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A comprehensive program for preterm infants with patent ductus arteriosus
Leah Apalodimas1, Benjamin Rush Waller Iii1, Ranjit Philip1
1Department of Pediatric Cardiology, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee.
Insights
Transcatheter PDA closure (TCPC) offers a safe and effective treatment for preterm infants with patent ductus arteriosus (PDA). A specialized clinic ensures optimal post-discharge follow-up, improving long-term outcomes for these vulnerable infants.
Area of Science:
- Neonatal Cardiology
- Pediatric Interventional Cardiology
- Neonatal Intensive Care
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants, potentially requiring intervention.
- Hemodynamically significant PDAs can impact infant health and require timely management.
Purpose of the Study:
- To describe a transcatheter PDA closure (TCPC) program tailored for preterm infants.
- To outline a comprehensive outpatient follow-up strategy for infants undergoing TCPC.
Main Methods:
- A multidisciplinary team approach was utilized for the care of extremely low birth weight (ELBW) infants.
- TCPC was performed on 134 ELBW infants, with detailed follow-up managed by the Memphis PDA Clinic.
- Outcomes were assessed based on respiratory support, enteral feeding tolerance, growth, and neurodevelopmental progress.
Main Results:
- TCPC facilitated faster ventilator weaning, improved enteral feeding tolerance, and enhanced somatic growth in ELBW infants.
- The Memphis PDA Clinic successfully provided optimal post-discharge follow-up, contributing to improved long-term outcomes.
- TCPC led to a shorter overall hospital length of stay.
Conclusions:
- Transcatheter PDA closure (TCPC) is a safe and effective intervention for hemodynamically significant PDAs in ELBW infants.
- A dedicated multispecialty clinic for post-discharge follow-up is crucial for improving outcomes in this population.
Objectives:
Patent ductus arteriosus (PDA) is a common finding in preterm infants. A hemodynamically significant PDA may require intervention for closure. This article aims to describe a transcatheter PDA closure (TCPC) program for preterm infants and the components of a comprehensive outpatient follow-up strategy.
Setting:
A multidisciplinary team approach including neonatology, cardiology, anesthesiology, medical transport team, pulmonology, cardiac surgery, neurodevelopmental specialist, nutrition, speech therapy, social work, research collaborators, and other health care specialists is integral to the dedicated care and promotion of wellness of extremely low birth weight (ELBW) infants.
Patients:
To date, we have performed TCPC on 134 ELBW infants weighing <2 kg at the time of the procedure, 54 of whom were <1 kg with the smallest weighing 640 g with a median gestation age of 25 weeks (range 23-27 weeks).
Interventions:
A comprehensive follow-up strategy with the creation of the Memphis PDA Clinic was implemented.
Outcome Measures:
Respiratory support, tolerance of enteral feeds, growth, and neurodevelopmental progress are indicators of favorable outcomes.
Results:
TCPC has benefited ELBW infants with faster weaning off the ventilator, increase in enteral feedings, and somatic growth with the overall shortening of the hospital length of stay. The Memphis PDA Clinic has ensured optimal postdischarge follow-up to improve long-term outcomes.
Conclusions:
TCPC is a safe and effective alternative to manage ELBW infants with a hemodynamically significant PDA. Comprehensive follow-up after discharge provided in a multispecialty clinic developed specifically for this unique population has been successful in improving outcomes.
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