Abstract
Background: The management of the patent ductus arteriosus in the preterm neonate continues to be a major factor affecting morbidity and mortality.
Objectives: To identify factors that may be important in determining which patients respond to medical therapy and which would suggest that surgical management is likely necessary.
Methods: A total of 117 patients' charts were retrospectively reviewed. Twenty-two were excluded due to incomplete data. Ninety-five patients were divided into medical responders (R) and non-responders (NR). Demographics and clinical data were compared using independent t-testing and ANOVA. A Ductal Response Score (DRS) was developed using factors known to be of significance for successful medical closure. This score was calculated on a subset of patients where all necessary data were present.
Results: Responders had higher gestational age (GA), body surface area (BSA) and left ventricular Z-score (LVZ-score). The interaction between groups showed significant difference between R and NR in LA/AO (P < 0.001), LV Z-score (P < 0.001), and BUN/Cr (P = 0.046), where NR had higher values compared to R. The effect of time on the DRS regardless of the group (10 patients) showed statistically insignificant difference (P= 0.263). Interaction between the groups (R = 6, NR = 4) showed significant worsening of the DRS in NR (P = 0.047). Extrapolation of data was performed. Independent t-test on DRS between groups, post-extrapolation (R = 19, NR = 9), showed statistically insignificant difference between the groups (P = 0.144).
Conclusion: The concept of determining a DRS may prove to be useful in evaluating response to medical therapy. However, further prospective study is needed.