An Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosus

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dc.authoridArslan, zehra/0000-0002-1939-405X
dc.authoridOkulu, Emel/0000-0002-1101-3355
dc.authoridOncel, Mehmet Yekta/0000-0003-0760-0773
dc.authoridKader, Şebnem/0000-0001-7585-4228
dc.authoridAKCAN, ABDULLAH/0000-0003-0181-1166
dc.authoridCelik, Yalcin/0000-0002-1357-0585
dc.authorwosidArslan, zehra/IXD-5561-2023
dc.authorwosidErtugrul, Sabahattin/JUU-2567-2023
dc.authorwosidCELIK, Kiymet/AFB-0179-2022
dc.authorwosidOkulu, Emel/AAH-8855-2020
dc.authorwosidOncel, Mehmet Yekta/L-5664-2013
dc.authorwosidCelik, Yalcin/AAA-4342-2021
dc.authorwosidKader, Şebnem/AAL-6753-2021
dc.contributor.authorOkulu, Emel
dc.contributor.authorErdeve, Omer
dc.contributor.authorArslan, Zehra
dc.contributor.authorDemirel, Nihal
dc.contributor.authorKaya, Huseyin
dc.contributor.authorGokce, Ismail Kursad
dc.contributor.authorErtugrul, Sabahattin
dc.date.accessioned2024-08-04T20:48:47Z
dc.date.available2024-08-04T20:48:47Z
dc.date.issued2020
dc.departmentİnönü Üniversitesien_US
dc.description.abstractNo consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7)and 28(6/7)weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 +/- 1.4 weeks and 926 +/- 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (>= Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p> 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80,p= 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92,p= 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p= 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.en_US
dc.description.sponsorshipTurkish Neonatal Society [1-2017]en_US
dc.description.sponsorshipThis study was supported by Turkish Neonatal Society with grant number 1-2017, received by EO. The financial fund was used to create the Turkish INTERPDA Study Online Registry database.en_US
dc.identifier.doi10.3389/fped.2020.00434
dc.identifier.issn2296-2360
dc.identifier.pmid32850547en_US
dc.identifier.scopus2-s2.0-85089525278en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.3389/fped.2020.00434
dc.identifier.urihttps://hdl.handle.net/11616/99462
dc.identifier.volume8en_US
dc.identifier.wosWOS:000561673100001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherFrontiers Media Saen_US
dc.relation.ispartofFrontiers in Pediatricsen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectpatent ductus arteriosusen_US
dc.subjectpretermen_US
dc.subjectconservativeen_US
dc.subjectmanagementen_US
dc.subjectmorbidityen_US
dc.subjectmortalityen_US
dc.subjectibuprofenen_US
dc.subjectparacetamolen_US
dc.titleAn Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosusen_US
dc.typeArticleen_US

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