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Updated: Aug 16, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Association Between Early Screening for Patent Ductus Arteriosus and In-Hospital Mortality Among Extremely Preterm
Jean-Christophe Rozé1, Gilles Cambonie2, Laetitia Marchand-Martin3
1Department of Neonatal Medicine, Nantes University Hospital, Nantes, France2Epidémiologie Clinique, Centre d'Investigation Clinique (CIC004), Nantes University Hospital, Nantes, France.
Insights
Early screening echocardiography for patent ductus arteriosus (PDA) in extremely preterm infants is linked to reduced in-hospital mortality and pulmonary hemorrhage. Further research is needed for definitive conclusions on long-term outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Research
Background:
- There is no established consensus on screening and managing patent ductus arteriosus (PDA) in extremely preterm infants.
- Current practices show a trend towards less pharmacological intervention and more supportive care without strong evidence.
Purpose of the Study:
- To investigate the association between early screening echocardiography for PDA and in-hospital mortality in extremely preterm infants.
- To assess the impact of early PDA screening on neonatal morbidities.
Main Methods:
- A national prospective population-based cohort study (EPIPAGE 2) included preterm infants born before 29 weeks gestation.
- Infants were compared based on early screening echocardiography (before day 3) for PDA.
- Statistical analyses included propensity score matching and instrumental variable analysis to mitigate selection bias.
Main Results:
- Early PDA screening was associated with increased PDA treatment (OR, 1.62).
- Screened infants showed lower in-hospital mortality (OR, 0.73) and pulmonary hemorrhage (OR, 0.60).
- No significant differences were observed in necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions.
Conclusions:
- Early screening echocardiography for PDA in extremely preterm infants may reduce in-hospital mortality and pulmonary hemorrhage.
- The instrumental variable analysis suggests a potential mortality benefit, though with some ambiguity.
- Longer-term follow-up is necessary to fully understand the implications of early PDA screening.
Importance:
There is currently no consensus for the screening and treatment of patent ductus arteriosus (PDA) in extremely preterm infants. Less pharmacological closure and more supportive management have been observed without evidence to support these changes.
Objective:
To evaluate the association between early screening echocardiography for PDA and in-hospital mortality.
Design, Setting, And Participants:
Comparison of screened and not screened preterm infants enrolled in the EPIPAGE 2 national prospective population-based cohort study that included all preterm infants born at less than 29 weeks of gestation and hospitalized in 68 neonatal intensive care units in France from April through December 2011. Two main analyses were performed to adjust for potential selection bias, one using propensity score matching and one using neonatal unit preference for early screening echocardiography as an instrumental variable.
Exposures:
Early screening echocardiography before day 3 of life.
Main Outcomes And Measures:
The primary outcome was death between day 3 and discharge. The secondary outcomes were major neonatal morbidities (pulmonary hemorrhage, severe bronchopulmonary dysplasia, severe cerebral lesions, and necrotizing enterocolitis).
Results:
Among the 1513 preterm infants with data available to determine exposure, 847 were screened for PDA and 666 were not; 605 infants from each group could be paired. Exposed infants were treated for PDA more frequently during their hospitalization than nonexposed infants (55.1% vs 43.1%; odds ratio [OR], 1.62 [95% CI, 1.31 to 2.00]; absolute risk reduction [ARR] in events per 100 infants, -12.0 [95% CI, -17.3 to -6.7). Exposed infants had a lower hospital death rate (14.2% vs 18.5% ; OR, 0.73 [95% CI, 0.54 to 0.98]; ARR, 4.3 [95% CI, 0.3 to 8.3]) and a lower rate of pulmonary hemorrhage (5.6% vs 8.9%; OR, 0.60 [95% CI, 0.38 to 0.95]; ARR, 3.3 [95% CI, 0.4 to 6.3]). No differences in rates of necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions were observed. In the overall cohort, instrumental variable analysis yielded an adjusted OR for in-hospital mortality of 0.62 [95% CI, 0.37 to 1.04].
Conclusions And Relevance:
In this national population-based cohort of extremely preterm infants, screening echocardiography before day 3 of life was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage but not with differences in necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions. However, results of the instrumental variable analysis leave some ambiguity in the interpretation, and longer-term evaluation is needed to provide clarity.
