Open AccessEffects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus
Author(s) -
Lílian S. R. Sadeck,
Cléa Rodrigues Leone,
Renato Soibelmann Procianoy,
Ruth Guinsburg,
Francisco Eulógio Martinez,
Monnet Elisabeth,
Renato Machado Fiori,
Lígia S L Ferrari,
Jucille A. Menezes,
Paulyne Stadler Venzon,
José Luiz,
Marynea V. Nunes,
Lêni Márcia Anchieta
Publication year - 2016
Publication title -
revista chilena de pediatría
Language(s) - English
Resource type - Journals
eISSN - 0717-6228
pISSN - 0370-4106
DOI - 10.1016/j.rchipe.2014.04.001
Subject(s) - medicine , necrotizing enterocolitis , bronchopulmonary dysplasia , ductus arteriosus , intraventricular hemorrhage , retinopathy of prematurity , gestational age , pediatrics , antenatal steroid , respiratory distress , neonatal intensive care unit , birth weight , apgar score , retrospective cohort study , umbilical artery , anesthesia , pregnancy , gestation , biology , genetics
AbstractObjectiveTo analyze the effects of treatment approach on the outcomes of newborns (birthweight [BW] <1000g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD.MethodsThis was a multicentric, cohort study, retrospective data collection, including new-borns (BW<1000g) with gestational age (GA) <33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to December 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital mal-formation or infection were excluded. Groups: G1 – conservative approach (without treatment), G2 – pharmacologic (indomethacin or ibuprofen), G3 – surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5min. Apgar score <4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPEII), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (<2h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, Chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p values <0.05 were considered statistically significant.Results1097 newborns were selected and 494 newborns were included: G1 – 187 (37.8%), G2 – 205 (41.5%), and G3 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14–0.62) and conservative (OR 0.34; 95% CI: 0.140.79) treatments were protective for the outcome death/BPD36wks.ConclusionThe conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks