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May 24, 2009 11:00 AM
by: Piya Samankatiwat
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ATS May 2009: Is there an optimal timing for surgical ligation of patent...
Posted:
Apr 28, 2009 9:19 AM
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[nobr]ATS May 2009: Vida VL, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg 2009;87: 1509-15.
In the May 2009 Annals, Vida et al (representing a very experienced cardiac team at the University of Padua) attempt to define the variables associated with hospital outcome in preterm infants with patent ductus arteriosus (PDA), and determine the optimal timing for PDA closure. Included were 201 babies < or = 32 weeks gestational age (2001-2007) with PDA who received primary medical treatment with ibuprofen. Number of ibuprofen cycles, gestational age, body weight, and presence of symptomatic hypotension requiring vasoactive/inotropic drugs were related to hospital outcome, including hospital mortality, presence of necrotizing enterocolitis, acute renal failure, intraventricular hemorrhage, retinopathy and bronchopulmonary dysplasia at week 36. Medical treatment was effective in 75%, and 25% eventually required surgical ligation. The latter group had younger gestational age lower birth weight, and a higher incidence of hypotension as compared to ibuprofen responders. Use of more than two cycles of ibuprofen was significantly associated with an increased risk for bronchopulmonary dysplasia and acute renal failure. The authors concluded that prolonged patency of the ductus arteriosus in preterm infants is related to an increased morbidity, and that surgical ligation is a safe and effective treatment and should be done soon after two complete cycles of ibuprofen to improve clinical outcome.
This paper summarizes a well documented clinical experience, making a reasonable case for early or perhaps primary use of surgery for PDA closure in premature infants. The practice worldwide varies enormously and the standard of care is not well defined.
Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/87/5/1509 and add you own comments and experience in the Dilemmas in Pediatric Discussion Forum. Experience supporting or refuting what has been presented by Vida et al would be of value.
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Re: ATS May 2009: Is there an optimal timing for surgical ligation of paten
Posted:
May 24, 2009 11:00 AM
in response to: Tom Karl
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Dear Tom
It's me, Piya, Dr Sam's colleague from Thailand. Many thanks for the forum. I have my personal experience together with unpublished data from my hospital concerning the ductal closure in premature babies. We have experience that only 40% of very low birth weight premature newborn responding to ibuprofen. Therefore we proceed to the surgical closure of the ductus as soon as possible. We strongly agree with the authors to do the operation if the patients do not respond to the regimen.
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