Abstract
The management of very small premature infants with cardio-respiratory failure (CRF) associated with a patent ductus arteriosus (PDA) remains controversial. Nineteen premies averaging a weight of 1204±67 grams and a gestational age of 30.6±0.5 weeks were included in the study. All patients were in CRF requiring mechanical ventilation and had clinical evidence of a hemodynamically significant left to right ductal shunt. All patients were treated initially for 48 hours with digitalis, diuretics and fluid restriction. Four patients(21%) responded well and required no further treatment. Seven patients underwent surgical closure of the PDA. Two of those patients died later on with severe lung disease. Eight patients were treated with oral Indomethacin(I) at 0.1 to 0.2mg/kg q 8 hs(3 doses). Five of those patients (62%) responded well and were extubated. Two patients(25%) did not respond to (I) and required surgical closure of the PDA. One patient showed signs of PDA closure following (I) but expired later with severe lung disease. These preliminary results suggest that a trial of medical therapy with digitalis, diuretics and fluid restriction is justified in all premies under 1500 grams with CRF and PDA for a period of 48 hours. If no improvement occurs, a course of oral (I) may be helpful. Surgical PDA closure should be reserved for patients not responding to the deconaestive and Indomethacin treatments.
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Truccone, N., Cepeda, I., Green, E. et al. 165 MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN PREMIES WEIGHING LESS THAN 1500 GRAMS. Pediatr Res 12 (Suppl 4), 391 (1978). https://doi.org/10.1203/00006450-197804001-00170
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DOI: https://doi.org/10.1203/00006450-197804001-00170