An Observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for patent ductus arteriosus

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dc.authorid0000-0003-0903-6520en_US
dc.contributor.authorOkulu, Emel
dc.contributor.authorErdeve, Ömer
dc.contributor.authorArslan, Zehra
dc.contributor.authorDemirel, Nihal
dc.contributor.authorKaya, Hüseyin
dc.contributor.authorGökçe, İsmail Kürşad
dc.contributor.authorErtuğrul, Sabahattin
dc.contributor.authorÇetinkaya, Merih
dc.contributor.authorBüyükkale, Gökhan
dc.contributor.authorÖzlü, Ferda
dc.contributor.authorŞimşek, Hüseyin
dc.contributor.authorÇelik, Yalçın
dc.contributor.authorÖzkan, Hilal
dc.contributor.authorKöksal, Nilgün
dc.contributor.authorAkcan, Barış
dc.contributor.authorTürkmen, Münevver
dc.contributor.authorÇelik, Kıymet
dc.contributor.authorArmangil, Didem
dc.contributor.authorBülbül, Ali
dc.contributor.authorTekgündüz, Kadir Şerafettin
dc.contributor.authorÖncel, Mehmet Yekta
dc.contributor.authorTüzün, Funda
dc.contributor.authorErgenekon, Ebru
dc.contributor.authorErgin, Hacer
dc.contributor.authorArsan, Saadet
dc.date.accessioned2021-09-07T12:52:03Z
dc.date.available2021-09-07T12:52:03Z
dc.date.issued2020en_US
dc.departmentDicle Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalıen_US
dc.descriptionWOS:000561673100001
dc.descriptionPMID: 32850547
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.identifier.citationOkulu, E., Erdeve, Ö., Arslan, Z., Demirel, N., Kaya, H., Gökçe, İ.K., ve diğerleri. (2020). An Observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for patent ductus arteriosus. Frontiers in Pediatrics, 8(434), 1-10.en_US
dc.identifier.doi10.3389/fped.2020.00434
dc.identifier.endpage10en_US
dc.identifier.issn2296-2360
dc.identifier.issue434en_US
dc.identifier.pmid32850547
dc.identifier.scopus2-s2.0-85089525278
dc.identifier.scopusqualityQ2
dc.identifier.startpage1en_US
dc.identifier.urihttps://www.frontiersin.org/articles/10.3389/fped.2020.00434/full
dc.identifier.urihttps://hdl.handle.net/11468/7469
dc.identifier.volume8en_US
dc.identifier.wosWOS:000561673100001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorErtuğrul, Sabahattin
dc.language.isoenen_US
dc.publisherFrontiers Media SAen_US
dc.relation.ispartofFrontiers in Pediatrics
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.titleAn Observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for patent ductus arteriosus
dc.typeArticleen_US

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