Management of the persistent ductus arteriosus in infants of very low birth weight: early and long-term results.

The hemodynamically relevant persistent ductus arteriosus (PDA) impairs pulmonary and cardiac function. Frequently, PDA can be closed only via surgery. In this retrospective study, early and long-term results in very low birth weight newborns are evaluated. Eighty-seven of 634 very low weight newborns presented with PDA All patients (pts; age: +/-14 days; weight: +/-1064 g) were ventilator-dependent. Surgical closure (after 29+/-5 days) was indicated if echocardiography and prolonged ventilation (>20+/-2 days) evidenced a hemodynamically relevant PDA. Sixteen pts, in which indomethacin therapy failed preoperatively are included in the 36 surgically treated pts; no pt died intra- or early postoperatively (<3 day). Overall mortality 30 days after delivery was n=9. Early plus late mortality was n=19. Long-term follow-up (3-12 years) in 46 (68%) pts: 15 were solely physically, 11 were mentally and neurologically, and 4 were physically, mentally and neurologically retarded. From these 30 pts, 15 were severely (e.g. tetraspasm; severe cerebral paresis) and 15 were slightly (e.g. psychosomatic and language development prolongation) retarded. Sixteen pts exhibited no disability; no long-term complications owing to surgery. The relatively large number of neurological injuries was not owing to chromosomal syndromes or pre-existing abnormalities but can be explained by severe and frequent prematurity, hypoxia, and intracerebral bleeding. Indomethacin was successful only in a few patients. Early surgery (after frustran early indomethacin therapy) of a hemodynamically relevant PDA is recommended. In the long-term, severe disabilities develop.