Agnathia is an extremely rare condition. Disorder has also been termed agnathia-holoprosencephaly spectrum, agnathiaotocephaly complex, agnathia-astomia-synotia, or cyclopia-otocephaly association. The spectrum of agnathia ranges from isolated agnathia or virtual absence of the mandible to otocephaly. Agnathia-otocephaly can occur alone or in association with other abnormalities, Holoprosencephaly being the most common. A severe form of holoprosencephaly resulting in children being born with Cyclopia. It results from failure of the cerebral hemisphere to separate during fetal development. It is incompatible with life. Majority result in miscarriages or stillbirths. In this report we present a male preterm baby with cyclopia, otocephaly, agnathia, astomia and synotia (Kanwar Syndrome). As it is a lethal syndrome, knowledge of every variant of this is important for prenatal diagnosis and prognostication. To the best of our knowledge, this unique combination is the first case reported by us in the world.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Mechanical ventilation is one of the most common therapies in the neonatal intensive care unit (NICU), it is an area where technical complexity overlap individual preferences due to lack of extensive scientific evidence. Our aim is to provide clinical practice guidelines for conventional mechanical ventilation of newborn infants, utilizing the best available scientific evidence and to address the controversies. These guidelines are meant to help the clinician in managing ventilated newborn infants; it should not replace clinical judgment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Facial nerve palsy in the neonatal period can be result of few reasons including congenital, trauma at the time of birth, or developmental. The majority of infants (more than 90%) with congenital facial palsy usually recover by 3-6 months. The most important step in management is eye care as these infants have incomplete eye closure. If the weakness persistent beyond 3 months than plastic surgeon should be brought in picture.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Therapeutic hypothermia (TH) is used for hypoxic ischemic encephalopathy (HIE) of the term or near-term newborns to reduce the possible neurological handicap. The aim of this review is to focus on monitorization and management of newborns undergoing TH in Neonatal Intensive Care Unit. MEDLINE search was performed with keywords “therapeutic hypothermia, newborn.” Articles on human subjects published between 2004 and 2015 were included. TH is defined as moderate hypothermia where the core body temperature measured by the esophageal or rectal probe is cooled down to 33.0–35°C for 72 h. It may be administered by selective head cooling or with total body cooling methods by using a variety of different devices. TH is suggested to be used within certain guidelines in newborns with moderate to severe HIE meeting definitive criteria. For best results treatment needs to be started no later than 6 h of life which at times may be challenging for the clinician in newborns who initially appear mildly affected but later on progress to have more severe disease. TH has been used in many multicentered clinical studies showing neuroprotective effects. However, it has several effects that the clinician needs to be aware during treatment including; cardiopulmonary, renal, hematological, and metabolic effects. Drug metabolism may be delayed, there may be clotting disorders and the tendency for infection and skin problems as well. Optimal patient care including adequate sedation, antibiotic treatment, fluid, and nutritional management are very important during the course of TH. Patients need to be fully monitored including vital signs particularly core temperature. Frequent blood work may be necessary to follow the general condition of the patient and side effects. Echocardiographic assessment, head ultrasound, amplitude integrated electroencephalography are other methods used to evaluate treatment effects and guide management. Rewarming after 72 h of TH is also a very important part of treatment. Rewarming should be completed within 4–12 h and close follow-up including vital signs, respiratory, and circulatory conditions is required to detect the changes occurring in the patient and treat accordingly.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Congenital hypothyroidism (CH) is one of the most common causes of preventable mental retardation. Thyroid hormone has an essential role in the brain development during the first 2–3 years of life. Incidence of CH is 1:3000–1:4000 live births, but there is evidence that its incidence is increasing. Majority of newborn babies do not exhibit obvious clinical signs and symptoms until the age of 3 months due to either some residual thyroid function or transplacental passage of maternal thyroid hormone. Common clinical symptoms include lethargy, sleepiness, poor feeding, constipation, and prolonged jaundice. Other common findings on clinical examination include macroglossia, large fontanels, umbilical hernia, and hypotonia. Neonatal screening for CH is practiced in the developed countries for the last three decades, and various studies show that normal cognitive function is attainable with early detection and treatment. This review discusses different protocols being used for screening. It highlights recent recommendation of screening and retesting cutoffs. Thyroid imaging can help in differentiating underlying etiology, either thyroid dysgenesis or dyshormonogenesis. Treatment with levothyroxine (L-T4) 10–15 mcg/kg should be started immediately after diagnosis without delaying for imaging purposes. Frequent and vigilant monitoring with L-T4 dose adjustment is mandatory in infancy and childhood to achieve normal physical growth and neurodevelopment. Children with CH are followed by different pediatric specialties including general pediatricians, neonatologists, developmental pediatricians, and endocrinologists and in primary care; therefore, it is essential to increase the awareness of monitoring protocols among all physicians.