Restrictive Infusion Therapy in Patent Ductus Arteriosus Management in Premature Infants

The persistence of hemodynamically significant patent ductus arteriosus (НPDA) has a great value on a short term and long term outcomes in preterm infant. There is no hesitation that PDA should be closed pharmacologically or surgically if present. The aim of the study was to establish the advisability, efficiency and safety of using different volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the НPDA closure. Retrospectively has been studied 91 preterm infants with gestational age 26-31 weeks, manifestations of respiratory distress syndrome, НPDA treated at the NICU. The research groups were representative for gestational age, gender and weight (1205.0 ± 435.0 grams). The therapy of PDA closure included using of different volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) in combination with COX inhibitors. COX inhibitors prescribed according to standard regimens: in the first 3 days - indomethacin orally in doses 0.2/0.1/0.1 mg/kg/day. If the preterm infant had symptoms of intestinal paresis (this prevented the oral administration of indomethacin). Ibuprofen administered in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in a rectal form. In all groups of preterm used a standard therapy of PDA closure. The volume of infusion therapy was restricted in the first group. Preemies received 53.5 ± 6.4 ml/kg/day on DOL1 and 2. From the third day increased urinary excretion, there was an increase in the amount of infusion therapy up to 63.6 ± 5.6 ml/kg/day, and at day 5 it was raised to 89.7 ± 6.8 ml/kg/day. In the second group there was no strict adherence to the restriction of the volume of infusion therapy (especially in the first 5 days), and delayed term for the PDA closure (on average at 14.55 ± 0.56 DOL) associated with that fact. In the first group the limit of the volume of infusion therapy observed more clearly in the first 5 days, and the closure of the arterial duct occurred exceptionally early (at 2.35 ± 0.48 DOL). With regard to the volume of infusion therapy in a more distant terms (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups, which suggests that the principle was the restriction of the infusion therapy in the first 5 days only