A Major Cause of Mortality and Morbidity of Very Low Birth Weight Infants: Patent Ductus Arteriosus/Cok Dusuk Dogum Agirlikli Bebeklerde Major Mortalite ve Morbidite Nedeni; Patent Duktus Arteriozus

• Published in: Güncel pediatri Vol. 10; no. 1; p. 8
• Main Authors: Aygun, Fatih, Koksal, Nilgun, Bostan, Ozlem M, Uysal, Fahrettin, Varal, Ipek Guney, Dogan, Pelin
• Format: Journal Article
• Language: Turkish
• Published: Galenos Yayinevi Tic. Ltd 01.04.2012
• Subjects: Health aspects; Infants; Infants (Premature); Patent ductus arteriosus; Patient outcomes; Pediatric research; Statistics; Turkey
• ISSN: 1304-9054

Introduction: Patent Ductus Arteriosus (PDA), a cardiac pathology commonly seen in preterm infants, has negative effects on mortality and morbidity. Persistent patency of PDA is positively correlated with respiratory distress syndrome (RDS), prolonged respiratory support, pulmonary hemorrhage, broncopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage, renal failure, neurodevelopmental impairment (cerebral palsy), retinopathy of prematurity and death. The standard treatment regimen is to close symptomatic PDA and cyclooxygenase inhibitors such as indomethacin, ibuprofen are the first choises. Our aim in this study is to report PDA rate, treatment and complications in premature infants. Materials and Methods: This study retrospectively enrolled 103 infants born <33 gestational weeks, without any major congenital anomaly or congenital heart defects between January 2010-November 2011. Echocardiograms was performed in the first week. PDA related pulmonary hemorrhage, NEC, BPD, ROP and death were demonstrated. Results: Among of 103 infants, 45 were male and 58 were female. Seventy infants were born with cesarian section and 33 were born with normal labor. The mean gestational week was 29.7 [+ or -] 2.2, the mean gestational week of infants with PDA was 28.8 [+ or -] 2.3. The mean birth weight of infants was 1323 [+ or -] 375 grams. The mean Apgar score was 7.25 [+ or -] 1.83, the scores of infants with patent ductus arteriosus were significantly low (6.7 [+ or -] 1.9). Echocardiography was performed on the mean of 4.8 [+ or -] 4.4 days, PDA was determined in 48 of 103 infants (%46). The mean of birth weight of infants with persistant PDA was 1162 [+ or -] 351 grams, it was 1465 [+ or -] 340 g in the closed group. The rate of pulmonary hemorrhage, NEC, BPD, ROP and death was significantly higher in infants with PDA compared with infants having ductal closure (p<0.05). Conclusion: The early closure of PDA in very low birth weight infants will reduce both mortality and early or late morbidities. Key words: Patent ductus arteriosus, preterm, ibuprofen Giris: Patent duktus arteriozus (PDA), preterm yenidoganlarda siklikla karsilasilan, morbidite ve mortalite uzerine olumsuz etkileri olan kardiyak bir patolojidir. PDA'nin acik kalmasi ile respiratuvar distres sendromu (RDS), uzamis respirator destegi, pulmoner hemoraji, bronkopulmoner displazi (BPD), nekrotizan enterokolit (NEK), intraventrikuler kanama (IVK), renal yetmezlik, norogelisimsel kusur (serebral palsi), premature retinopatisi (ROP) ve olum arasinda anlamli iliski vardir. Semptomatik PDA'larin kapatilmasi standart hale gelmis ve ilk tercih indometazin ve ibuprofen (IBU) gibi siklooksijenaz inhibitorleri olmustur. Bu calismada preterm bebeklerde PDA sikligi, tedavisi ve komplikasyonlarinin arastirilmasi amaclanmistir. Gerec ve Yontem: Ocak 2010 ile Kasim 2011 tarihleri arasinda 33 hafta ve oncesinde dogan, konjenital major anomalisi veya konjenital kalp hastaligi olmayan, ilk hafta icinde ekokardiyografisi (EKO) yapilmis 103 bebek retrospektif olarak degerlendirildi. PDA'yla iliskili pulmoner hemoraji, NEK, BPD, ROP ve olum oranlari incelendi. Bulgular: Calismada 103 bebegin 45'i erkek ve 58'i kizdi. Yetmis bebek sezeryan, 33 bebek normal dogumla dogmustu. Bebeklerin gestasyonel haftasi ortalama 29,7 [+ or -] 2,2, PDA'si acik grupta gebelik haftasi daha dusuk olup 28,8 [+ or -] 2,3 hafta idi. Bebeklerin ortalama tartisi 1323 [+ or -] 375 g idi. Ayni sekilde APGAR skoru ortalama 7,25 [+ or -] 1,83 olup PDA'si acik grupta anlamli dusuktu (6,7 [+ or -] 1,9). Dogumdan ortalama 4,8 [+ or -] 4,4 gun sonra EKO yapildi ve 103 bebegin 48 (%46)'inde PDA saptandi. PDA'si acik olan grupta ortalama dogum tartisi 1162 [+ or -] 351 g, PDA'si kapali grupta ise 1465 [+ or -] 340 g bulundu. PDA'si acik bebeklerde pulmoner hemoraji, NEK, BPD, ROP ve olum oranlari PDA'si kapali olanlarla karsilastirildiginda istatistiksel olarak anlamli olcude yuksek bulundu (p<0,05). Sonuc: PDA'nin ozellikle cok dusuk dogum agirlikli pretermlerde erken kapatilmasi hem mortaliteyi, hem de gelisebilecek erken ve gec morbiditeleri azaltacaktir. Anahtar kelimeler: Patent duktus arteriozus, preterm, ibuprofen