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

Autor: Bhat R; Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama., Dolma K; Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama., Zayek M; Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama., Batten L; Division of Pediatric Cardiology, Department of Pediatrics, University of South Alabama, Mobile, Alabama., Peevy K; Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama., Eyal F; Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.
Jazyk: angličtina
Zdroj: American journal of perinatology [Am J Perinatol] 2018 Jul; Vol. 35 (8), pp. 729-736. Date of Electronic Publication: 2017 Dec 19.
DOI: 10.1055/s-0037-1613673
Abstrakt: 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.
Competing Interests: None.
(Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
Databáze: MEDLINE
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