Does primary surgical closure of the patent ductus arteriosus gestation reduce the incidence of necrotizing enterocolitis? (part 7)

17 Jul
2012

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 significant higher incidence of the combined outcome of NEC and SIP in the indomethacin group, compared with the primary surgery group.

The study also reported, in the surgical group, an overall reduced risk of the combined complications of NEC/SIP, IVH, thrombocytopenia and acute renal failure, thus favouring primary surgical ligation. Conversely, Laughon et al reported that IVH, retinopathy of prematurity,CLD and mortality were ‘most common’ among the primary surgery group, who were smaller and less mature. Take advantage of this opportunity – buy levaquin 500 mg only here to enjoy lowest prices online.

The recurrent confounders in these studies were that patients selected for primary PDA surgery were of lower BW and younger GA, and had higher incidence of pretreatment IVH. The hemodynamic significance of the PDA was not quantified, a confounder that could be addressed in future studies. Inclusion of NEC and SIP in some of the studies may have resulted in misclassification bias in the NEC outcome.

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