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Evaluer l'impact à court terme du traitement médical et chirurgical des canaux artériels persistants sur des grands prématurés. Une attention particulière sera portée à la ligature. Méthodes: il s'agit d'une étude rétrospective unicentrique de cohorte sur la base de dossiers médicaux de patients de moins de 1500 g et/ou de moins de 32 semaines du service de néonatalogie de Saint-Luc, entre le 1er janvier 2008 et le 31 décembre 2012. Une comparaison de la mortalité et des morbidités (utilisation d'02, DAO, hémorragies pulmonaires, DBP, sepsis, utilisation d'inotropes, NEC 2, IR, HIV 2, leucomalacies, ROP 3) a été opérée entre 3 groupes (nouveau-nés non traités, traités médicalement ou traités chirurgicalement après l'échec médicamenteux). Les complications immédiates de la chirurgie ont également été étudiées. Les variables continues ont été comparées via un test « t » de Student. Les variables qualitatives ont été comparées via un test exact de Fisher. Résultats : L'étude compte 372 patients dont 288 enfants non traités (77,42 %) (37 avec canal ouvert, 251 avec canal fermé ou n'ayant pas eu d'échographie), 71(19,09 %) traités médicalement et 13 enfants (3,49 %) traités par ligature suite à l'échec du traitement médicamenteux. Les patients non traités ont un âge gestationnel et un poids de naissance plus élevés. Ces différences ne sont pas significatives entre le groupe médical et le groupe chirurgical. Nous retrouvons plus de complications associées aux groupes traités avec une différence statistiquement significative pour toutes les complications pulmonaires, les septicémies, l'utilisation d'inotropes, les IR, les NEC, les hémorragies cérébrales et les rétinopathies. En comparant le groupe chirurgical avec le groupe médical, nous observons plus de DBP à 36 semaines (61,54 % versus 15,49 %, p : 0,0006), une plus longue durée d'utilisation de ventilation mécanique (CPAP,DuoPAP, HFOV), ainsi qu'un taux plus élevé de DAO (84,62 % versus 23,94 %, p : < 0,0001) et de parésies des cordes vocales (30,77 % versus 1,41%,p : 0,0012) dans le groupe traité chirurgicalement. Conclusion : Les enfants nécessitant un traitement pour une persistance de canal sont plus susceptibles de souffrir de complications diverses. Chez les enfants ligaturés, nous observons plus particulièrement une augmentation significative de maladies pulmonaires chroniques à 36 semaines, une plus longue durée d'utilisation de ventilation mécanique, un taux plus élevé de dommages alvéolaires diffus et de parésies des cordes vocales. Une RCT, ou au minimum une large étude non randomisée ajustée avec l'histoire périnatale et avec les complications pré-chirurgicales, serait nécessaire afin de réellement progresser dans le domaine. Objective: Assessing the short-term impact of the medical and chirurgical treatment of patent ductus arteriosus on extremely premature infants. Particular attention will be paid to ligation. Methods: it is a retrospective unicentric cohort study based on medical files of patients < 1500 g and/or < 32 weeks admitted to the department of neonatology of Saint-Luc between 1 January 2008 and 31 December 2012. A comparison in terms of mortality and morbidities (use of 02, diffuse alveolar damage, pulmonary hemorrhages, bronchopulmonary dysplasia, sepsis, use of inotropes, necrotizing enterocolitis 2, kidney failure, intraventricular hemorrhages 2, leukomalacia, retinopathy of prematurity 3) has been made between three groups (untreated newborns, medically treated newborns, and surgically treated newborns after failure of the drug therapy).The immediate complications of the surgery have also been analyzed.The continuous variables have been compared by means of a Students t-test, whereas the qualitative variables have been compared by means of a Fisher's exact test .Results: The study evaluated 372 patients, including 288 untreated infants (77, 42%) (37 with ductus arteriosus open, 251 with ductus arteriosus closed or who did not undergo ultrasonography), 71 (19,09%) medically treated, and 13 (3,49%) received ligation after failure of the drug therapy. The untreated patients had higher gestational ages and higher birth weights. These differences are not significant between the medical group and the surgical group. The treated groups develop more complications; with a statistically significant difference for ail pulmonary complications, septicemias, uses of inotropes, kidney failures, necrotizing enterocolitis, cerebral hemorrhages, and retinopathies. A comparison between the surgical group and the medical group reveals that the surgically treated group suffers more from chronic pulmonary disorders at 36 weeks (61,54% versus 15,49%, p: 0,0006),longer requires mechanical ventilation (CPAP, DuoPAP, HFOV),and has higher rates of diffuse alveolar damages (84,62% versus 23,94%, p: < 0,0001) and of vocal cord pareses (30,77% versus 1,41%, p: 0,0012).Conclusion: Children who need to be treated for patent ductus arteriosus are more likely to suffer from various complications. Among ligated infants, we especially notice a significant increase in chronic pulmonary disorders at 36 weeks, a longer use of mechanical ventilation, and a higher rate of diffuse alveolar damages and vocal cord pareses. A randomized controlled trial, or at least a large non-randomized study adjusted with the perinatal history and the pre-surgical complications, would be necessary to achieve considerable progress in this field.

Infant, Premature --- Ductus Arteriosus, Patent

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The patent ductus arteriosus continues to pose a considerable challenge to clinicians and scientists alike. Why does it close spontaneously in most infants but remain open in others? How best can we select those infants who are most likely to benefit from treatment, i.e. are there echocardiographic criteria that would help in defining a more selective treatment approach? Would it be better to take an aggressive approach and prescribe prophylactic treatment to all extremely immature infants ‑ and if so, what is the best way to define such a subgroup? Or should we be more restrictive in defining treatment indications and adopt a 'wait and see' policy in most, if not all, premature infants? Finally, are there data to suggest that one of the treatment approaches that are available to close the patent ductus arteriosus is superior to the other? This book deals with these questions and tries to give some answers, based on the evidence currently available. It is intended for neonatologists, pediatric cardiologists and researchers.

Infant, Newborn --- Heart Defects, Congenital --- Cardiovascular Abnormalities --- Infant --- Heart Diseases --- Cardiovascular Diseases --- Congenital Abnormalities --- Age Groups --- Diseases --- Congenital, Hereditary, and Neonatal Diseases and Abnormalities --- Persons --- Named Groups --- Ductus Arteriosus, Patent --- Infant, Premature --- Pediatric cardiology. --- Medicine. --- Obstetrics. --- Pediatrics. --- Medicine & Public Health. --- Medicine/Public Health, general. --- Obstetrics/Perinatology. --- Cardiology --- Obstetrics/Perinatology/Midwifery. --- Paediatrics --- Pediatric medicine --- Medicine --- Children --- Maternal-fetal medicine --- Clinical sciences --- Medical profession --- Human biology --- Life sciences --- Medical sciences --- Pathology --- Physicians --- Health and hygiene --- Health Workforce