Management of patent ductus arteriosus in preterm infants

Objective: To evaluate the incidence of symptomatic patent ductus arteriosus (PDA) in preterm infants, and the results of the intraveno- us indomethacine treatment and surgery. Methods: Among 394 preterm infants (<37 weeks), symptomatic PDA was diagnosed by echocardiography in 51 babies and they were examined retrospectively. All infants were managed conservatively and then IV indomethacine was given to non-responders (n=30). Sur- gical closure was performed in 12 babies. Results: The incidence of symptomatic PDA in preterm infants was 12.9%: median age: 3 days, mean birth weight: 1434±540 g (540-2900g) and mean gestational ages (GA) 30.9±3.3 weeks (23-37 weeks). With indomethacine, ductal closure was achieved in 70% infants. Early clinical improvement was observed in all cases that underwent surgery and most of them had a low birth weight (< 1500 g) and an early gestational age (< 32 weeks). None of them died due to operation. Conclusion: The incidence of symptomatic PDA is high in preterm infants. Treatment with indomethacine improves ductal closure and as- sociated with few reversible adverse effects. In the other hand, early clinical improvement and high success rate was achieved after surgery. If indomethacine fails to achieve ductal closure, decision of surgery must be made immediately.