Background Preterm infants with a PDA are at risk for

Background Preterm infants with a PDA are at risk for Rabbit polyclonal to ADAM33. death or development of BPD. with the combined end result of death or BPD. Results Of 187 preterm infants with a PDA 75 were treated with indomethacin or surgery and 25% were managed conservatively. Death or BPD occurred in 80 (43%). Logistic regression found lower gestational age (OR 0.5) earlier year of birth during the study period (OR 0.9) and larger ductal diameter (OR 4.3) were associated with the decision to treat the PDA while gestational age was the only variable associated with death or BPD (OR 0.6 95 CI 0.5-0.8). Conclusion Only lower gestational age and not PDA treatment or ECHO score was associated with the adverse end result of death or BPD. Further investigation of PDA management strategies and effects on adverse outcomes of prematurity is needed. Introduction The ductus arteriosus closes within hours of birth in most term infants. AST-1306 However in 50-70% of preterm infants with birth excess weight <1500 grams the ductus remains patent (1). Preterm infants with a persistently significant patent ductus arteriosus (PDA) are at risk for complications including death and bronchopulmonary dysplasia (BPD) (2-5). An open ductus may contribute to the development of BPD by shunting blood into the lungs resulting in pulmonary edema and the persistent need for ventilatory support. This populace of preterm infants with a PDA would benefit from strategies to reduce complications and optimize outcomes. Historically clinicians have advocated closure of the PDA through medical treatment with indomethacin or ibuprofen and/or surgical ligation AST-1306 however recent controversy has developed over the need to treat a PDA. The ductus has a high incidence of spontaneous closure over time (6) and medical therapy may be ineffective in closing the PDA (7). Treatment is also not without risk of short and long-term complications (8-14). Moreover treatment of a prolonged PDA may not AST-1306 reduce the risk of common morbidities including BPD intraventricular hemorrhage or necrotizing enterocolitis (15 16 While an association may exist between the presence of a PDA and AST-1306 complications of prematurity such as death and BPD this association may not be causal given the possible lack of treatment effect. Conservative management of the PDA or “watchful waiting” has been advocated as another strategy in lieu of active treatment. This approach may entail use of fluid restriction and diuretics higher positive airway distending pressures inotropic support and liberal blood transfusions in order to minimize pulmonary edema from your left to right shunt and maintain adequate systemic oxygenation (17). The disadvantages to such an approach include delayed feeding and nutrition as well as delayed weaning from respiratory support while the PDA remains hemodynamically significant. In addition if a prolonged PDA does indeed contribute to adverse long-term complications like BPD and death then missing the windows of opportunity to treat a PDA by electing to manage conservatively could lead to adverse consequences for the infant. A randomized clinical trial of PDA treatment versus no treatment would be the ideal method to determine the benefit of treatment. However current neonatal clinical practice has until recently been biased towards treatment of the PDA making it difficult to maintain the equipoise needed for such a trial. We conducted a retrospective study to determine the effect of treatment on the outcome of death or BPD for preterm infants with a PDA and associations with clinical and echocardiographic (ECHO) factors. Methods Subjects Eligible infants were preterm infants with birth excess weight <1500 grams given birth to between 1/1/06-12/31/2010 and admitted to the Neonatal Intensive Care Unit (NICU) at Lucile Packard Children’s Hospital at Stanford with a diagnosis of a PDA by echocardiogram. Infants who were AST-1306 outborn or those with congenital heart disease or other congenital or chromosomal anomalies were excluded. Expedited approval without consent was obtained from the Stanford University or college Human Subjects in Medical Research Committee. Data Collection Clinical variables collected included gestational age birth excess weight Apgar scores oxygen requirement ventilatory support and radiographic findings. In addition information on the degree of apnea and bradycardia metabolic acidosis hypotension feeding intolerance and oliguria at the time of PDA diagnosis was collected. A clinical.