By Christian Poets, Petra Koehne, Axel Franz
The patent ductus arteriosus keeps to pose a substantial problem to clinicians and scientists alike. Why does it shut spontaneously in such a lot babies yet stay open in others? How top will we opt for these babies who're probably to profit from remedy, i.e. are there echocardiographic standards that might assist in defining a extra selective therapy procedure? wouldn't it be greater to take an competitive technique and prescribe prophylactic therapy to all tremendous immature babies ? and if that is so, what's the most sensible solution to outline this sort of subgroup? Or should still we be extra restrictive in defining remedy symptoms and undertake a 'wait and notice' coverage in such a lot, if no longer all, untimely babies? ultimately, are there information to signify that one of many remedy ways which are on hand to shut the patent ductus arteriosus is more desirable to the opposite? This e-book offers with those questions and attempts to offer a few solutions, according to the proof presently to be had. it really is meant for neonatologists, pediatric cardiologists and researchers.
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Additional info for Controversies Around Treatment of the Open Duct
4). No differences were found in perinatal and early and late morbidity data (. 5). The number of infants with therapy related oliguria (indomethacin 3 and ibuprofen 1) was small in both groups. PDA closure rates were alike 26 Chapter 2 · Treatment Results After Ductal Closure . 6. Neurodevelopmental results of infants after PDA intervention 2 Indomethacin (n=89) Ibuprofen (n=93) COX-inhibitor treatment failure (n=54) Survivors follow-up, n [%] 78 (88) 82 (88) 41 (76) Follow-up complete, n [%) 71 (91) 70 (85) 32 (78) Hearing threshold >35dB, n [%] 7 (10) 7 (10) 3 (9) EMPP 12 months >4, n [%| 12 (17) 9 (13) 9 (28) Griffiths‘ DQ 22 months 92 (84–97) 98 (88–105) 93 (90–97) Bayley MDI 24 months – 87 (72–98) 80 (49–87) Griffiths‘ 22 months <88 or Bayley 24 months <70, n [%] 23 (32) 15 (22) 7 (22) Free walking at 2 years, n [%] 67 (94) 67 (96) 30 (94) Composite poor outcome, n [%] 27 (38) 19 (28) 8 (25) Only data of infants with complete follow-up data are shown.
In the period where both test methods were used simultaneously, the outcome of 11 infants was equally categorized as either normal (7 infants) or poor (4 infants). The fact that all follow-up examinations were performed by the same examiners during the entire study period supports the reliability of our follow-up analysis despite the use of two different tests. 2 25 Impact of Patent Ductus Arteriosus Intervention . 5. ), n [%] 31 (35) 27 (29) 31 (68)* PVL, n [%] 7 (8) 6 (7) 6 (13) ROP > 2°, n [%] 9 (10) 5 (5) 9 (20)* NEC, n [%] 10 (11) 11 (12) 5 (10) Hospitalization days 89 (72–106) 76 (60–96) 101 (82–131)* COX-treatment failure, n [%] 24 (27) 30 (32) Median and quartiles are displayed, if not otherwise indicated.
7. 5 (6/54)b Tension pneumothorax 0 5 0 Pneumoperitoneum 0 1 0 Intraoperative bleeding 0 2 0 Pulmonary hemorrhage 0 1 0 Phrenic palsy 0 1 0 Wound infection 0 2 0 Clinical profile of infants before PDA intervention (upper part) and complications and adverse events after PDA intervention (lower part). Values are median (range) or numbers (%), abefore Indomethacin therapy, bbefore surgery. GA gestational age; CRIB critical risk index for babies; IVH intraventricular hemorrhage; NEC necrotizing enterocolitis.