cardiovascular-agents and Cerebral-Palsy

To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes.. In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224).. During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1.. A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months.

Topics: Age Factors; Blindness; Cardiovascular Agents; Cerebral Palsy; Child, Preschool; Combined Modality Therapy; Deafness; Developmental Disabilities; Ductus Arteriosus, Patent; Female; Follow-Up Studies; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Ligation; Logistic Models; Male; Multivariate Analysis; Risk Factors; Treatment Outcome

Topics: Adolescent; Biomedical Research; Cardiovascular Agents; Cerebral Palsy; Child; Chlordiazepoxide; Diazepam; Drug Therapy; Humans; Muscle Relaxants, Central; Placebos; Reflex; Reflex, Abnormal; Toxicology

Topics: Cardiovascular Agents; Cerebral Palsy; Child; Chlorzoxazone; Drug Therapy; Humans; Intellectual Disability; Muscle Relaxants, Central; Toxicology

Topics: Cardiovascular Agents; Cerebral Palsy; Chorea; Ergot Alkaloids; Giant Cell Arteritis; Headache; Humans; Methysergide; Migraine Disorders; Oxytocics; Selective Serotonin Reuptake Inhibitors; Serotonin; Trigeminal Neuralgia

Topics: Cardiovascular Agents; Cerebral Palsy; Child; Humans; Infant; Movement Disorders; Muscle Relaxants, Central

Topics: Brain; Cardiovascular Agents; Carisoprodol; Cerebral Palsy; Child; Infant; Movement Disorders; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Carisoprodol; Cerebral Palsy; Muscle Relaxants, Central; Neurons

Topics: Cardiovascular Agents; Carisoprodol; Cerebral Palsy; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cerebral Palsy; Indomethacin; Muscle Relaxants, Central; Zoxazolamine

Topics: Biperiden; Cardiovascular Agents; Cerebral Palsy; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cerebral Palsy; Muscle Relaxants, Central

Topics: Anticonvulsants; Behavior; Cardiovascular Agents; Cerebral Palsy; Epilepsy; Meprobamate; Muscle Relaxants, Central; Personality Disorders

Topics: Cardiovascular Agents; Cerebral Palsy; Cyclopentanes; Muscle Relaxants, Central; Parasympatholytics; Trihexyphenidyl