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Patent ductus arteriosus in preterm infants born at 23-24 weeks' gestation: Should we pay more attention?
Carlo Dani1, Fabio Mosca2, Francesco Cresi3
1Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Italy.
Insights
Infants born at 23-24 weeks gestation have a higher risk of hemodynamically significant patent ductus arteriosus (hsPDA) that often requires surgery. Management strategies for hsPDA in extremely preterm infants need careful consideration.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatology
Background:
- Extremely preterm infants (23-24 weeks gestation) face the highest risk of developing hemodynamically significant patent ductus arteriosus (hsPDA).
- hsPDA in this population is often refractory to medical management, necessitating surgical intervention.
- Existing studies on PDA closure have not specifically focused on this high-risk group.
Purpose of the Study:
- To compare the incidence of hsPDA between infants born at 23-24 weeks gestation and those born at 25-28 weeks gestation.
- To evaluate the failure rate of initial pharmacological treatment for hsPDA in these two groups.
- To determine the rate of surgical closure for hsPDA in infants across these gestational age ranges.
Main Methods:
- Retrospective multicenter study.
- Inclusion of infants born between 23 and 28 weeks gestation from January 2013 to December 2017.
- Echocardiographical assessment for hsPDA diagnosis, pharmacological treatment, and surgical closure.
Main Results:
- A higher incidence of hsPDA was observed in infants born at 23-24 weeks (70%) compared to 25-28 weeks (59%) gestation (P < 0.001).
- The failure rate of the first course of pharmacological treatment was significantly higher in the 23-24 weeks group (69%) versus the 25-28 weeks group (40%) (P < 0.001).
- Surgical closure was more frequently required in infants born at 23-24 weeks (19%) than in those born at 25-28 weeks (10%) (P < 0.011).
Conclusions:
- Infants born at 23-24 weeks gestation exhibit a greater risk of developing hsPDA that is refractory to medical treatment and requires surgical closure.
- Findings underscore the need for tailored and vigilant management strategies for hsPDA in extremely preterm infants.
- Individualized approaches are crucial for optimizing outcomes in this vulnerable population.
Background:
Infants born at 23-24 weeks' gestation have the highest risk of developing a hemodynamically significant patent ductus arteriosus (hsPDA), that is refractory to pharmacological closure requiring surgical ligation. Thus, these patients might have the greatest benefits from hsPDA closure, although previous studies on PDA closure were not focused on this population.
Aim:
To compare the occurrence of hsPDA, failure rate of the first course of ibuprofen in closing hsPDA, and need of surgical closure in infants born at 23+0-24+6 weeks' gestation to those in infants born at 25+0-28+6 weeks' gestation.
Study Design:
This is a retrospective multicenter study including infants born at 23+0-28+6 weeks of gestation admitted to the neonatal care units from January 2013 to December 2017. All infants underwent echocardiographical assessment for hsPDA diagnosis and eventually pharmacological treatment, and surgical closure.
Results:
We studied a total of 842 infants of which 562 (67%) developed a PDA. Among those with PDA, 511 (91%) received a pharmacological treatment for a hsPDA. We found that a hsPDA occurred in 70% (106/151) of infants born at 23-24 weeks and in 59% (405/691) of infants born at 25-28 weeks of gestation (P < 0.001). Failure of closure with the first-treatment cycle (69 vs. 40%; P < 0.001) and need of surgical closure (19 vs 10%) were more frequent (P < 0.011) in infants born at 23-24 than 25-28 gestational weeks. Paracetamol vs. ibuprofen treatment and gestational age of 23-24 versus 25-28 weeks increased closure failure, while less severe RDS and maternal clinical chorioamnionitis decreased it.
Conclusions:
Among extremely preterm infants, infants born at 23-24 weeks of gestation have the highest risk of developing a hsPDA refractory to pharmacological treatment requiring surgical closure. Our findings support the need of individualized more careful strategies for hsPDA management in this special population.