Short-Term Outcome Of Different Treatment Modalities Of Patent Ductus Arteriosus In Preterm Infants. Five Years Experiences In Qatar

Abstract

Background: The incidence of patent ductus arteriosus (PDA) ranges from 40 to 60 percent in infants born before 28 weeksgestation. In recent years, there has been growing debate regarding the need to treat PDA during the neonatal period. Objective: To study the short-term outcome of PDA treated with different treatment modalities in preterm infants of = 32 weeks gestational age. Methods : This study is a descriptive retrospective chart review conducted at NICU Womens Hospital, Hamad Medical Corporation, State of Qatar. The files of all infants born in the hospital with a gestational age of = 32 weeks and a diagnosis of PDA over a five-year period, January 2003 to December 2007 were reviewed. Results: For the five-year period, a total of 82 cases of PDA were diagnosed in infants of = 32 weeksgestational age. Pharmaceutical intervention was used in 63/82 infants (76%), 20/82 infants (24%) required surgical ligation after failed medication, while the PDA in 32 infants (39%) closed spontaneously. Medication was successful in only 30/63 cases (47%). Large PDA significantly increased the mortality, IVH, and ROP (P value 0.002-0.003). However, PDA size had no protective effect on BPD or NEC (P value 0.54, 0.06, respectively). Infants who received medication or surgery experienced no significant difference in all adverse outcomes except for ROP, which had a P value of 0.003. Preterm infants =32 weeks who had spontaneous closure of their PDA experienced a lower rate of CLD, ROP, NEC and IVH (p<0.001-0.045). Conclusion: The results suggest that conservative treatment of PDA is the first-choice approach before resorting to medical and surgical treatment.