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Patent Ductus Arteriosus in the Preterm Infant: An Update on Morbidity and Mortality
1DeVos Cardiovascular Research Program of Van Andel Institute-Spectrum Health, 333 Bostwick Avenue NE, Grand Rapids, MI 49503, USA. eric.kort@helendevoschildrens.org.
Insights
Patent ductus arteriosus (PDA) in preterm infants is unlikely to cause major long-term issues like mortality or chronic lung disease, but it remains a risk factor for intraventricular hemorrhage and potential neurological deficits.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Research
Background:
- Patent ductus arteriosus (PDA) is a frequent complication in preterm infants, with ongoing debate about its long-term consequences and the effects of interventions.
- The long-term impact of PDA and its iatrogenic closure in premature neonates remains a subject of clinical controversy.
Purpose of the Study:
- To systematically review and analyze the existing literature on the relationship between PDA and mortality and morbidity in preterm infants.
- To quantify the association between PDA and various adverse outcomes, including mortality, bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity.
Main Methods:
- A systematic literature review was conducted to identify relevant studies.
- Data from selected studies were abstracted and analyzed using linear modeling to determine summary estimates of effect size (odds ratio).
- Studies were categorized based on PDA exposure in case and control groups.
Main Results:
- Current data suggest PDA is unlikely to be significantly associated with mortality, bronchopulmonary dysplasia/chronic lung disease, necrotizing enterocolitis, or retinopathy of prematurity.
- However, the association with mortality warrants further discussion.
- PDA is identified as a risk factor for intraventricular hemorrhage, with potential implications for long-term neurological outcomes.
Conclusions:
- Further research is needed to fully understand the physiological effects of PDA and its closure in preterm infants.
- Identifying novel biochemical or physiological factors that mediate or confound PDA's effects is crucial for developing targeted therapies and improving patient outcomes.
Background:
Patent ductus arteriosus (PDA) is a common factor complicating the care of the preterm infant, but controversy remains regarding the long term effects of PDA and iatrogenic closure of PDA.
Methods:
Studies presenting data relevant to the relationship between PDA and mortality and morbidity were identified via a systematic literature review. These studies were classified based on PDA exposure in the case and control groups. The data was abstracted and summarized using linear modeling, resulting in summary estimates of mean effect size (odds ratio).
Results:
Recently published data suggests that a significant relationship between PDA and mortality, bronchopulmonary dysplasia/chronic lung disease, necrotizing enterocolitis, or retinopathy of prematurity is unlikely. However, the data related to mortality leaves room for some debate. Quantitative analysis of the data shows that PDA is a risk factor for intraventricular hemorrhage and related studies suggest this risk may carry over into long term neurological outcomes.
Conclusion:
Further efforts to better understand the physiologic consequences of PDA and its closure in preterm infants is necessary. A focus on new biochemical or physiologic factors that mediate or confound any apparent effect of PDA and are themselves amenable to targeted therapy is imperative to further progress in improving the outcomes of these patients.