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Neonatal Intensive Care Unit (NICU) is a specialized unit created for sick and premature newborns. Parents of admitted newborns came in stress when they came to know that their child is admitted to the NICU. In developing countries such as India, people having very less knowledge regarding physiotherapy interventions adopted in the NICU. Previously available literature from inception to 2017, searched with the keywords: “Parents perceptions,” “NICU Physiotherapy,” and “Medical staff perceptions” highlight the experiences of parents or stress levels in parents of hospitalized newborns in the NICU and perceptions of health-care providers' (HCP) toward patients' safety or the NICU research procedures adopted. Until now, there is no documentation on perceptions of both parents and HCP toward physiotherapy interventions adopted in the NICU.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

In this review, we aim to summarize available data on vitamin D in neonates critically. Vitamin D is a fat-soluble, steroid hormone with pleiotrophic effects not only on bone metabolism but also on optimal functioning of many organ systems. Deficiency is considered when 25-hydroxyvitamin D value is ˂20 ng/ml. Vitamin D deficiency is a global problem that prevales even in developed countries. Vitamin D deficiency is closely related to multiple disease states. It may influence obstetrical complications as preeclampsia, gestational diabetes, bacterial vaginosis, preterm birth, low-birth weight and cesarean section. Long-term outcomes in the offspring including asthma, multiple sclerosis, schizophrenia, abnormal neurocognitive outcome, type 1 diabetes mellitus, and insulin resistance can occur with vitamin D deficiency. Trials are needed to assess the effect of vitamin D supplementation and its dosage during pregnancy and lactation on clinical outcomes. The American Academy of Pediatrics recommends 400 IU/day of supplemental vitamin D for breastfed infants from the 1 ^st day of life. Preterm infants born <32 weeks are at a greater risk to develop vitamin D deficiency. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition has recommended higher intakes of vitamin D of 800-1000 IU/day for preterm infants. However, studies are needed to evaluate the dose and duration of vitamin D supplementation to preterm infants.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

In this case report, we describe a patient with extravasation injury with vancomycin given through a peripheral catheter. Extravasation occurs more in children and old people. A 1-month-old girl came to the hospital complaining of lethargy, poor feeding, fever, dyspnea, coughing, and cyanosis and was admitted in the neonatal department. The patient was diagnosed with pneumonia after blood tests and chest radiography. On the 2^nd day of treatment, the nurse noticed extravasation of vancomycin with severe painful blistering surrounding the infusion site on the patient's left leg. Necrotic ulcer at the vancomycin leakage site was visible. Moreover, according to the surgeon, necrotic ulcer needed debride. However, modern dressing with collagen besides the combination dressing of Aquasel Ag+, foam Aquasel, and ColActive collagen was used for treatment. The patient's wound was improved with modern dressing and was recovered after 31 days. She was discharged from the hospital without a certain problem.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Potter's sequence is a rare fatal disorder that occurs in sporadic and autosomal recessive forms with an incidence of 1 in 4000 births. Babies born with this condition are either still born or die very early within the neonatal period. We report a case of Potter's sequence with the typical physical findings and histological findings.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Objectives: To conduct a systematic review of the clinical trials evaluating the role of antibiotics for prevention or treatment of meconium aspiration syndrome (MAS). Methods: We searched several electronic databases including MEDLINE, EMBASE, CINAHL, SCOPUS (until September 2013), and CENTRAL (until August 2013). Additional citations were retrieved from the bibliographies of the selected articles. Studies were included if they were: Randomized or quasi-randomized trials, compared use of antibiotics with no antibiotics for treatment or prevention of MAS, and reported on clinical outcomes in the neonatal period. Results: Four randomized controlled trials (RCTs) were identified; three studies enrolled subjects for treatment of MAS and one study evaluated the prophylactic use of antibiotics in infants exposed to meconium stained amniotic fluid (MSAF). These trials enrolled 695 infants, with the duration of antibiotics between 3 and 7 days. All studies excluded subjects considered to be at higher risk for neonatal sepsis at onset. There were no differences noted for the outcomes of infection rates (relative risk [RR] [95% confidence interval: 0.85 [0.42, 1.73] for clinical sepsis, and 0.93 [0.36, 2.40] for culture-proven sepsis), need for mechanical ventilation (RR: 1.39 [0.68, 2.82]), air leaks syndrome (RR: 1.65 [0.68, 3.99]), hospital stay (mean difference − 0.34 days [−1.13, 0.45]), or mortality (RR: 1.25 [0.36, 4.39]) between the intervention and control groups. Conclusions: In neonates at low-risk for sepsis, insufficient evidence exists to support the routine use of antibiotics following exposure to MSAF or for the treatment of for suspected MAS. We discuss the implications and limitations of review findings for clinical practice.