摘要
Background: Surgical ligation of patent ductus arteriosus (PDA) is widely prac tised in preterm infants despite no clear evidence that this improves outcomes. Geographical isolation meant that ductal ligation was not an option in King Edwa rd Memorial Hospital until recently. Objective: A retrospective data analysis to test the hypothesis that outcomes of infants with persistent PDA were no worse than those of infants with no significant duct or a duct that closed after medic al treatment. Patients and Methods: A total of 252 infants (gestation ≤28 weeks ) born between 1 January 2000 and 30 June 2002 were divided into three groups: g roup 1, no significant PDA (n = 154); group 2, significant PDA which closed afte r medical treatment (n = 65); group 3, significant PDA remaining patent after me dical treatment (n = 33). A significant PDA was de-fined by a left atrium to ao rtic root ratio of >1.4 or a ductal diameter >1.5 mm with a left to right shunt. Results: Twenty four (10%) infants died at median (interquartile range) 15.5 ( 9-35) days. After adjustment for gestational age, relative to group 1, the infa nts from group 3 were at a 4.02 times increased risk of death (95%confidence in terval 1.12 to 14.51). There was no significant difference between groups in the incidence of chronic lung disease, chronic lung disease or death, necrotising e nterocolitis, intraventricular haemorrhage, duration of oxygen, or hospital stay . Conclusion: Mortality was higher in infants with a persistent PDA, but other m orbidities were not significantly different. A randomised trial is needed to det ermine whether surgical ligation will reduce mortality in such infants.
Background: Surgical ligation of patent ductus arteriosus (PDA) is widely prac tised in preterm infants despite no clear evidence that this improves outcomes. Geographical isolation meant that ductal ligation was not an option in King Edwa rd Memorial Hospital until recently. Objective: A retrospective data analysis to test the hypothesis that outcomes of infants with persistent PDA were no worse than those of infants with no significant duct or a duct that closed after medic al treatment. Patients and Methods: A total of 252 infants (gestation ≤28 weeks ) born between 1 January 2000 and 30 June 2002 were divided into three groups: g roup 1, no significant PDA (n = 154); group 2, significant PDA which closed afte r medical treatment (n = 65); group 3, significant PDA remaining patent after me dical treatment (n = 33). A significant PDA was de-fined by a left atrium to ao rtic root ratio of >1.4 or a ductal diameter >1.5 mm with a left to right shunt. Results: Twenty four (10%) infants died at median (interquartile range) 15.5 ( 9-35) days. After adjustment for gestational age, relative to group 1, the infa nts from group 3 were at a 4.02 times increased risk of death (95%confidence in terval 1.12 to 14.51). There was no significant difference between groups in the incidence of chronic lung disease, chronic lung disease or death, necrotising e nterocolitis, intraventricular haemorrhage, duration of oxygen, or hospital stay . Conclusion: Mortality was higher in infants with a persistent PDA, but other m orbidities were not significantly different. A randomised trial is needed to det ermine whether surgical ligation will reduce mortality in such infants.
