Conservative treatment for patent ductus arteriosus in the preterm.

Abstract

Background: Patent ductus arteriosus (PDA) remains common among preterms. Prophylactic medical treatment has been advocated as first-line approach. Conservative treatment may result in equal outcome, without exposition to harmful side-effects.

We retrospectively observed a ductal closure rate of 94 % after conservative treatment with adapting ventilation (lowering inspiratory time and giving more positive end expiratory pressure) and fluid restriction.

Objective: To study prospectively during one year the PDA closure rate, morbidity and mortality following conservative treatment.

Study design:In a prospective study from January 1st 2005 till December 31st 2005, thirty newborns ¡Ü 30 weeks¡¯ gestation were included, all ventilated and requiring surfactant. Echocardiography was performed 48-72 hours after birth. Clinically significant PDA was conservatively treated as described above. Percentage of children with PDA, ductal ligation and major complications were determined.

Results: Ten neonates (33 %) developed a clinical significant PDA. Following conservative treatment ductus closed in all neonates (100%). None required ductal ligation or medical treatment. No higher rates of major complications as compared to Vermont Oxford network and literature.

Conclusion: 72 % of our preterm newborns did not develop symptomatic PDA. Early conservative treatment of clinically significant PDA resulted in ductal closure in 94%, which is similar to the rate reported with medical treatment (90%). Prophylactic treatment would have exposed these babies (94%) unnecessarily to medication. Applying our managed care plan prospectively resulted in an overall ductal closure rate of 100 %, postulating that conservative treatment of PDA is a worthy alternative to prophylactic medical treatment.