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 secondary surgery. These observational studies were within single centres or two centres (Table 1).
TABLE 1 Retrospective observational studies comparing outcome of necrotizing enterocolitis (NEC) among groups treated for patent ductus arteriosus (PDA)
|Author (reference), year||Study design||Study patients||Prophylacticindomethacin||Medical treatment NEC, n/N||Indomethacin NEC, n/N||Primary surgery NEC, n/N||Surgery after indomethacin NEC, n/N||loe *|
|Alexander et al (12), 2009t||Single centre retrospective 1996-2005||<1000 g N=298||No||21/140(15%)||3/46(7%)t||3/58(6%)||2(S)Q-fair|
|Hwang et al (13), 2005*||Single centre retrospective 1999-2002||<1000 g N=57||No||0/16(0%)||2/19(10.5%)||0/14(0%)*||1/8(12.5%)||2(N)Q-fair|
|Koehne et al (14), 2001||Single centre retrospective 1989-1998||<1500 g N=56||No||5/67(7%)||1/55(2%)§||2/34(6%)||2(N)Q-fair|
|O’Donovan et al (15), 2003||Single centre retrospective 1995-1998||<1500 g N=224||No||14/108(13%)||7/50(14%)||8/66(12%)||2(N)Q-good|
|Palder et al (16), 1987||Two centreretrospective1981-1986||<1500 g N=183||No||6/76(8%)||22/107(21%)||2(O)Q-poor|
|Laughon et al (17), 2007||Multicentredatabaseretrospective1997-2004||23-30 weeks N=12,581||Yes576/6189(10%)||271/3886(7%)||458/5690(8%)||s ^ 8 (1||No PDA 826/1836(5%)||2(N)Q-fair|
*Letters in parentheses under level of evidence (LOE): N Neutral to intervention; O Oppose intervention; S Support intervention; fLower gestation, lower birthweight, higher rate pretreatmentintraventricular hemorrhage (IVH); Alexander et al (2009) identified spontaneous intestinal perforation (SIP) and NEC as combined outcome tLower birthweight, higher rate renal dysfunction before surgery; O’Donovan (2003) identified SIP separately and reported similar incidence across groups, other studies did not differentiate between the two outcomes; §Lower gestation, lower birthweight, higher rate pre-treatmentIVH; HPatients almost exclusively <27 weeks’ gestation, higher rate of mortality, IVH, retinopathy of prematurity and chronic lung disease; Q Quality Most reliable pharmacy offering efficient medicationslike cheapalesseclick here is ready to offer its services and all the help you need. Your health is precious, and so are you: as customer, person and patient, no matter which kind oftreatment you are looking for.