Is medical therapy succesful in hemodynamically significant patent ductus treatment in term newborns?

Abstract

Aim: To investigate the clinical success of medical patent ductus arteriosus closure treatment for hemodynamically significant patent ductus arteriosus in term babies. Methods: Our study included patients treated in two neonatal intensive care units with hemodynamically significant patent ductus arteriosus after the 3rd postnatal day and administered medical patent ductus arteriosus closure treatment (ibuprofen and paracetamol) at the discretion of the pediatric cardiologists while awaiting referral for surgical closure treatment. Our retrospective analysis included anthropometric measurements at birth, the day treatment started postnatally, and other existing clinical conditions that might influence the prognosis of patent ductus arteriosus. Then, treatment success was evaluated by echocardiographic results. Results: We included all ten patients diagnosed with hemodynamically significant patent ductus arteriosus and administered medical treatment with a mean gestational age at birth of 38.4 ± 1.21 weeks, and median birth weight of 3125 grams (3005-3200). We started medical closure treatment at mean postnatal 11.6 ± 4.9 days with ibuprofen (70%, n=7) or paracetamol (30%, n=3). 40% (n=4) of the infants had complete closure, 20% (n=2) became asymptomatic, and 10% (n=1) underwent surgical ligation. 30% (n=3) of patients died due to different complications during surgical preparation. As we defined treatment success as complete or partial closure and compared paracetamol and ibuprofen success, there was no statistically significant difference between them (p=0.5). Conclusion: Medical closure treatment might be effective in the presence of hemodynamically significant patent ductus arteriosus in term infants. There was no statistical superiority of paracetamol or ibuprofen treatments over each other in terms of treatment success.