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PATENT DUCTUS ARTERIOSUS(PDA) IN EARLY GESTATION OF VIABILITY AT 23 WEEK GESTATIONS,EXPERIENCE FROM TERTIARY NEONATAL UNIT,UK
Abstract
Background
The incidence of PDA in<28weeks babies is 75%
Objectives
To review the medical management of PDA in extreme preterm babies born at early gestation of viability at 23 weeks in a tertiary Neonatal unit in UK.
Methods
All babies born at 23+0 to 23+6 weeks were included during the study period(Jan 2010- Dec 2014).Data was collected about PDA diagnosis and management from the medical notes and local neonatal database.Significant PDA was defined as on Echo: Duct size >1.5mm,left heart dilatation La:Ao (Left atrium:Aortic) ratio: >1.4,Pulsatile ductal flow pattern,Velocity max>2mm/s,diastolic retrograde flow in descending aorta. Ibuprofen was only drug used for medical management of PDA.
Results
21 babies born during the study period were reviewed,4 babies died before ECHO at age<24 hours,constituting 17 babies in the study. Mean PDA detection was at 5.5 days.Average PDA size was 2 mm(+/- 0.78 SD), significant duct size was measured in 82 % (14/17). Average LA-Ao ratio was 1.4(0.30 SD) and significant in 47%.10 babies required Ibuprofen treatment and 7 did not require and the mean age was 5.8 days for administering it.8 babies required 1 course (Dose 10, 5, 5 mg) and 2 babies required 2 courses,1 of which required surgical ligation.Treatment associated effects of altered renal functions and NEC in 1 baby each and thrombocytopenia in 2 babies.Other co-morbidities noted were IVH(9), CLD(11),NEC-confirmed(3).6/17 babies survived to discharge.
Conclusion
Medical management of PDA even from a single NICU is quite variable.The unit will be participating in a multicenter RCT to answer some of these uncertainties.