Optimal Management of Patent Ductus Arterisus in Premature / 대한흉부외과학회지

ABSTRACT

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational age(29.6+/-3.1weeks vs. 28.1+/-1.6weeks) and birth weight(1,413+/-580gm, 1,098+/-235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical ligation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22%, 2/9). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in stead of moving the patient to the operating room.