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Am J Perinatol 2018; 35(08): 729-736
DOI: 10.1055/s-0037-1613673
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonsurgical Management of Persistent and Hemodynamically Significant Patent Ductus Arteriosus among Extremely Low Birth Weight Infants: A Propensity Score Matched Analysis

Ramachandra Bhat
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Kalsang Dolma
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
2   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Michael Zayek
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Lynn Batten
3   Division of Pediatric Cardiology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Keith Peevy
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Fabien Eyal
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
› Author Affiliations
Further Information

Publication History

08 August 2017

14 November 2017

Publication Date:
19 December 2017 (online)

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Abstract

Objective The objective of this study was to evaluate the impact of a nonsurgical approach (with the incorporation of late postnatal hydrocortisone treatment to facilitate extubation) in comparison to the surgical approach for the management of persistent hemodynamically significant patent ductus arteriosus (hsPDA) among chronically ventilator-dependent extremely low birth weight (ELBW) infants.

Methods In this retrospective study, ELBW infants with a diagnosis of hsPDA (diagnosed based on the echocardiographic criteria and chronic ventilator dependence) that were persistent beyond 14 days of postnatal age despite adequate medical treatment were included.

Results Out of 127 infants (surgical approach group, n = 67 and nonsurgical approach group, n = 60), 72 infants were matched based on the propensity scores. In the matched cohort, in comparison to infants managed with the surgical approach (control group, n = 36), infants in the nonsurgical approach group (treatment group, n = 36) had a lower rate of surgical ligation (14 vs. 100%, p = < 0.001), but there were no differences in both primary outcome (death or bronchopulmonary dysplasia) and secondary outcome measures.

Conclusion For chronically ventilator-dependent ELBW infants with persistent hsPDA, a nonsurgical management approach is associated with a reduced rate of surgical ligation of PDA, but not associated with increased risk of adverse major short-term neonatal outcomes.

Keywords

patent ductus arteriosus - extremely low birth weight infants - mechanical ventilation - bronchopulmonary dysplasia - hydrocortisone

Authors' Contributions

R.B. conceptualized and designed the study, collected the data, performed data analyses, and drafted the initial article and revisions. K.D. participated in the study conceptualization and study design, collected the data, critically reviewed the article, and approved the final article for submission. M.Z. assisted in the study design and data analysis, critically reviewed and revised the article, and approved the final article for submission. L.B. assisted in the study design, critically reviewed and revised the article, and approved the final article for submission. K.P. assisted in the study design, critically reviewed and revised the article, and approved the final article for submission. F.E. conceptualized and designed the study, provided the supervision, revised the article, and approved the final article submission.


Supplementary Material

 

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