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Despite surfactant and mechanical ventilation being the standard of care for preterm infants with respiratory failure, non-invasive respiratory support is increasingly being employed in neonatal units. The latter can be accomplished in a variety of ways but none of them have been proven so far to be superior to intubation and mechanical ventilation. Nonetheless, they appear to be safe and effective in experienced hands. This article relates to the use of non-invasive forms of respiratory support and evidence is reviewed from the clinical trials which have evaluated the use of these techniques.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Linear nevus sebaceous syndrome is a multisystem disorder including nevus sebaceous, which is the hallmark of this syndrome, together with central nervous system, ocular and skeletal anomalies. We report a case of extensive skin lesions, CNS and eye anomalies in a full term infant who was conceived by intracytoplasmic sperm injection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Fibromatosis colli is a benign swelling involving sternocleidomastoid muscle. It is usually seen in neonatal age group. The history of prolonged labor or difficult delivery may be present in many cases. The presentation usually is asymptomatic neck swelling or mass in neonates. In some cases, torticollis may be present. The diagnosis is usually done by ultrasound which may typically show fusiform and thickened sternocleidomastoid muscle on the affected side. We hereby report four cases of fibromatosis colli presenting in the neonatal period. All of them presented with neck swelling and were diagnosed to be having fibromatosis colli on ultrasound.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objectives: The objective was to review the available evidence comparing oral paracetamol versus oral ibuprofen for the closure of patent ductus arteriosus (PDA) in preterm infants. Methods: We searched all the major databases (Medline via Ovid and PubMed) till April 2014. Randomized trials were included. Primary outcome measure was the primary closure rate of PDA after the first course of the drug. Review manager (version 5.2) was used for all the analyses. GRADE criteria were used to rate the quality of evidence. Results: Of 38 full-text articles assessed for eligibility, two trials (n = 240) were included in the final analysis. There was no significant difference between the two groups except for the following parameters, which favored the paracetamol group: Shorter mean days needed for PDA closure (mean difference, −0.49 [95% confidence interval [CI], −0.54 to − 0.44], P < 0.00001), a lower risk of gastro-intestinal bleeding (odds ratio [OR], 0.25 [95% CI, 0.06-1.02], P = 0.05) as well as hyperbilirubinemia (OR, 0.46 (95% CI, 0.23-0.95), P = 0.04). The GRADE evidence was found to be of "low quality." Conclusions: There is not enough evidence to judge about the efficacy or safety of ibuprofen versus paracetamol for treating the PDA in preterm infants. Randomized trials with low risk of bias and adequate sample size including different subgroups of preterm infants are needed before any firm recommendation can be made.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Objectives: The Kangaroo mother care (KMC) method is the best care method that can provide the newborn's skin normal contact with the mother's skin for all newborns, especially the premature or underweight. However, this method has not still become common in some countries and many hospitals in Iran. Thus, the present study aimed to determine the impact of KMC method on vital signs and arterial oxygen saturation of newborns compared to the incubator care method in order to facilitate this method. Materials and Methods: This clinical trial study was performed on 53 neonates who have been hospitalized in Neonatal Intensive Care Unit; they were randomly divided into two case and control groups. The KMC was conducted on newborns in the study group for an hour each day for 3 consecutive days. The vital signs including temperature, respiratory and heart rate per minute, and the arterial oxygen saturation rate were measured and recorded before, during and after caring process in both groups and then were compared and analyzed. Results and Conclusion: The results showed that the average temperature variations and the arterial oxygen saturation rate between the two groups had significant differences in 3 days of examining (P < 0/056, P = 0/00), but there were no significant differences in the mean heart and respiration rate between the two groups (P = NS). Thus, the Kangaroo care method is effective in the improvement and stabilizing of vital signs of newborns, and nurses can train this method to mothers.