10 research outputs found
Arteriosus
No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7)and 28(6/7)weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 +/- 1.4 weeks and 926 +/- 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (>= Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p> 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80,p= 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92,p= 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p= 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.C1 [Okulu, Emel; Erdeve, Omer; Arsan, Saadet] Ankara Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Arslan, Zehra] Univ Hlth Sci, Etlik Zubeyde Hanim Womens Hlth Teaching & Res Ho, Dept Neonatol, Ankara, Turkey.[Demirel, Nihal] Ankara Yildirim Beyazit Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Kaya, Huseyin; Gokce, Ismail Kursad] Inonu Univ, Sch Med, Dept Pediat, Div Neonatol, Malatya, Turkey.[Ertugrul, Sabahattin] Dicle Univ, Sch Med, Dept Pediat, Div Neonatol, Diyarbakir, Turkey.[Cetinkaya, Merih; Buyukkale, Gokhan] Univ Hlth Sci, Kanuni Sultan Suleyman Training & Res Hosp, Dept Neonatol, Istanbul, Turkey.[Ozlu, Ferda; Simsek, Huseyin] Cukurova Univ, Sch Med, Dept Pediat, Div Neonatol, Adana, Turkey.[Celik, Yalcin] Mersin Univ, Sch Med, Dept Pediat, Div Neonatol, Mersin, Turkey.[Ozkan, Hilal; Koksal, Nilgun] Uludag Univ, Sch Med, Dept Pediat, Div Neonatol, Bursa, Turkey.[Akcan, Baris; Turkmen, Munevver] Adnan Menderes Univ, Sch Med, Dept Pediat, Div Neonatol, Aydin, Turkey.[Celik, Kiymet] Diyarbakir Gazi Yasargil Training & Res Hosp, Neonatal Intens Care Unit, Diyarbakir, Turkey.[Armangil, Didem] Koru Hosp, Neonatal Intens Care Unit, Ankara, Turkey.[Bulbul, Ali] Univ Hlth Sci, Sisli Etfal Hamidiye Training & Res Hosp, Dept Neonatol, Istanbul, Turkey.[Tekgunduz, Kadir Serafettin] Ataturk Univ, Sch Med, Dept Pediat, Div Neonatol, Erzurum, Turkey.[Oncel, Mehmet Yekta] Izmir Katip Celebi Univ, Sch Med, Dept Pediat, Div Neonatol, Izmir, Turkey.[Tuzun, Funda] Dokuz Eylul Univ, Sch Med, Dept Pediat, Div Neonatol, Izmir, Turkey.[Ergenekon, Ebru] Gazi Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Ergin, Hacer] Pamukkale Univ, Sch Med, Dept Pediat, Div Neonatol, Denizli, Turkey