| Resum: |
Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation. Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared. This study included 188 patients (27 ± 2 weeks, 973 ± 272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85. 7% P1 versus 56% P2, p < 0. 001) and surgical closure (34. 5% P1 versus 16. 1% P2, p < 0. 001) were observed. No differences were found in chronic lung disease (28. 8% versus 13. 9%, p = 0. 056), severe retinopathy of prematurity (7. 5% versus 11. 8%, p = 0. 403), necrotizing enterocolitis (15. 5% versus 6. 9%, p = 0. 071), severe intraventricular hemorrhage (25. 4% versus 18. 4%, p = 0. 264), mortality (17. 5% versus 15. 2%, p = 0. 690) or survival-without-morbidity adjusted OR = 1. 10 (95% CI: 0. 55-2. 22); p = 0. 783. In P2, 24. 5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n = 82) showed significant differences: lower incidence of chronic lung disease (50% versus 19. 6%, p = 0. 019) and more survival-without-morbidity (20% versus 45. 6%, p = 0. 028) were found. A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated. |
visitant ::
identificació
(Hospital Clínic i Provincial de Barcelona)
