Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress
Respiratory distress and patent ductus arteriosus (PDA) in neonates are mutually perpetuating. Contrary to the situation in premature infants, the recognition, clinical relevance and optimal management of PDA in full-term neonates are unclear. The present study aimed to identify PDA as a possible ca...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2010-06-01
|
| Series: | Pediatrics and Neonatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957210600307 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850204388788797440 |
|---|---|
| author | Yu-Chen Lin Hsuan-Rong Huang Reyin Lien Pen-Hong Yang Wen-Jen Su Hung-Tao Chung Te-Jen Chen Won-Hsiung Liu |
| author_facet | Yu-Chen Lin Hsuan-Rong Huang Reyin Lien Pen-Hong Yang Wen-Jen Su Hung-Tao Chung Te-Jen Chen Won-Hsiung Liu |
| author_sort | Yu-Chen Lin |
| collection | DOAJ |
| description | Respiratory distress and patent ductus arteriosus (PDA) in neonates are mutually perpetuating. Contrary to the situation in premature infants, the recognition, clinical relevance and optimal management of PDA in full-term neonates are unclear. The present study aimed to identify PDA as a possible cause of respiratory distress in term and near-term neonates, and to examine the clinical responsiveness of PDA to different treatment modalities in mature-gestational-age neonates.
Methods: Patients with gestational ages of over 34 weeks were included in this retrospective chart review; they had PDA as the sole recognizable cause of respiratory distress and were free of all other diseases. Clinical responsiveness to different regimens, including conservative treatment, drug therapy with preload reduction and inotropic agent with or without the addition of indomethacin, and surgical intervention were analyzed.
Results: Forty-four neonates qualified for this study. Six received no treatment and their cardiorespiratory symptoms resolved within 1 week (regimen A). Symptoms in 11 neonates were relieved after use of diuretic and inotropic agents (regimen B). Twelve neonates became asymptomatic without further intervention after indomethacin treatment in addition to preload reduction and inotropes (regimen C). A total of 15 of the 44 infants underwent PDA ligation (regimen D) due to persistent heart failure following regimens B or C, but had speedy resolution of respiratory symptoms following surgery. There were significant differences in birth body weight and hemodynamic variation based on left atrium to aortic root dimensional ratio between the treatment (regimens B, C and D) and non-treatment (regimen A) groups (p < 0.05).
Conclusion: PDA plays an important role in prolonging respiratory distress in term or near-term neonates. Although most infants respond to noninvasive medical treatment, surgical ligation during the neonatal period is warranted in certain mature infants. Surgical treatment should be considered in patients with smaller birth body weights and those with increased left atrium to aortic root dimensional ratios. |
| format | Article |
| id | doaj-art-a1559131eec14a748c1917c4bf1f01e7 |
| institution | OA Journals |
| issn | 1875-9572 |
| language | English |
| publishDate | 2010-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj-art-a1559131eec14a748c1917c4bf1f01e72025-08-20T02:11:18ZengElsevierPediatrics and Neonatology1875-95722010-06-0151316016510.1016/S1875-9572(10)60030-7Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory DistressYu-Chen Lin0Hsuan-Rong Huang1Reyin Lien2Pen-Hong Yang3Wen-Jen Su4Hung-Tao Chung5Te-Jen Chen6Won-Hsiung Liu7Department of Pediatrics, Chi Mei Medical Center, Liouying Campus, Tainan, TaiwanGraduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Pediatrics, Chi Mei Medical Center, Tainan, TaiwanDepartment of Pediatrics, Chi Mei Medical Center, Tainan, TaiwanRespiratory distress and patent ductus arteriosus (PDA) in neonates are mutually perpetuating. Contrary to the situation in premature infants, the recognition, clinical relevance and optimal management of PDA in full-term neonates are unclear. The present study aimed to identify PDA as a possible cause of respiratory distress in term and near-term neonates, and to examine the clinical responsiveness of PDA to different treatment modalities in mature-gestational-age neonates. Methods: Patients with gestational ages of over 34 weeks were included in this retrospective chart review; they had PDA as the sole recognizable cause of respiratory distress and were free of all other diseases. Clinical responsiveness to different regimens, including conservative treatment, drug therapy with preload reduction and inotropic agent with or without the addition of indomethacin, and surgical intervention were analyzed. Results: Forty-four neonates qualified for this study. Six received no treatment and their cardiorespiratory symptoms resolved within 1 week (regimen A). Symptoms in 11 neonates were relieved after use of diuretic and inotropic agents (regimen B). Twelve neonates became asymptomatic without further intervention after indomethacin treatment in addition to preload reduction and inotropes (regimen C). A total of 15 of the 44 infants underwent PDA ligation (regimen D) due to persistent heart failure following regimens B or C, but had speedy resolution of respiratory symptoms following surgery. There were significant differences in birth body weight and hemodynamic variation based on left atrium to aortic root dimensional ratio between the treatment (regimens B, C and D) and non-treatment (regimen A) groups (p < 0.05). Conclusion: PDA plays an important role in prolonging respiratory distress in term or near-term neonates. Although most infants respond to noninvasive medical treatment, surgical ligation during the neonatal period is warranted in certain mature infants. Surgical treatment should be considered in patients with smaller birth body weights and those with increased left atrium to aortic root dimensional ratios.http://www.sciencedirect.com/science/article/pii/S1875957210600307indomethacinligationpatent ductus arteriosusrespiratory distress |
| spellingShingle | Yu-Chen Lin Hsuan-Rong Huang Reyin Lien Pen-Hong Yang Wen-Jen Su Hung-Tao Chung Te-Jen Chen Won-Hsiung Liu Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress Pediatrics and Neonatology indomethacin ligation patent ductus arteriosus respiratory distress |
| title | Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress |
| title_full | Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress |
| title_fullStr | Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress |
| title_full_unstemmed | Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress |
| title_short | Management of Patent Ductus Arteriosus in Term or Near-term Neonates With Respiratory Distress |
| title_sort | management of patent ductus arteriosus in term or near term neonates with respiratory distress |
| topic | indomethacin ligation patent ductus arteriosus respiratory distress |
| url | http://www.sciencedirect.com/science/article/pii/S1875957210600307 |
| work_keys_str_mv | AT yuchenlin managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT hsuanronghuang managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT reyinlien managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT penhongyang managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT wenjensu managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT hungtaochung managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT tejenchen managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress AT wonhsiungliu managementofpatentductusarteriosusintermorneartermneonateswithrespiratorydistress |