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objective: To establish hematological values (complete blood count) in healthy full-term newborns born at Dr. Soliman Fakeeh Hospital, as a reference value for healthy newborns in Jeddah, KSA. Methods: This is a cross-sectional study. Two thousand one hundred and sixty-three newborns were enrolled between January 1, 2013, and April 30, 2013, from Dr. Soliman Fakeeh Hospital in Jeddah - KSA. Newborn babies' blood was collected in ethylenediaminetetraacetic acid containing tubes in the 1^st day of life and analyzed for three different parameters: hematological, leukocytic, and thrombocytic. Red blood corpuscles analysis included cell count, hemoglobin (Hb) concentration, hematocrit, mean corpuscular volume (MCV), mean corpuscular Hb, and mean corpuscular Hb concentration. White blood corpuscles (WBCs) assessment included total leukocytic count (TLC) and monocytes, lymphocytes, neutrophils, eosinophils, and basophils percentages. Platelet count was assessed. Results: There were no significant differences between males' and females' hematological parameters. Leukocytic parameters showed significant difference between males and females in TLC (P = 0.017) and a statistically significant difference between the monocytes in both genders (P = 0.037). The differential WBCs parameters were similar between both genders. Conclusion: We established the reference range of hematological parameters from cord blood in healthy full-term newborns in Jeddah, KSA. Our results can be used as a reference range to support clinical diagnosis, treatment, and public health interventions in healthy full-term newborns in Jeddah.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Prune belly syndrome (PBS) is a rare congenital anomaly of uncertain etiology. Many associations of PBS with other malformations were previously reported, but only few cases of the association with VACTERL have been described. We report a rare case of a Moroccan new born with PBS and complete VACTERL association. The cause of this association is still unknown, but a common etiology is possible, especially when for the two syndromes, a defect in mesodermal differentiation, in early first trimester, has been suggested.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Recognizing the need for neurological monitoring in critically ill neonates such as the other vital parameters, neonatologists, and neurologists is becoming more familiar and comfortable with the use of amplitude-integrated electroencephalography (aEEG) in the neonatal intensive care unit, with minimal training and can be interpreted by care providers without neurophysiology backgrounds. In its simplest form, aEEG is a processed single-channel electroencephalogram that is filtered and time compressed. Current evidence demonstrates that aEEG is useful to monitor cerebral background activity, diagnose and treat seizures, and predict neurodevelopmental outcomes for preterm and term infants. This review aims to explain the fundamentals behind aEEG and its clinical applications specially referring to neonatal hypoxic-ischemic encephalopathy and hypothermia.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Hemolytic conditions in preterm neonates, including Rhesus (Rh) disease, can lead to mortality and long-term impairments due to bilirubin neurotoxicity. Universal access to Rh immunoprophylaxis, coordinated perinatal-neonatal care, and effective phototherapy has virtually eliminated the risk of kernicterus in many countries. In the absence of jaundice due to isoimmunization and without access to phototherapy or exchange transfusion (in 1955), kernicterus was reported at 10.1%, 5.5%, and 1.2% in babies <30, 31-32, and 33-34 wks gestational age, respectively. Phototherapy initiated at 24±12 hr effectively prevented hyperbilirubinemia in infants <2,000 g even in the presence of hemolysis. This approach (in 1985) reduced exchange transfusions from 23.9% to 4.8%. Now with 3 decades of experience in implementing effective phototherapy, the need for exchange transfusions has virtually been eliminated. However, bilirubin neurotoxicity continues to be associated with prematurity alone. The ability to better predict this risk, other than birthweight and gestation, has been elusive. Objective tests such as total bilirubin, unbound or free bilirubin, albumin levels, and albumin-bilirubin binding, together with observations of concurrent hemolysis, sepsis, and rapid rate of bilirubin rise have been considered, but their individual or combined predictive utility has yet to be refined. The disruptive effects of immaturity, concurrent neonatal disease, cholestasis, use of total parenteral nutrition or drugs that alter bilirubin-binding abilities augment the clinical risk of neurotoxicity. Current management options rely on the "fine-tuning" of each infant's exposure to beneficial antioxidants and avoidance of silent neurotoxic properties of bilirubin navigated within the safe spectrum of operational thresholds demarcated by experts.