Therapeutic strategies, including a high surgical ligation rate

19 Jul
2012

Therapeutic strategies, including a high surgical ligation rate

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre. The increasing number of preterm infants has resulted in the persistent patent ductus arteriosus (PDA) being the most common cardiac diagnosis in the neonatal period, including up to 80% of infants with a birthweight <1200 g. The presence of a PDA in a preterm infant is associated with necrotizing enterocolitis (NEC), intraventricular hemorrhage and chronic lung disease (CLD), and if left untreated, may be associated with an increase in mortality . Despite these associations, medical treatment and surgical ligation of the PDA do not reduce the incidence of NEC or CLD. There remains much debate in the literature concerning the pathophysiological consequences of the PDA and indications for treatment, particularly in the most premature infants. Recent reports indicate that some clinicians are choosing not to treat a PDA. In the NICUs at the
Ottawa Hospital General Campus and Children’s Hospital of Eastern Ontario, the usual first-line treatment for a hemodynamic-ally significant PDA is indomethacin. If the PDA fails to close, a second course of indomethacin, surgical ligation, or a ‘watch and wait’ approach is chosen, depending on the clinical scenario and preference of the attending physician. There is no clear answer in the literature as to which option is best.

We suspect that in many centres a high percentage of these extremely premature infants, regardless of the quantity of indo-methacin given, eventually undergo a PDA ligation. We believed that, in our centre, a majority of 23 weeks +0 days (23+0) to 26 weeks+6 days’ gestational age infants receiving more than one course of indomethacin received ligation. We hypothesized that those receiving ligation, particularly after repeated indomethacin courses, would have worse clinical outcomes than those receiving only indomethacin. Shop online with the best pharmacy that will ensure high quality of your medications and will offer cheapest cialis professional online cialis professional 20 mg with no rx required any time you need this or any other one for your medical problem.

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