The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters.

Détails

ID Serval
serval:BIB_E9EF06D8EADE
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters.
Périodique
Journal of Thoracic and Cardiovascular Surgery
Auteur⸱e⸱s
Tschuppert S., Doell C., Arlettaz-Mieth R., Baenziger O., Rousson V., Balmer C., Prêtre R., Dodge-Khatami A.
ISSN
1097-685X (Electronic)
ISSN-L
0022-5223
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
135
Numéro
1
Pages
78-82
Langue
anglais
Résumé
OBJECTIVE: We sought to analyze the effect of patent ductus arteriosus diameter on treatment success in premature neonates.
METHODS: Among 537 consecutive neonates born between 1985 and 2005 with a diagnosed patent ductus arteriosus, 201 premature patients (<35 weeks' gestation) treated for a hemodynamically significant patent ductus arteriosus were retrospectively reviewed. Two groups were compared: group MED (n = 154; successful treatment with indomethacin) and group FAIL (n = 47; failure of medication to reduce the patent ductus arteriosus diameter to hemodynamic insignificance).
RESULTS: After unsuccessful medical treatment, 33 patients required surgical patent ductus arteriosus closure, 12 died before further possible treatment, and 2 were discharged home without clinical symptoms but with an open patent ductus arteriosus. Mean patent ductus arteriosus diameter in the FAIL group (2.8 +/- 0.9 mm) was significantly larger than that in the MED group (2.4 +/- 0.6 mm, P < .01). Assisted respiration time (ventilation plus continuous positive airway pressure) before patent ductus arteriosus closure was longer in the FAIL group (20 days) than in the MED group (9 days, P < .001) but was similar after patent ductus arteriosus closure. By using an index of patent ductus arteriosus diameter squared/birth weight (in square millimeters per kilogram), a cutoff value of less than 9 mm2/kg correctly predicts medical patent ductus arteriosus closure in 87.5% of patients. Values of greater than 9 mm2/kg correctly predict medication failure in 41.5% of patients.
CONCLUSIONS: In preterm babies requiring surgical patent ductus arteriosus closure, longer respiration times reflect a delay while attempting medical treatment, but respiration time is equally short between groups after shunt elimination. Medical treatment, although a valid first option, is likely to fail with larger patent ductus arteriosus diameters and lower birth weights. Unwarranted assisted respiration and corresponding hospital stay might be shortened by earlier surgical referral for patent ductus arteriosus closure in preterm babies with a patent ductus arteriosus index of greater than 9 mm2/kg.
Pubmed
Web of science
Open Access
Oui
Création de la notice
16/12/2014 19:18
Dernière modification de la notice
20/08/2019 16:12
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