Affiliations: Department of Pediatric Cardiology, The University of
Toledo Medical Center, St. Vincent Mercy Children Hospital, Toledo, OH, USA
Note: [] Corresponding author: Dr. Sawsan M. Awad, 1653 W Congress PKWY,
Chicago, IL 60612, USA. Tel.: +1 216 702 8035; Fax: +1 312 942 3182; E-mail:
sawsanawadd@hotmail.com
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.
Keywords: Patent ductus arteriosus, surgical ligation of patent ductus arteriosus, failure of PDA medical treatment
