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Morbidities associated with patent ductus arteriosus in preterm infants. Nationwide cohort study
Pia Härkin1,2, Riitta Marttila1,2, Tytti Pokka1,2
1a PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu , Finland.
Insights
The severity of lung disease, not just prematurity, predicts the need for patent ductus arteriosus (PDA) treatment in preterm infants. Treatments for PDA were linked to severe bronchopulmonary dysplasia, with surgical ligation increasing risks of intraventricular hemorrhage and necrotizing enterocolitis.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Research
Background:
- Patent ductus arteriosus (PDA) is a common complication in preterm infants.
- Predictive factors and treatment morbidities of PDA require further investigation.
Purpose of the Study:
- To identify factors predicting hemodynamically significant PDA in preterm infants.
- To assess morbidities associated with PDA treatments during initial hospitalization.
Main Methods:
- Analysis of Finnish national register data (2005-2013) for preterm infants (<32 weeks).
- Comparison of morbidities between infants treated (n=1132) and untreated (n=2536) for PDA.
- Statistical adjustment for gestational age, growth, antenatal steroids, delivery hospital, and respiratory distress syndrome (RDS).
Main Results:
- Respiratory distress syndrome (RDS) and mechanical ventilation independently increased PDA treatment risk.
- Medical and surgical PDA treatments correlated with severe bronchopulmonary dysplasia (BPD).
- Surgical ligation was linked to increased risks of severe intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC); however, treatments were associated with lower mortality.
Conclusions:
- Lung disease severity, rather than prematurity alone, is associated with PDA requiring therapy.
- Both medical and surgical PDA therapies are linked to severe BPD.
- Primary surgical ligation is associated with NEC and severe IVH, though treatments may reduce mortality.
Purpose:
To evaluate the predictive factors for the development of haemodynamically significant patent ductus arteriosus (PDA) in preterm infants and to study the morbidities associated with the treatment of PDA during the first hospitalization.
Materials And Methods:
Data were collected from the Finnish national register of preterm infants (<32 gestational weeks) born in 2005-2013. In total, 3668 infants were included. Morbidities during the first hospitalization were analysed and compared between infants who received treatments for the closure of PDA (n = 1132) and infants who received no treatment for PDA (n = 2536). The results were adjusted for the duration of pregnancy, intrauterine growth pattern, antenatal steroids, delivery hospital and respiratory distress syndrome (RDS).
Results:
RDS and mechanical ventilation were independently associated with an increased risk of PDA requiring treatment. Medical and surgical treatments were associated with the risk of severe bronchopulmonary dysplasia (BPD). Primary surgical ligation was associated with an increased risk of severe intraventricular haemorrhage (IVH) and necrotizing enterocolitis (NEC). Medical treatment itself and also followed by surgical ligation was associated with lower mortality.
Conclusion:
The severity of lung disease rather than prematurity per se was associated with the development of PDA requiring therapy. Both medical and surgical therapies for PDA were associated with severe BPD, and primary surgical ligation was associated with NEC and severe IVH.
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