Patent ductus arteriosus in preterm infants born before 30 weeks' gestation: high rate of spontaneous closure after hospital discharge.

Abstract

AimThe aim of this study was to determine the spontaneous closure rate of patent ductus arteriosus at a 2-year follow-up, following failed medical therapy and beyond initial hospital discharge, and to evaluate in-hospital spontaneous or pharmacological closure rates.Materials and methodsA retrospective evaluation was conducted in a cohort of preterm infants admitted to the Neonatal ICU of Ancona between January, 2004 and June, 2013. Inclusion criteria were gestational age between 24+0 and 29+6 weeks or birth weight 1.5 mm, a left atrium-to-aorta ratio >1.4, and/or reversal of end-diastolic flow in the aorta >30% of the anterograde. First-line treatment was intravenous ibuprofen. Intravenous indomethacin was used if ibuprofen failed. Surgical ligation was considered in haemodynamically significant patent ductus arteriosus after medical treatment.

RESULTS:

A total of 593 infants met the inclusion criteria, and patent ductus arteriosus was diagnosed in 317 (53.4%). Among them, 283 (89.3%) infants had haemodynamically significant patent ductus arteriosus, with pharmacological closure achieved in 228 (80.6%) infants and surgical ligation performed in 20 (7.1%). Follow-up at 24 months was available for 39 (81.3%) of 48 infants with patent ductus arteriosus at the hospital discharge: 36 (92.3%) underwent spontaneous closure, two (5.1%) underwent surgical ligation, and one (2.6%) had a patent ductus arteriosus.DiscussionA significant number of patent ductus arteriosus that fail pharmacological closure undergo spontaneous closure by the age of 2 years. This information should be taken into account when considering surgery or additional attempts of pharmacological closure.

• Authors: Vittorio Romagnoli, Annalisa Pedini, Monica Santoni, Grazia Scutti, Massimo Colaneri, Marco Pozzi, Paola E Cogo, Virgilio P Carnielli
• Journal: Cardiology in the young (Cardiol Young) Vol. 28 Issue 8 Pg. 995-1000 (Aug 2018) ISSN: 1467-1107 [Electronic] England
• PMID: 29954463 (Publication Type: Journal Article)

Chemical References

• Cyclooxygenase Inhibitors
• Ibuprofen
• Indomethacin

Topics

• Administration, Intravenous
• Cyclooxygenase Inhibitors (therapeutic use)
• Ductus Arteriosus, Patent (therapy)
• Female
• Follow-Up Studies
• Gestational Age
• Humans
• Ibuprofen (therapeutic use)
• Indomethacin (therapeutic use)
• Infant
• Infant, Extremely Low Birth Weight
• Infant, Extremely Premature
• Infant, Newborn
• Italy (epidemiology)
• Ligation
• Male
• Patient Discharge
• Remission Induction
• Remission, Spontaneous
• Retrospective Studies