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CLINICAL FEATURES AND MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN PRETERM INFANTS BORN ≤ 28 WEEKS AT THE NEONATAL INTENSIVE CARE UNIT OF CHILDREN’S HOSPITAL 2
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Abstract
Introduction: Patent ductus arteriosus (PDA) is common in infants. The higher rate of PDA leads to a higher risk of mortality and morbidity in extremely preterm infants. Currently, there is a lack of consensus on diagnosis and treatment in prematurity. The study was conducted to provide information on PDA incidence, the current status of therapeutic strategies for PDA in preterm ≤28 weeks in the Neonatal intensive care unit of Children's Hospital 2. Method: Prospectively follow-up study. Preterm ≤28 weeks admitted from October 1, 2021 to March 31, 2022 had an echocardiogram to screen for PDA. Symptomatic hsPDA (hemodynamically significant PDA on ultrasound) is treated with a drug (intravenous Paracetamol or oral Ibuprofen) or ligation when indicated. Mortality, and serious complications (necrotizing enterocolitis, cerebral hemorrhage, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD) were reported. Results: There were 33 children included, the hsPDA incidence was 26/33 (78.7%). At the time when echocardiography done at 48-72 hours of age, day 4 and week 2, the incidence of hsPDA needed pharmacological intervention was 80%, 100%, and 66.6%, respectively. Conservative management accounted for 4/26 (15.4%) hsPDA, while 19/26 (82.6%) hsPDA needed pharmacological therapy, of which 18 were treated with intravenous Paracetamol, 1 was treated with oral Ibuprofen. Paracetamol showed efficacy in 12/18 (66.67%) for PDA closure. There were no differences in mortality and serious complications between conservative and interventional management. Conclusions: hs-PDA is present in more than ¾ of extremely preterm infants ≤28 weeks. Echocardiography after 48 hours of age may increase the ability to detect hsPDA required pharmacological treatment. PDA closure could be achieved with conservative treatment, accounting for 15%. For pharmacological intervention, intravenous Paracetamol is an effective and safe option in the closure of PDA.
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Keywords
preterm, patent ductus arteriosus, PDA, IV paracetamol, conservative management.
References
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