BACKGROUND: @entity2461 ( @entity2461 ) with significant @entity1002 shunt in preterm @entity1 increases morbidity and mortality. Early closure of the ductus arteriosus may be achieved pharmacologically using cyclooxygenase inhibitors, or by surgery. The efficacy of both treatment modalities is well established. However, the preferred initial treatment of a symptomatic @entity2461 in a preterm @entity1 , surgical ligation or trial of @entity3352 , has not been well established. OBJECTIVES: To compare the effect of surgical ligation of @entity2461 versus medical treatment with cyclooxygenase inhibitors (using @entity3352 , @entity5018 , or @entity7154 ), each used as the initial treatment, on neonatal mortality in preterm @entity1 with a symptomatic @entity2461 . SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included search of electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), MEDLINE (1966 - December 2002), CINAHL (1982 - December 2002), EMBASE (1980 - December 2002); and hand search of abstracts of Pediatric Academic Societies annual meetings published in Pediatric Research (1990 - April 2002). No language restrictions were applied. SELECTION CRITERIA: All trials 1) using randomized or quasi-randomized @entity1 allocation, 2) in preterm @entity1 < 37 weeks gestational age or low-birth-weight @entity1 (< 2500 grams) with symptomatic @entity2461 in the neonatal period (< 28 days) and 3) comparing surgical ligation with medical treatment with cyclooxygenase inhibitors, each used as the initial treatment for closure of @entity2461 . DATA COLLECTION AND ANALYSIS: Assessment of methodological quality and extraction of data for included trials was undertaken independently by the authors. RevMan 4.1 was used for analysis of the data. MAIN RESULTS: Only one study, trial B in the report of Gersony 1983, was found eligible. The trial compared the effect of surgical ligation of @entity2461 versus medical treatment with @entity3352 , each used as the primary treatment. No trials comparing surgery to other cyclooxygenase inhibitors ( @entity5018 , @entity7154 ) were found. Trial B of Gersony 1983 enrolled 154 @entity1 . The study found no statistically significant difference between surgical closure and @entity3352 treatment in mortality during hospital stay, @entity1030 , other @entity548 , @entity3166 , @entity295 , @entity1011 level, or @entity548 . There was a statistically significant increase in the surgical group in incidence of pneumothorax [RR 2.68 (95% CI 1.45, 4.93); RD 0.25 (95% CI 0.11, 0.38); @entity15852 4 (95% CI 3, 9)] and @entity989 of @entity3465 grade III and IV [RR 3.80 (95% CI 1.12, 12.93); RD 0.11 (95% CI 0.02, 0.20), NNH 9 (95% CI 5, 50] compared to the @entity3352 group. There was as expected a statistically significant decrease in failure of ductal closure rate in the surgical group as compared to the @entity3352 group: [RR 0.04 (95% CI 0.01, 0.27); RD -0.32 (95% CI -0.43, -0.21), NNT 3 (95% CI 2, 4)]. REVIEWER'S CONCLUSIONS: The data regarding net benefit/harm are insufficient to make a conclusion as to whether surgical ligation or medical treatment with @entity3352 is preferred as initial treatment for symptomatic @entity2461 in preterm @entity1 .

Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm XXXX .

@entity1 :: ('9606', 'Species') :: ['patient', 'infants', 'infant'] @entity3166 :: ('MESH:D020345', 'Disease') :: ['necrotizing enterocolitis'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity548 :: ('MESH:D006470', 'Disease') :: ['intraventricular hemorrhage', 'bleeding'] @entity989 :: ('MESH:D012164', 'Disease') :: ['retinopathy'] @entity3465 :: ('MESH:C536271', 'Disease') :: ['prematurity'] @entity5018 :: ('MESH:D007052', 'Chemical') :: ['ibuprofen'] @entity2461 :: ('MESH:D004374', 'Disease') :: ['PDA', 'Patent ductus arteriosus'] @entity7154 :: ('MESH:D008528', 'Chemical') :: ['mefenamic acid'] @entity1030 :: ('MESH:D029424', 'Disease') :: ['chronic lung disease'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine'] @entity3352 :: ('MESH:D007213', 'Chemical') :: ['indomethacin'] @entity15852 :: ('CHEBI:30102', 'Chemical') :: ['NNH'] @entity1002 :: ('MESH:D018487', 'Disease') :: ['left to right']
@entity1 :: (9606,Species) :: ['infants']
