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Korean Journal of Pediatrics 2008;51(10):1065-1070.
Delayed closure effect in preterm infants with patent ductus arteriosus
Hyun Ju Lee, Gyu Hong Sim, Kyung Eun Jung, Jin A Lee, Chang Won Choi, Ee Kyung Kim, Han Suk Kim, Beyong Il Kim, Jung-Hwan Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
미숙아 동맥관개존증의 지연된 폐쇄가 예후에 미치는 영향
이현주, 심규홍, 정경은, 이진아, 최창원, 김이경, 김한석, 김병일, 최중환
서울대학교 의과대학 소아과학교실
Correspondence:  Jung-Hwan Choi,
Email: neona@plaza.snu.ac.kr
Abstract
Purpose : This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d).
Methods
: Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively.
Results
: The mean gestational age (GA) was 26¡¾2 weeks (range, 23-32 wk), and the birth weight was 782¡¾146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7¡¾1.7 wk vs. 27.1¡¾2.0 wk, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010)..
Conclusion
: Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.
Key Words: Patent ductus arteriosus, Prematurity, Indomethacin, Surgical procedures, Treatment


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