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Patent ductus arteriosus in preterm infants born before 30 weeks’ gestation: high rate of spontaneous closure after hospital discharge

Published online by Cambridge University Press:  29 June 2018

Vittorio Romagnoli Open the ORCID record for Vittorio Romagnoli [Opens in a new window] ,
Annalisa Pedini ,
Monica Santoni ,
Grazia Scutti ,
Massimo Colaneri ,
Marco Pozzi ,
Paola E. Cogo  and
Virgilio P. Carnielli
Vittorio Romagnoli*
Affiliation:
Department of Pediatrics, Presidio Ospedaliero G Salesi, Ancona, Marche, Italy
Annalisa Pedini
Affiliation:
Department of Pediatrics, Ospedale degli Infermi, Rimini, Emilia-Romagna, Italy
Monica Santoni
Affiliation:
Department of Neonatology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Marche, Italy
Grazia Scutti
Affiliation:
Department of Neonatology, Presidio Ospedaliero G Salesi, Ancona, Marche, Italy
Massimo Colaneri
Affiliation:
Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
Marco Pozzi
Affiliation:
Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
Paola E. Cogo
Affiliation:
Department of Pediatrics, Università degli Studi di Udine Polo Medico Medicina e Chirurgia, Udine, Friuli-Venezia Giulia, Italy
Virgilio P. Carnielli
Affiliation:
Department of Neonatology, Università Politecnica delle Marche, Ancona, Marche, Italy
*
Author for correspondence: V. Romagnoli, MD, Department of Pediatrics, Presidio Ospedaliero G Salesi, Via Corridoni, 11, 60123, Ancona, Marche, Italy. Tel: +39 71 596 2234; Fax: +39 71 596 2530; E-mail: [email protected]
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Abstract

Aim

The aim of this study was to determine the spontaneous closure rate of patent ductus arteriosus at a 2-year follow-up, following failed medical therapy and beyond initial hospital discharge, and to evaluate in-hospital spontaneous or pharmacological closure rates.

Materials and methods

A retrospective evaluation was conducted in a cohort of preterm infants admitted to the Neonatal ICU of Ancona between January, 2004 and June, 2013. Inclusion criteria were gestational age between 24+0 and 29+6 weeks or birth weight <1250 g; admission within 48 hours from birth; and discharge alive from hospital. All infants received routine heart ultrasound between 48 and 72 hours of life. Haemodynamically significant patent ductus arteriosus was defined as a duct diameter >1.5 mm, a left atrium-to-aorta ratio >1.4, and/or reversal of end-diastolic flow in the aorta >30% of the anterograde. First-line treatment was intravenous ibuprofen. Intravenous indomethacin was used if ibuprofen failed. Surgical ligation was considered in haemodynamically significant patent ductus arteriosus after medical treatment.

Results

A total of 593 infants met the inclusion criteria, and patent ductus arteriosus was diagnosed in 317 (53.4%). Among them, 283 (89.3%) infants had haemodynamically significant patent ductus arteriosus, with pharmacological closure achieved in 228 (80.6%) infants and surgical ligation performed in 20 (7.1%). Follow-up at 24 months was available for 39 (81.3%) of 48 infants with patent ductus arteriosus at the hospital discharge: 36 (92.3%) underwent spontaneous closure, two (5.1%) underwent surgical ligation, and one (2.6%) had a patent ductus arteriosus.

Discussion

A significant number of patent ductus arteriosus that fail pharmacological closure undergo spontaneous closure by the age of 2 years. This information should be taken into account when considering surgery or additional attempts of pharmacological closure.

Keywords

Patent ductus arteriosusspontaneous closurevery preterm infants
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 8 , August 2018 , pp. 995 - 1000
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Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Romagnoli V, Pedini A, Santoni M, Scutti G, Colaneri M, Pozzi M, Cogo PE, Carnielli VP. (2018) Patent ductus arteriosus in preterm infants born before 30 weeks’ gestation: high rate of spontaneous closure after hospital discharge. Cardiology in the Young28: 995–1000. doi: 10.1017/S1047951118000641

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