All issues > Volume 51(10); 2008

Original Article

Korean J Pediatr. 2008;51(10):1065-1070. Published online October 15, 2008.

Delayed closure effect in preterm infants with patent ductus arteriosus

Hyun Ju HJ Lee¹, Gyu Hong GH Sim¹, Kyung Eun KE Jung¹, Jin A JA Lee¹, Chang Won CW Choi¹, Ee Kyung EK Kim¹, Han Suk HS Kim¹, Beyong Il BI Kim¹, Jung-Hwan JH Choi¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence Jung-Hwan JH Choi ,Email: neona@plaza.snu.ac.kr

Abstract

Purpose
: This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d).
Methods
: Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively.
Results
: The mean gestational age (GA) was 26¡¾2 weeks (range, 23-32 wk), and the birth weight was 782¡¾146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7¡¾1.7 wk vs. 27.1¡¾2.0 wk, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010)..
Conclusion
: Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.

Keywords :Patent ductus arteriosus, Prematurity, Indomethacin, Surgical procedures, Treatment