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Ductus arteriosus and failed medical therapy
Tamara den Harink1, Sally-Ann B Clur1,2, Robin van der Lee3,4
1Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Cardiology, Amsterdam, The Netherlands.
Journal of Neonatal-Perinatal Medicine
|February 11, 2020
Summary
Surgical ligation of a patent ductus arteriosus (PDA) in preterm infants is influenced by respiratory support, heart size, and ductal steal. However, these factors explain limited variability, highlighting the need for evidence-based guidelines.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Practice Variation
Background:
- Management of patent ductus arteriosus (PDA) in preterm neonates after failed medical therapy is controversial.
- Significant practice variation exists in deciding PDA ligation strategies.
Purpose of the Study:
- To identify clinical and echocardiographic factors influencing the decision for surgical PDA ligation in preterm neonates.
- To evaluate predictors of surgical intervention following pharmacological treatment failure.
Main Methods:
- Retrospective single-center cohort study of preterm infants (<37 weeks gestation) with PDA.
- Inclusion criteria: PDA detected post-2 or 3 medical therapy courses.
- Logistic regression analysis used to assess predictors of surgical ligation.
Main Results:
- 45% of 89 included neonates underwent PDA ligation.
- Predictors for surgical ligation included invasive respiratory support (OR 3.6), left atrial/aortic root ratio (OR 5.48), and ductal steal (OR 3.82).
- Clinical and echocardiographic variables explained only 9% and 24% of ligation variability, respectively.
Conclusions:
- Invasive respiratory support, elevated left atrial/aortic root ratio, and ductal steal are key predictors for PDA ligation.
- The limited variability explained underscores the need for evidence-based guidelines for PDA management in preterm infants.
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