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Fluid regimens and the risk of patent ductus arteriosus in extremely low birth weight infants

Journal of Perinatology volume 28, pages 652–653 (2008)Cite this article

I read with interest the study by Stephens et al.1 assessing the influence of fluid regimens in the first week of life on patent ductus arteriosus (PDA) in infants ⩽1250 g birth weight and ⩽32 weeks gestational age. The authors conclude, after controlling for gestational age and illness severity, that high fluid intake on days 2 and 3 of life is a significant predictor of PDA, with fluid intake above 170 ml kg−1 day−1 on day 3 of life associated with increased risk of PDA among infants ⩽1250 g. I have a few questions and comments to add regarding this study.

In the Methods, the authors note that all infants in this cohort received prophylactic indomethacin and 10% of infants developed PDA.1 In comparison to other studies, this PDA incidence seems quite low. The incidence of a symptomatic PDA among extremely low birth weight (ELBW) infants is reported to be 55 to 70%.2 A large multicenter randomized control trial (TIPP trial) of infants <1000 g birth weight showed that indomethacin prophylaxis reduced the incidence of symptomatic PDA from 50% (placebo) to 24%.3 The low PDA incidence in the study by Stephens et al.1 may have been secondary to indomethacin prophylaxis and/or because they only included infants that survived to discharge, which might limit the ability to generalize their findings to initial fluid management. Also, indomethacin treatment may have modified the infants' tolerance to different fluid management strategies by decreasing the impact of an open ductus arteriosus in relation to morbidity outcomes. In their study, it cannot be deciphered whether PDA affected fluid management or fluid management affected PDA. Therefore, their results may not be applicable to infants that did not get prophylactic indomethacin.

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References

  1. Stephens BE, Gargus RA, Walden RV, Mance M, Nye J, McKinley L et al. Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 2008; 28: 123–128.

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  2. Hermes-DeSantis ER, Clyman RI . Patent ductus arteriosus: pathophysiology and management. J Perinatol 2006; 26: S14–S18.

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  3. Schmidt B, Davis P, Modemann D, Ohlsson A, Roberts RS, Saigal S et al. Long-term effects of indomethacin prophylaxis in extremely-low-birthweight infants. N Engl J Med 2001; 344: 1966–1972.

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  4. Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR . Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117: 1113–1121.

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  1. Department of Neonatology, US Naval Hospital Okinawa and 18th Medical Group, Kadena Air Base, Japan

    R M McAdams

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  1. R M McAdams
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Correspondence to R M McAdams.

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The opinions expressed in this paper are solely those of the authors and do not represent the views of the United States Air Force, United States Navy, Department of Defense or the United States Government.

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McAdams, R. Fluid regimens and the risk of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 28, 652–653 (2008). https://doi.org/10.1038/jp.2008.79

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