Download PDF
Am J Perinatol 2016; 33(06): 584-589
DOI: 10.1055/s-0035-1570340
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Patent Ductus Arteriosus with Cyclo-oxygenase Inhibitors beyond 2 Weeks of Age in Very Low Birth Weight Infants

Shabnam Lainwala
1   Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
,
Naveed Hussain
1   Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
› Author Affiliations
Further Information

Publication History

18 May 2015

04 November 2015

Publication Date:
05 January 2016 (online)

    Permissions and Reprints

Abstract

Background Cyclo-oxygenase inhibitors (COX-I) treatment of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants during the early postnatal period is well established, but their use beyond early postnatal period is not well studied.

Objective The objective of this study was to determine the effectiveness of postnatal COX-I for PDA treatment beyond 2 weeks of age in VLBW infants.

Study Design A retrospective cohort of VLBW infants admitted to two tertiary NICUs between 1990 and 2008 were studied. Infants with symptomatic PDA were treated with COX-I and infants with failed medical treatment were candidates for surgical ligation. Effectiveness of COX-I treatment, measured by the need for surgical ligation, was compared between early (day of life [DOL] < 14, early treatment group [ETG]) and late (DOL ≥ 14, late treatment group [LTG]) treatment groups.

Results Of the 1,289 infants with PDA, 1,082 (84%) were treated with COX-I; 1,046 (97%) infants were in ETG and 36 (3%) in LTG. PDA ligation rates after COX-I treatment were 15% in ETG and 14% in LTG (p-value: not significant). There were no significant differences in demographics or morbidities between the two groups.

Conclusions In VLBW infants, late treatment of PDA with COX-I was as effective as early treatment. Trial of late COX-I treatment is warranted for symptomatic PDA before surgical treatment.

Keywords

patent ductus arteriosus - COX inhibitor - treatment - PDA ligation - premature infant
 

