Does primary surgical closure of the patent ductus arteriosus gestation reduce the incidence of necrotizing enterocolitis? (part 4)

14 Jul

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), yearStudy designStudy patientsProphylacticindomethacinMedical treatment NEC, n/NIndomethacin NEC, n/NPrimary surgery NEC, n/NSurgery after indomethacin NEC, n/Nloe *
Alexander et al (12), 2009tSingle centre retrospective 1996-2005<1000 g N=298No21/140(15%)3/46(7%)t3/58(6%)2(S)Q-fair
Hwang et al (13), 2005*Single centre retrospective 1999-2002<1000 g N=57No0/16(0%)2/19(10.5%)0/14(0%)*1/8(12.5%)2(N)Q-fair
Koehne et al (14), 2001Single centre retrospective 1989-1998<1500 g N=56No5/67(7%)1/55(2%)§2/34(6%)2(N)Q-fair
O’Donovan et al (15), 2003Single centre retrospective 1995-1998<1500 g N=224No14/108(13%)7/50(14%)8/66(12%)2(N)Q-good
Palder et al (16), 1987Two centreretrospective1981-1986<1500 g N=183No6/76(8%)22/107(21%)2(O)Q-poor
Laughon et al (17), 2007Multicentredatabaseretrospective1997-200423-30 weeks N=12,581Yes576/6189(10%)271/3886(7%)458/5690(8%)s ^ 8 (1No 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.