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Effects of practice change on outcomes of extremely preterm infants with patent ductus arteriosus

B Ezenwa1, E Pena2,3, A Schlegel2,3

  • 1Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.

Acta Paediatrica (Oslo, Norway : 1992)
|May 29, 2018
PubMed

Insights

Reducing patent ductus arteriosus (PDA) treatment and ligation in extremely preterm infants did not increase mortality or bronchopulmonary dysplasia (BPD). This suggests PDA ligation may not improve outcomes in extremely preterm infants.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Clinical Research

Background:

  • Patent ductus arteriosus (PDA) is common in extremely preterm (EP) infants.
  • Management strategies for PDA, including medical treatment and surgical ligation, have evolved.
  • Recent literature suggested potential increased morbidities associated with PDA ligation.

Purpose of the Study:

  • To investigate the association between decreased PDA treatment and ligation rates and subsequent changes in mortality and morbidities in EP infants.
  • To evaluate the impact of updated clinical guidelines on PDA management in EP infants.

Main Methods:

  • An observational study was conducted on EP infants admitted between 2008 and 2015.
  • Data analysis focused on trends in PDA medical treatment and ligation rates.
  • Changes in mortality and key morbidities, including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and intraventricular hemorrhage, were assessed.

Main Results:

  • A significant decline in both PDA medical treatment and ligation rates was observed after 2010.
  • The annual mortality rate also significantly decreased during the study period.
  • Rates of BPD, necrotizing enterocolitis, and intraventricular hemorrhage remained unchanged.

Conclusions:

  • A substantial decrease in PDA ligation rates in EP infants since 2010 was not associated with adverse effects on mortality or BPD.
  • These findings support the notion that PDA ligation may not confer improved outcomes in EP infants.
  • The study suggests a re-evaluation of routine PDA ligation practices in this vulnerable population is warranted.
Abstract

Keywords:
Bronchopulmonary dysplasiaExtremely preterm infantNeurodevelopmental outcome

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