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Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants
Y P Saldeño1, V Favareto, J Mirpuri
1Division of Neonatal-Perinatal Medicine, BC Children's Hospital, Vancouver, BC, Canada. yolpesa@hotmail.com
Insights
Prolonged persistent patent ductus arteriosus (PP-PDA) in preterm infants is linked to increased morbidities. Early intervention for PDA may mitigate risks of serious health issues and improve long-term outcomes.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Perinatal Medicine
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants, with ongoing debate on optimal closure timing.
- Potential morbidities from delayed or untreated PDA are not well-documented.
- This study investigates the association between prolonged persistent PDA (PP-PDA) and adverse outcomes in extremely preterm infants.
Purpose of the Study:
- To determine if PP-PDA (lasting >3 weeks) is associated with increased morbidities in preterm infants born at ≤28 weeks gestation or weighing ≤1250g.
- To quantify the impact of PP-PDA on specific neonatal complications.
Main Methods:
- A matched case-control study analyzed 28 months of data from a level III US center.
- Infants with PP-PDA were compared to controls with PDA but without PP-PDA (2:1 ratio).
- Outcomes included mechanical ventilation, oxygen use, hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and more.
Main Results:
- PP-PDA significantly increased days on mechanical ventilation, oxygen, and length of hospital stay.
- Higher rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), and delayed growth (70% vs 21%) were observed in PP-PDA cases.
- Tracheostomy (15% vs 0%) and prolonged parenteral nutrition (>40 days, 70% vs 21%) were also significantly higher in the PP-PDA group.
Conclusions:
- Prolonged exposure to PDA is not benign and is associated with a higher prevalence of severe morbidities.
- These morbidities may have significant and lasting effects on infant health.
- The findings underscore the importance of considering the timing of PDA closure in preterm infants.
Objective:
Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants ≤28 weeks or 1250 g.
Study Design:
This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl(-1) and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and χ (2). Significance was set at P<0.05.
Result:
PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA.
Conclusion:
A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.
