All of these factors likely contribute to the disparate results of the studies. The database studies, with larger numbers of patients, were not able to demonstrate an advantage to primary surgery of the PDA compared with indomethacin treatment. There was insufficient information in these studies to review and make any comments on a relationship between […]
One study identified SIP separately and reported an incidence of approximately 3% across groups. Another study, reported an intestinal perforation incidence of 1% in patients without PDA and 3% in indomethacin-treated patients, compared with 6% in patients undergoing primary ligaton. Other studies did not differentiate between these two outcomes. Only one study reported a statistically […]
Quality of the studies The prophylactic surgery study had very high mortality, approximately 60% in both study groups, reflective of outcomes in the presurfactant era. Also, the 30% incidence of NEC in the control group was higher than reported in current populations.
One study reported a statistically nonsignificant trend toward less NEC in the primary surgery group compared with a medical treatment group and an indomethacin treatment group. There were only three cases of NEC in this small sample (n=57), an incidence of 5.2%. Four studies reported comparison between two groups: indomethacin treatment and primary surgery. Two […]
Five studies (n=918) used indomethacin as first-line treatmentor after failed medical therapy. Within each of these studies, there was a group of infants who underwent primary surgery (without any prior exposure to indomethacin) for a clinically and echocardiogram-identified PDA, allowing for comparison with an indomethacin treated group. Most studies also described a group treated with […]
RESULTS The process for selection of the studies is outlined in Figure 1. Two studies were published before 1990, all other studies were published between 2001 and 2009. A single-centre RCT (LOE 1) published in 1989 addressed prophylactic surgical ligation of the PDA . Subjects with BW <1000 g were randomly assigned to prophylactic surgical […]
Databases searched were Ovid Medline 1950 – 2011, Scopus 1997 – 2009, Web of Science 1997 – 2009, Embase 1987 – 2008, PubMed 1975 – 2011, CINAHL 1996 – 2011, Central Register of Controlled Trials Cochrane 1st Quarter 2011 and Cochrane Database of Systematic Reviews 1st Quarter 2011. The authors reviewed the abstracts of all […]