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Published on: January 27, 2023
Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus
Frederick Alexander1, Louisa Chiu, Matthew Kroh
1Hackensack University Medical Center, Hackensack, NJ 07601, USA. falexander@humed.com
Insights
Surgical ligation offers better outcomes for extremely low birth weight (ELBW) infants with patent ductus arteriosus (PDA) compared to indomethacin, especially for high-risk infants. Ligation is linked to lower complication rates and improved survival in these vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Surgical Outcomes
Background:
- Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants.
- Indomethacin is a standard treatment for PDA in ELBW infants.
- Surgical intervention is an alternative, but its comparative effectiveness is debated.
Purpose of the Study:
- To compare predischarge outcomes of ELBW infants with PDA treated with no treatment, indomethacin, surgical ligation, or ligation after indomethacin failure.
- To determine if surgical ligation offers superior outcomes in select ELBW infants with PDA.
Main Methods:
- Retrospective comparison of 298 ELBW infants with echocardiography-proven PDA.
- Infants were grouped by treatment: no treatment, indomethacin, ligation, or ligation after indomethacin failure.
- Statistical analysis included chi-squared and Wilcoxon rank-sum tests.
Main Results:
- Surgical ligation (group 3) was associated with significantly lower gestational age, birth weight, and 5-minute Apgar scores compared to indomethacin (group 2).
- Post-treatment complications (renal failure, necrotizing enterocolitis, thrombocytopenia, IVH) were more frequent with indomethacin (groups 2 and 4) than with ligation (group 3).
- Survival rates were higher for infants receiving indomethacin or ligation (82.4%-92.7%) compared to no treatment (57.7%), with ligation showing favorable outcomes in high-risk infants.
Conclusions:
- Treatment for PDA in ELBW infants is crucial for maximizing survival.
- While indomethacin and ligation yield similar survival in low-risk infants, indomethacin has higher failure and complication rates.
- Surgical ligation is preferable for high-risk ELBW infants due to its lower complication rate and improved survival.
Purpose:
Indomethacin is accepted therapy for patent ductus arteriosus (PDA) in ELBW infants (<1000 g). We hypothesize that surgical ligation may provide comparatively superior outcomes in select ELBW infants.
Methods:
Predischarge outcomes of 298 ELBW infants with echocardiography-proven PDA were retrospectively compared by treatment provided: no treatment (group 1, n = 54), indomethacin (group 2, n = 140), ligation (group 3, n = 46), and ligation after indomethacin failure (group 4, n = 58). chi(2) and Wilcoxon rank sum tests were used to test for significance. Institutional review board approval was obtained (IRB/05-00395).
Results:
Group 3 had significantly lower gestational age (P < .001), birth weight (P = .006), and 5-minute Apgar scores (P = .03) compared with group 2. Group 3 and group 1 had a higher rate of pretreatment intraventricular hemorrhage (IVH) compared with group 2 (P < .001). By contrast, posttreatment complications including acute renal failure, necrotizing enterocolitis, thrombocytopenia, and IVH occurred more frequently in groups 2 (P = .004) and 4 (P = .001) compared with group 3. Survival was 57.7% in group 1 compared with groups 2, 3, and 4 (82.4%, 86.0%, and 92.7% respectively; P = .001). Preoperative conditions associated with nonsurvival include gestational age (P = .009), birth weight (P = .002), maternal preeclampsia (P = .015), 5-minute Apgar score (P = .013), and sepsis (P = .018). Posttreatment complications associated with nonsurvival include acute renal failure (P = .002), thrombocytopenia (P = .002), and necrotizing enterocolitis (P = .034). Survival was not influenced by any congenital comorbidity, pre- or posttreatment IVH, diameter of the PDA, or recurrence of the PDA after indomethacin therapy.
Conclusions:
(1) Patent ductus arteriosis requires treatment in ELBW infants to maximize survival. (2) Indomethacin and surgical ligation permit equivalent survival in low-risk ELBW infants, but indomethacin results in a high failure and complication rate requiring operative salvage in a number of patients. (3) Surgical ligation permits survival of high-risk ELBW infants with a low complication rate and is preferable to indomethacin in ELBW infants with the above risk factors.
