Patent ductus arteriosus in premature infants: to treat or not to treat?

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OBJECTIVE:Closing patent ductus arteriosus (PDA) is a widely accepted approach in the management of very low birth weight (VLBW) infants. Our objective is to test the hypothesis that conservative management (no treatment) of PDA will not affect survival without chronic lung diseases (CLD).STUDY DESIGN:This retrospective study utilizes a prospectively collected database to compare two cohorts of VLBW infants. Infants in the first group (2001 to 2009) had their PDA treated with pharmacological and if necessary with surgical ligation. PDA in the second group (2010 to 2014) was not treated with medical or surgical intervention. The primary outcome was survival without oxygen requirement at 36 weeks. Pulmonary and non-pulmonary morbidities were also compared. Logistic regression analyses were performed to control for confounders.RESULTS:This study included 643 VLBW infants, of them 415 infants in the Treat group and 228 in the No-Treat group. The rate of survival without CLD did not differ between Treat and No-Treat groups (78.4% vs 83.9%, respectively; adjusted odds ratio (aOR) = 1.72, confidence interval (CI): 0.92 to 3.23, P = 0.09). Mortality declined in No-Treat group (15.2% vs 10.5%, aOR = 0.51, CI: 0.25 to 0.99, P = 0.049), but the two groups did not differ in the incidence of CLD among survivors (5.8% vs 5.0%, P=0.47). Pulmonary complications and non-pulmonary morbidities did not differ between groups.CONCLUSIONS:Conservative management (no treatment) of PDA may not compromise survival without CLD and is not associated with increased morbidities in VLBW infants. Prospective physiological studies are needed to determine the sector of VLBW infants, if any, who could benefit from PDA treatment.

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