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Published on: January 27, 2023
Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity
Nancy Chorne1, Carol Leonard, Robert Piecuch
1Department of Pediatrics, University of California, San Francisco, CA, USA.
Insights
Infant immaturity, not patent ductus arteriosus itself, largely explains morbidities. However, surgical ligation for patent ductus arteriosus is linked to chronic lung disease, independent of prematurity.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Research
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- The association between PDA and neonatal morbidities is complex.
- Distinguishing PDA effects from prematurity is crucial.
Purpose of the Study:
- To investigate if PDA morbidities stem from the shunt, its treatments, or infant immaturity.
- To analyze the impact of PDA and its management on specific neonatal outcomes.
Main Methods:
- Logistic regression analysis of 446 infants (<28 weeks' gestation).
- Examined PDA presence, indomethacin treatment, and surgical ligation.
- Assessed effects on retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment.
Main Results:
- Infant gestational immaturity explained most PDA-associated morbidities.
- Surgical ligation for PDA showed a significant association with chronic lung disease.
- This association with chronic lung disease was independent of gestational age and other risk factors.
Conclusions:
- Gestational immaturity is a primary driver of PDA-related morbidities.
- Surgical ligation for PDA carries risks, notably chronic lung disease.
- Evidence questions the net benefit of neonatal surgical ligation for PDA.
Objectives:
The purpose of this work was to determine whether the reported association between neonatal morbidities and a patent ductus arteriosus is because of the left-to-right patent ductus arteriosus shunt itself, the therapies used to treat it, or the immaturity of the infants who are likely to develop a patent ductus arteriosus.
Methods:
A total of 446 infants (<28 weeks' gestation) were treated with the same patent ductus arteriosus care-oriented protocol, and logistic regression analysis was used to examine the effects of several patent ductus arteriosus-related variables (presence of a symptomatic patent ductus arteriosus, the number of indomethacin doses used, the ductus response to indomethacin, and the use of surgical ligation) on the incidence of retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment.
Results:
Most of the predictive effects that the presence of a patent ductus arteriosus and its treatment had on neonatal morbidity could be accounted for by the infants' immature gestation. Use of surgical ligation, however, was significantly associated with the development of chronic lung disease and was independent of immature gestation, other patent ductus arteriosus-related variables, or other perinatal and neonatal risk factors known to be associated with chronic lung disease.
Conclusions:
These findings add to the growing uncertainty about the benefits and risks of surgical ligation during the neonatal period.
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