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Published on: January 27, 2023
Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome
Juliette C Madan1, Douglas Kendrick, James I Hagadorn
1aDivision of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA 02111, USA. jmadan@tuftsmedicalcenter.org
Insights
Surgical treatment for patent ductus arteriosus in extremely low birth weight infants may increase risks for neurodevelopmental impairment and bronchopulmonary dysplasia compared to indomethacin. Prophylactic indomethacin did not alter these outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Perinatal Research
Background:
- Patent ductus arteriosus (PDA) is a common complication in extremely low birth weight (ELBW) infants.
- Therapeutic interventions for PDA aim to prevent adverse outcomes, but treatment strategies vary.
- The comparative effectiveness of different PDA therapies in ELBW infants remains an area of active investigation.
Purpose of the Study:
- To evaluate the association between different therapies for patent ductus arteriosus and outcomes in extremely low birth weight infants.
- To determine if PDA treatment is a risk factor for death, neurodevelopmental impairment, bronchopulmonary dysplasia, or necrotizing enterocolitis.
- To compare outcomes associated with supportive care, indomethacin, and surgical interventions for PDA.
Main Methods:
- Retrospective analysis of infants born between 2000-2004 at 23-28 weeks' gestation and <1000g birth weight with PDA.
- Inclusion in the National Institute of Child Health and Human Development Neonatal Research Network Generic Data Base.
- Bivariable and multivariable analyses to assess PDA therapy as a risk factor for specific outcomes.
Main Results:
- Among 2838 infants with PDA, treatments included supportive care, indomethacin only, indomethacin with secondary surgery, and primary surgery.
- Supportive care and indomethacin-only groups showed similar outcomes.
- Primary and secondary surgical interventions were associated with increased risks of neurodevelopmental impairment and bronchopulmonary dysplasia compared to indomethacin alone; secondary surgery also showed decreased mortality risk.
- No significant difference in necrotizing enterocolitis risk was observed among treatments.
- Indomethacin prophylaxis did not alter the outcomes of PDA therapy.
Conclusions:
- Infants treated surgically for PDA may face higher risks of adverse short- and long-term outcomes compared to those treated with indomethacin.
- Surgical intervention for PDA in ELBW infants requires careful consideration due to potential increased risks.
- Early indomethacin prophylaxis did not mitigate the long-term consequences of PDA treatment strategies.
Objective:
The purpose of this work was to evaluate therapy for patent ductus arteriosus as a risk factor for death or neurodevelopmental impairment at 18 to 22 months, bronchopulmonary dysplasia, or necrotizing enterocolitis in extremely low birth weight infants.
Methods:
We studied infants in the National Institute of Child Health and Human Development Neonatal Research Network Generic Data Base born between 2000 and 2004 at 23 to 28 weeks' gestation and at <1000-g birth weight with patent ductus arteriosus. Patent ductus arteriosus therapy was evaluated as a risk factor for outcomes in bivariable and multivariable analyses.
Results:
Treatment for subjects with patent ductus arteriosus (n = 2838) included 403 receiving supportive treatment only, 1525 treated with indomethacin only, 775 with indomethacin followed by secondary surgical closure, and 135 treated with primary surgery. Patients who received supportive therapy for patent ductus arteriosus did not differ from subjects treated with indomethacin only for any of the outcomes of interest. Compared with indomethacin treatment only, patients undergoing primary or secondary surgery were smaller and more premature. When compared with indomethacin alone, primary surgery was associated with increased adjusted odds for neurodevelopmental impairment and bronchopulmonary dysplasia in multivariable logistic regression. Secondary surgical closure was associated with increased odds for neurodevelopmental impairment and increased adjusted odds for bronchopulmonary dysplasia but decreased adjusted odds for death. Risk of necrotizing enterocolitis did not differ among treatments. Indomethacin prophylaxis did not significantly modify these results.
Conclusions:
Our results suggest that infants treated with primary or secondary surgery for patent ductus arteriosus may be at increased risk for poor short- and long-term outcomes compared with those treated with indomethacin. Prophylaxis with indomethacin in the first 24 hours of life did not modify the subsequent outcomes of patent ductus arteriosus therapy.
