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Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort
Estella M Janz-Robinson1, Nadia Badawi2, Karen Walker2
1Department of Medicine, Canberra Hospital, Garran, Australian Capital Territory, Australia.
Insights
Treatment for patent ductus arteriosus (PDA) in extremely preterm infants was associated with increased risk of adverse neurodevelopmental outcomes. This finding suggests a potential need for reconsidering PDA treatment strategies in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Perinatal Research
Background:
- Patent ductus arteriosus (PDA) is common in extremely preterm infants.
- Neurodevelopmental outcomes are a critical concern for this population.
- Current treatment strategies for PDA vary, with ongoing debate regarding optimal management.
Purpose of the Study:
- To compare neurodevelopmental outcomes in extremely preterm infants with PDA who received medical or surgical treatment versus those without PDA or untreated PDA.
- To identify potential risks associated with PDA treatment in this cohort.
Main Methods:
- Retrospective population-based cohort study.
- Included preterm infants born at <29 weeks gestation (1998-2004) from a defined region in Australia.
- Neurodevelopmental outcomes assessed at 2-3 years corrected age, defining moderate/severe disability.
Main Results:
- Infants with medically treated PDA (aOR 1.622) and surgically treated PDA (aOR 2.001) had significantly greater risk of adverse neurodevelopmental outcomes compared to infants without PDA or untreated PDA.
- This association was particularly pronounced in infants born at <25 weeks gestation.
Conclusions:
- PDA treatment in extremely preterm infants may be linked to a higher risk of adverse neurodevelopmental outcomes.
- Findings suggest a potential benefit of permissive tolerance for PDAs, warranting further investigation.
- Prospective trials are needed to elucidate the reasons for this association and guide future clinical practice.
Objective:
To compare neurodevelopmental outcomes of extremely preterm infants diagnosed with patent ductus arteriosus (PDA) who were treated medically or surgically and those who were not diagnosed with PDA or who did not undergo treatment for PDA.
Study Design:
This retrospective population-based cohort study used data from a geographically defined area in New South Wales and the Australian Capital Territory served by a network of 10 neonatal intensive care units. Patients included all preterm infants born at <29 completed weeks of gestation between 1998 and 2004. Moderate/severe functional disability at 2-3 years corrected age was defined as developmental delay, cerebral palsy requiring aids, sensorineural or conductive deafness (requiring bilateral hearing aids or cochlear implant), or bilateral blindness (best visual acuity of <6/60).
Results:
Follow-up information at age 2-3 years was available for 1473 infants (74.8%). Compared with infants not diagnosed with a PDA or who did not receive PDA treatment for PDA, those with medically treated PDA (aOR, 1.622; 95% CI, 1.199-2.196) and those with surgically treated PDA (aOR, 2.001; 95% CI, 1.126-3.556) were at significantly greater risk for adverse neurodevelopmental outcomes at age 2-3 years.
Conclusion:
Our results demonstrate that treatment for PDA may be associated with a greater risk of adverse neurodevelopmental outcome at age 2-3 years. This was particularly so among infants born at <25 weeks gestation. These results may support permissive tolerance of PDAs; however, reasons for this association remain to be elucidated through carefully designed prospective trials.