  • References

  • 1 Wyllie J. Treatment of patent ductus arteriosus. Semin Neonatol 2003; 8 (6) 425-432
    CrossrefPubMedGoogle Scholar
  • 2 Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2008; (1) CD003951
    PubMedGoogle Scholar
  • 3 Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2013; 4: CD003481
    PubMedGoogle Scholar
  • 4 Sekar KC, Corff KE. Treatment of patent ductus arteriosus: indomethacin or ibuprofen?. J Perinatol 2008; 28 (Suppl. 01) S60-S62
    CrossrefPubMedGoogle Scholar
  • 5 Chorne N, Jegatheesan P, Lin E, Shi R, Clyman RI. Risk factors for persistent ductus arteriosus patency during indomethacin treatment. J Pediatr 2007; 151 (6) 629-634
    CrossrefPubMedGoogle Scholar
  • 6 Clyman RI. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. J Pediatr 1996; 128 (5 Pt 1) 601-607
    CrossrefPubMedGoogle Scholar
  • 7 Merritt TA, Harris JP, Roghmann K , et al. Early closure of the patent ductus arteriosus in very low-birth-weight infants: a controlled trial. J Pediatr 1981; 99 (2) 281-286
    CrossrefPubMedGoogle Scholar
  • 8 Van Overmeire B, Van de Broek H, Van Laer P, Weyler J, Vanhaesebrouck P. Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome. J Pediatr 2001; 138 (2) 205-211
    CrossrefPubMedGoogle Scholar
  • 9 Shortland DB, Gibson NA, Levene MI, Archer LN, Evans DH, Shaw DE. Patent ductus arteriosus and cerebral circulation in preterm infants. Dev Med Child Neurol 1990; 32 (5) 386-393
    PubMedGoogle Scholar
  • 10 Cotton RB, Stahlman MT, Kovar I, Catterton WZ. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978; 92 (3) 467-473
    CrossrefPubMedGoogle Scholar
  • 11 Cotton RB, Stahlman MT, Bender HW, Graham TP, Catterton WZ, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 1978; 93 (4) 647-651
    CrossrefPubMedGoogle Scholar
  • 12 Chock VY, Punn R, Oza A , et al. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus. Pediatr Res 2014; 75 (4) 570-575
    CrossrefPubMedGoogle Scholar
  • 13 Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?. J Perinatol 2010; 30 (4) 241-252
    CrossrefPubMedGoogle Scholar
  • 14 Laughon M, Bose C, Clark R. Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol 2007; 27 (3) 164-170
    CrossrefPubMedGoogle Scholar
  • 15 Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2003; (2) CD003745
    PubMedGoogle Scholar
  • 16 Fowlie PW, Davis PG. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2002; (3) CD000174
    PubMedGoogle Scholar
  • 17 Clement WA, El-Hakim H, Phillipos EZ, Coté JJ. Unilateral vocal cord paralysis following patent ductus arteriosus ligation in extremely low-birth-weight infants. Arch Otolaryngol Head Neck Surg 2008; 134 (1) 28-33
    CrossrefPubMedGoogle Scholar
  • 18 Clyman R, Cassady G, Kirklin JK, Collins M, Philips III JB. The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial. J Pediatr 2009; 154 (6) 873-876
    CrossrefPubMedGoogle Scholar
  • 19 Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A. Trial of Indomethacin Prophylaxis in Preterms Investigators. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150 (3) 229-234 , 234.e1
    CrossrefPubMedGoogle Scholar
  • 20 Mandhan P, Brown S, Kukkady A, Samarakkody U. Surgical closure of patent ductus arteriosus in preterm low birth weight infants. Congenit Heart Dis 2009; 4 (1) 34-37
    CrossrefPubMedGoogle Scholar
  • 21 Teixeira LS, Shivananda SP, Stephens D, Van Arsdell G, McNamara PJ. Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention. J Perinatol 2008; 28 (12) 803-810
    CrossrefPubMedGoogle Scholar
  • 22 Wickremasinghe AC, Rogers EE, Piecuch RE , et al. Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus. J Pediatr 2012; 161 (6) 1065-1072
    CrossrefPubMedGoogle Scholar
  • 23 Jhaveri N, Moon-Grady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr 2010; 157 (3) 381-387 , 387.e1
    CrossrefPubMedGoogle Scholar
  • 24 Jhaveri N, Soll RF, Clyman RI. Feeding practices and patent ductus arteriosus ligation preferences-are they related?. Am J Perinatol 2010; 27 (8) 667-674
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?. Semin Perinatol 2012; 36 (2) 123-129
    CrossrefPubMedGoogle Scholar
  • 26 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (1) 179-201
    PubMedGoogle Scholar
  • 27 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 28 Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967; 276 (7) 357-368
    CrossrefPubMedGoogle Scholar
  • 29 Bancalari EH, Jobe AH. The respiratory course of extremely preterm infants: a dilemma for diagnosis and terminology. J Pediatr 2012; 161 (4) 585-588
    CrossrefPubMedGoogle Scholar
  • 30 Nelson RJ, Thibeault DW, Emmanouilides GC, Lippmann M. Improving the results of ligation of patent ductus arteriosus in small preterm infants. J Thorac Cardiovasc Surg 1976; 71 (2) 169-178
    PubMedGoogle Scholar
  • 31 Kääpä P, Lanning P, Koivisto M. Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome. Acta Paediatr Scand 1983; 72 (2) 179-184
    CrossrefPubMedGoogle Scholar
  • 32 Mahony L, Carnero V, Brett C, Heymann MA, Clyman RI. Prophylactic indomethacin therapy for patent ductus arteriosus in very-low-birth-weight infants. N Engl J Med 1982; 306 (9) 506-510
    CrossrefPubMedGoogle Scholar
  • 33 Pongiglione G, Marasini M, Silvestri G , et al. Early treatment of patent ductus arteriosus in premature infants with severe respiratory distress syndrome. Pediatr Cardiol 1988; 9 (2) 91-94
    CrossrefPubMedGoogle Scholar
  • 34 Canty Sr TG, Mainwaring R, Vecchione T , et al. Separation of omphalopagus twins: unique reconstruction using syngeneic cryopreserved tissue. J Pediatr Surg 1998; 33 (5) 750-753
    CrossrefPubMedGoogle Scholar
  • 35 Cassady G, Crouse DT, Kirklin JW , et al. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth. N Engl J Med 1989; 320 (23) 1511-1516
    CrossrefPubMedGoogle Scholar
  • 36 Schmidt B, Davis P, Moddemann D , et al; Trial of Indomethacin Prophylaxis in Preterms Investigators. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 2001; 344 (26) 1966-1972
    CrossrefPubMedGoogle Scholar
  • 37 McCarthy JS, Zies LG, Gelband H. Age-dependent closure of the patent ductus arteriosus by indomethacin. Pediatrics 1978; 62 (5) 706-712
    PubMedGoogle Scholar
  • 38 Madan J, Fiascone J, Balasubramanian V, Griffith J, Hagadorn JI. Predictors of ductal closure and intestinal complications in very low birth weight infants treated with indomethacin. Neonatology 2008; 94 (1) 45-51
    CrossrefPubMedGoogle Scholar
  • 39 Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr 1983; 102 (6) 895-906
    CrossrefPubMedGoogle Scholar
  • 40 Gonzalez A, Sosenko IR, Chandar J, Hummler H, Claure N, Bancalari E. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less. J Pediatr 1996; 128 (4) 470-478
    CrossrefPubMedGoogle Scholar
  • 41 Ibrahim TK, Haium AA, Chandran S, Rajadurai VS. Current controversies in the management of patent ductus arteriosus in preterm infants. Indian Pediatr 2014; 51 (4) 289-294
    CrossrefPubMedGoogle Scholar