Does primary surgical closure of the patent ductus arteriosus gestation reduce the incidence of necrotizing enterocolitis? (part 5)

15 Jul
2012

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 of the studies did not show a statistically significant difference in NEC outcome between the two groups. One study reported a higher incidence of the combined outcome of NEC and spontaneous intestinal perforation (SIP) in the indo-methacin treatment group. The fourth study, published in 1987, showed a statistically significant increase in NEC in the primary surgery group.In a retrospective study that used the database of a multicentre health care provider group (n=12,581), comparison was made among five groups: prophylactic indomethacin, indomethacin treatment, primary surgery, PDA without treatment and no PDA. There was no difference in the incidence of NEC across the groups, except for the comparison between the primary surgery and no PDA groups. Very cheap drugs at your disposal – cialis professional 20 mg to get best deals at best pharmacy.

Two other studies were pertinent to our review question. A study using regression models on data from the National Institute of Child Health and Human Development (n=2383) showed no difference in the adjusted risk of NEC (OR 1.22 [98.3% CI 0.67 to 2.24]) between the indomethacin treatment group and the primary surgery group; acknowledging that 13% of the surgery group was exposed to prophylactic indomethacin (LOE 2). Compared with indomethacin treatment, infants undergoing primary surgery were at increased risk of BPD (OR 2.19 [98.3% CI 1.16 to 4.15]) and borderline increased risk of neurodevelopmental impairment at 18 to 22 months of age (OR 1.79 [98.3% CI 0.998 to 3.21]). Chorne et al reviewed infants <28 weeks’ gestational age (GA) (n=446) from a single centre, who were all exposed to prophylactic indomethacin. Using multivariable regression analysis to investigate potential predictors of adverse outcomes, controlling for GA and neonatal morbidities, none of the treatment variables, including primary PDA ligation or indomethacin treatment, were predictive for development of NEC (LOE 2). The authors suggested that primary PDA ligation was associated with increased risk of chronic lung disease (CLD).

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