstitial emphysema (11%), NEC (8%), intestinal perforation (4%), and bleeding (3%). Seventy-seven babies (36%) required operations (92% in the NICU) performed by pediatric surgeons. Ligation criteria included hypoxia, hypercapnia, decreasing compliance, CHF, and contraindications/failure of indomethacin. Complications included pneumothorax (4%), IVH (4%), bleeding (4%), NEC (1%), and wound infection (1%). LOS averaged 82 days. Conclusions: Although indomethacin therapy is a reasonable treatment alternative, it is associated with significant complications. Ductus ligation may be preferable, especially in very low birth weight babies, because it is associated with low morbidity and almost certain degree of success.

Original languageEnglish (US)
Pages (from-to)492-496
Number of pages5
JournalJournal of Pediatric Surgery
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2003

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Patent Ductus Arteriosus
Indomethacin
Ligation
Diastole
Weights and Measures
Length of Stay
Hemorrhage
Intestinal Perforation
Oliguria
Therapeutics
Ductus Arteriosus
Pulmonary Emphysema
Very Low Birth Weight Infant
Aortic Coarctation
Hypercapnia
Hyponatremia
Systole
Blood Urea Nitrogen
Cardiomegaly
Pneumothorax

Keywords

  • Patent ductus arteriosus

ASJC Scopus subject areas

  • Surgery

Cite this

Patent ductus arteriosus in micropreemies and full-term infants : The relative merits of surgical ligation versus indomethacin treatment. / Little, Danny C.; Pratt, Theodore C.; Blalock, Shannon E.; Krauss, Donald R.; Cooney, Donald R.; Custer, Monford D.

In: Journal of Pediatric Surgery, Vol. 38, No. 3, 01.03.2003, p. 492-496.

Research output: Contribution to journalArticle

Little, Danny C. ; Pratt, Theodore C. ; Blalock, Shannon E. ; Krauss, Donald R. ; Cooney, Donald R. ; Custer, Monford D. / Patent ductus arteriosus in micropreemies and full-term infants : The relative merits of surgical ligation versus indomethacin treatment. In: Journal of Pediatric Surgery. 2003 ; Vol. 38, No. 3. pp. 492-496.
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abstract = "Background/Purpose: Treatment of ductus arteriosus is controversial. The merits and timing of ductus ligation versus indomethacin treatment were compared. Methods: Study parameters for infants with PDA (June 1988 through March 2001) included age, weight, physical findings, echocardiograph, success/complications of treatment, and length of stay (LOS). Statistical analysis was by descriptive univariate analysis. Results: Two hundred twelve infants were included. Median gestational age was 26 weeks (range, 22-38); weight, 836 g (447 to 2,863). Findings included murmur (94{\%}), congestion (20{\%}), cardiomegaly (15{\%}), bounding pulses (6{\%}), hyperdynamic precordium (4{\%}), and CHF (2{\%}). Echocardiographic measurements were left atrial diameter, 0.92 cm; posterior wall thickness, 0.26 cm; PDA diameter, 2.5 mm; septal thickness, 0.27 cm; aortic root diameter, 0.64 cm; ejection fraction, 39{\%}; left ventricular internal diameter-diastole, 1.3 cm; left ventricular internal diameter-systole, 0.82 cm; right ventricular internal diameter-diastole, 0.51 cm. No measurement, except PDA diameter, was predictive of medical failure or need for reoperation. However, weight less than 1,000 g was highly predictive of medical failure. Additional cardiac anomalies included ASD (69{\%}), VSD (3{\%}), and aortic coarctation (1{\%}). One hundred sixty-seven babies (79{\%}) received indomethacin, closing the PDA in 88 cases (53{\%}, recurrence = 47{\%}). Indomethacin complications (73{\%}) included thrombocytopenia (36{\%}), BUN increase (31{\%}), sepsis (30{\%}), oliguria (25{\%}), hyponatremia (25{\%}), IVH (16{\%}), pulmonary interstitial emphysema (11{\%}), NEC (8{\%}), intestinal perforation (4{\%}), and bleeding (3{\%}). Seventy-seven babies (36{\%}) required operations (92{\%} in the NICU) performed by pediatric surgeons. Ligation criteria included hypoxia, hypercapnia, decreasing compliance, CHF, and contraindications/failure of indomethacin. Complications included pneumothorax (4{\%}), IVH (4{\%}), bleeding (4{\%}), NEC (1{\%}), and wound infection (1{\%}). LOS averaged 82 days. Conclusions: Although indomethacin therapy is a reasonable treatment alternative, it is associated with significant complications. Ductus ligation may be preferable, especially in very low birth weight babies, because it is associated with low morbidity and almost certain degree of success.",
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