Yukako Yoshikane1, Toshiko Mori2, Toshiyuki Yoshizato2, Yoshihiro Miyake3, Shinichi Hirose4. 1. Department of Pediatrics, Faculty of Medicine, Fukuoka University, 45-1-7 Nanakuma, Jonan, Fukuoka, 814-0180, Japan. yyoshika@fukuoka-u.ac.jp. 2. Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan. 3. Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 4. Department of Pediatrics, Faculty of Medicine, Fukuoka University, 45-1-7 Nanakuma, Jonan, Fukuoka, 814-0180, Japan.
Abstract
PURPOSE: To identify risk factors related to the failure of indomethacin therapy and the need for surgical repair in patent ductus arteriosus (PDA) in extremely low-birth-weight (<1000 g) infants (ELBWI). METHODS: Study subjects were 36 ELBWI with PDA born at a single tertiary perinatal center. They were classified into those who required surgery due to failure of indomethacin treatment (surgical group, n = 21) and those with effective indomethacin treatment (non-surgical group, n = 15). The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the relationship between selected risk factors and surgical treatment of PDA were calculated. RESULTS: Gestational age of <28 weeks and diameter of PDA of 2 mm or more were independent and significant determinants of the need for surgical repair of PDA (adjusted ORs [95% CIs] = 9.91 [1.16-84.48] and 24.80 [2.72-225.74], respectively). The need for surgical repair of PDA did not correlate with sex, birth weight, 1-min Apgar score, left atrium diameter/aortic diameter (LA/Ao), left ventricular internal dimension at end-diastole, prophylaxes with indomethacin, and total dosage of indomethacin. CONCLUSIONS: Gestational age at birth of <28 weeks and diameter of PDA of 2 mm or more are determinants of failure of indomethacin treatment for PDA and the need for surgical repair.
PURPOSE: To identify risk factors related to the failure of indomethacin therapy and the need for surgical repair in patent ductus arteriosus (PDA) in extremely low-birth-weight (<1000 g) infants (ELBWI). METHODS: Study subjects were 36 ELBWI with PDA born at a single tertiary perinatal center. They were classified into those who required surgery due to failure of indomethacin treatment (surgical group, n = 21) and those with effective indomethacin treatment (non-surgical group, n = 15). The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the relationship between selected risk factors and surgical treatment of PDA were calculated. RESULTS: Gestational age of <28 weeks and diameter of PDA of 2 mm or more were independent and significant determinants of the need for surgical repair of PDA (adjusted ORs [95% CIs] = 9.91 [1.16-84.48] and 24.80 [2.72-225.74], respectively). The need for surgical repair of PDA did not correlate with sex, birth weight, 1-min Apgar score, left atrium diameter/aortic diameter (LA/Ao), left ventricular internal dimension at end-diastole, prophylaxes with indomethacin, and total dosage of indomethacin. CONCLUSIONS: Gestational age at birth of <28 weeks and diameter of PDA of 2 mm or more are determinants of failure of indomethacin treatment for PDA and the need for surgical repair.
Authors: Christopher L Shaffer; Peter Gal; J Laurence Ransom; Rita Q Carlos; McCrae S Smith; Andrew M Davey; Mary Ann V T Dimaguila; Yvonne L Brown; Stewart A Schall Journal: Crit Care Med Date: 2002-02 Impact factor: 7.598