Symptomatic patent ductus arteriosus in very-low-birth-weight infants: 1987–1989

Symptomatic patent ductus arteriosus (sPDA) may occur in up to 50% of very-low-birth-weight (VLBW, ≤ 1500 g) infants. We reported a 16% incidence in 1979–1980 in a totally inborn population, demonstrating the importance of early fluid management. Although survival of VLBW infants, especially those < 1000 g, has increased, sPDA has not been carefully re-examined. Therefore, we sought to determine if the incidence, morbidity, treatment, or risk factors for sPDA had changed in this population. Between January 1, 1987 and December 31, 1989 all VLBW infants with sPDA surviving > 72 h (119/636) were identified and compared to matched controls ( n = 70). Incidence and onset of sPDA were 19% and 10 ± 6 days (±S.D.), respectively, the former increasing from 8% to 33% between 1251–1500 g and 500–750 g, respectively ( P < 0.001). Fluid and colloid administration were similar in sPDA and control infants. sPDA was associated with the occurrence of chronic lung disease (18% vs 7%, P = 0.005) and intracranial hemorrhage (53% vs 21%, P < 0.001). Using stepwise logistic regression analysis we were unable to create a model that accurately predicted sPDA. Medical management and indomethacin were unsuccessful in 66% and 25%, respectively, of infants so treated; 43% required surgical ligation. Although survival of VLBW infants has increased, our incidence of sPDA remains low, with > 80% of infants demonstrating spontaneous closure when fluid and colloid administration are judiciously used.