Abstract
Despite an increasing practice of ductal closure in the first 72h, neither the incidence of symptomatic PDA (sPDA) nor need for such aggressive therapy is clear. We have determined the incidence and onset of sPDA and related echocardiographic (ECHO) and clinical findings in a prospective study (6/1/79 to 4/30/80) of all inborn infants < 1500g BW surviving > 72h. The same physician examined all infants q 48h; sPDA was defined by criteria of Cotton,et.al. ECHOs at 7d were read blindly. sPDA occurred in 4/120 infants (3%) in the 1st week and only 19 infants total (16%), mean onset (± SD)=15 ± 3d. Ligation was required in 9 infants, 2 at <1 wk. sPDA group differed (p<.05) from others in mean BW (1034 vs 1188g), EGA (29 vs 31 wks), and early volume expanders (53 vs 22%) and vent, therapy (63 vs 37%), but not in fluid intake, Apgar, HMD, or NEC. On ECHO, LA/Ao, LVD/BW, and LA/BW were greater (p<.001) in infants later developing sPDA (1.43 ± 0.33, 13.7 ± 3.3, 8.26 ± 2.46) than those without sPDA (1.17 ± 0.25, 11.1 ± 2.1, 6.13 ± 1.31); however, the predictive value was limited, e.g., sensitivity of LA/Ao > 1.15 was 80% and specificity 50%, while LVD/BW > 12 was 67 and 75% and LA/BW > 6.0 was 73 and 49%, respectively. Values lower than these were ≥89% predictive for no sPDA after 7d. sPDA is not necessarily a common or early problem in infants <1500g. Although silent PDAs may alter the ECHO, indications and benefits of early closure remain to be determined by randomized studies.
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Furzan, J., Laird, W., Tyson, J. et al. 138 PROSPECTIVE ANALYSIS OF PATENT DUCTUS ARTERIO-SUS (PDA) IN INBORN INFANTS < 1500 GM. Pediatr Res 15 (Suppl 4), 462 (1981). https://doi.org/10.1203/00006450-198104001-00147
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DOI: https://doi.org/10.1203/00006450-198104001-00147