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening neonatal pathology resulting from poor hemodynamic and respiratory transition to extra uterine life. Inhaled nitric oxide (iNO) is a current, commonly used treatment of PPHN. However, iNO is not available therapy in many developing countries and around 50% of infants with PPHN do not respond to iNO therapy. Sildenafil is a phosphodiesterase inhibitor type 5 (PDE5) that has been shown to selectively reduce pulmonary vascular resistance in both animal models and adult humans. Recent studies have found that in PPHN, administration of Sildenafil was associated with a significant increase in the oxygenation and a reduction in mortality with no clinically important side effects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Introduction: The feeding of preterm neonates is one of the main challenges facing the neonatologist. Feeding intolerance can be defined by difficulty in ingestion or digestion of the milk that causes a disruption in the enteral feeding plan due to the manifestation of clinical symptoms. These symptoms include gastric residuals, emesis, abdominal distention, visible bowel loops, and change in the character of stool. Aim: To determine the incidence of feeding intolerance in preterm neonates. Methods: Study was carried out on 998 preterm neonates admitted at neonatal intensive care units of Port-Said in the period from 1st August 2014 till the 1st of March 2015. Inclusion criteria included Preterm infants of both genders from day 0 to day 28 of life and with gestational age from 28 to below 37 weeks (confirmed by maternal last menstrual period). Diagnosis of feeding intolerance depended on presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm as; increased gastric residuals of the previous feeding, emesis, abdominal distention, bloody stool, diarrhea and visible bowel loops. Results: The incidence of feeding intolerance in preterm was 2.6%. Conclusion: The percentage of feeding intolerance in Port-Said, Egypt is 2.6% of the preterm neonate.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency encountered in particular the preterm infants and less often in term and near-term infants. Since its description in the late 1950's and early 1960's, its incidence along with its associated mortality and morbidity has remained unchanged. In babies born < 1500 g or before to 32 weeks of gestation, its incidence ranges between 3% and 12% and mortality is between 20 and 30%, with highest among those requiring surgery. With better understanding of etiology and pathophysiology, it is now being increasingly recognized that "NEC" as diagnosed by most clinicians in clinical practice may not be a single disease but a spectrum of diseases that present with similar signs and symptoms. NEC is currently thought to be due to dysbiosis of the intestinal microbiome and an uncontrolled exuberant inflammatory response to this microbial imbalance. This comprehensive review discusses the differences between NEC as seen in term and near-term babies as opposed to that seen classically in preterm infants. It also discusses the epidemiology, pathogenesis, and newer diagnostic modalities for the diagnosis of NEC in great depth, because it is only by understanding and appreciation of these dynamics that is likely to lead to the development of successful strategies for prevention, diagnosis, treatment, and improved outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

A full-term female baby presented at birth with a swollen left labia and atrophic lesions affecting the sacrum and left buttocks. A diagnosis of focal dermal hypoplasia was made from the histopathology of the labial lesion. Patient presented at the age of 2 years with urinary incontinence and constipation and imaging of the neuro-spinal axis showed lipomyelomeningocele with tethered cord.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte sedimentation rate and total leucocyte count (TLC) in predicting sepsis. Study Design: Prospective observational hospital based study. Setting: Tertiary care hospital. Subjects: From November 2010 to October 2011, 936 neonates were admitted to the neonatal unit of Indira Gandhi Medical College, Shimla, Himachal Pradesh. Out of these, 355 neonates were admitted with suspected sepsis. Out of these, only 101 term neonates were without asphyxia and blood culture positive and were enrolled as cases, and 96 term neonates without the asphyxia admitted for neonatal jaundice without sepsis were enrolled as controls. Methods: All neonates, cases and control were investigated as per the protocol at admission and simultaneously the D-dimer levels were measured. D-dimer levels were evaluated in predicting neonatal sepsis and were compared with other established markers of sepsis in predicting sepsis. Results: In the study group, age ranged from 0 to 22 days with an average of 5.58 days. In the control group, age ranged from 0 to 23 days with an average of 5.62 days. Sex distribution was almost equal in both groups. The mean value of D-dimer in the cases and control group were 1.832 mg% and 1.365 mg% respectively. The study group had significantly higher values of D-dimer (P - 0.04). Sensitivity and negative predictive value of D-dimer in predicting sepsis were 90.0% and 84.4% respectively, the highest amongst all the markers studied in sepsis. Positive predictive value and specificity of TLC in sepsis was highest in all the marker studied. Negative predictive value of various markers was comparable in sepsis. Conclusion: D-dimer is a sensitive predictor of sepsis in neonates with a high sensitivity and negative predictive value. Hence, it should be included in the septic screening of newborns.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]