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Intraventricular Hemorrhage and Patent Ductus Arteriosus Ligation Association with Infant Mortality
Robert J McLoughlin1, Brittany M Dacier2, Max D Hazeltine1
1Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Insights
Premature infants undergoing patent ductus arteriosus (PDA) ligation face higher mortality if they also have intraventricular hemorrhage (IVH). High-grade IVH (grades III or IV) significantly increases this risk, indicating a need for careful management strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Clinical Outcomes Research
Background:
- Management of patent ductus arteriosus (PDA) in premature infants is evolving.
- Intraventricular hemorrhage (IVH) is a common complication in premature neonates.
- The impact of PDA ligation on mortality in premature infants with IVH requires further investigation.
Purpose of the Study:
- To assess the association between PDA ligation and mortality in premature infants with co-existing intraventricular hemorrhage (IVH).
- To identify specific IVH grades that contribute to increased mortality risk following PDA ligation.
Main Methods:
- Utilized the Kids' Inpatient Database (KID) from 2006, 2009, and 2012.
- Identified premature neonates (gestational age ≤36 weeks) with IVH diagnosis.
- Analyzed PDA ligation procedures and outcomes using ICD-9 codes, case weighting, and multivariable logistic regression.
Main Results:
- 7567 hospitalizations for premature neonates undergoing PDA ligation were identified.
- Infants with IVH had increased mortality (10.7% vs. 6.3%) and longer hospital stays compared to those without IVH.
- High-grade IVH (grades III or IV) was significantly associated with increased in-hospital mortality risk (aOR 2.59 for any IVH, aOR 1.99 for grade III, aOR 3.16 for grade IV).
Conclusions:
- Premature neonates with high-grade IVH (grades III or IV) undergoing PDA ligation face a significantly elevated risk of mortality.
- These findings underscore the critical need to consider IVH severity when managing PDA in vulnerable premature infants.
- Current practice patterns for PDA management should account for the heightened mortality risk in the presence of severe IVH.
Background:
Practice patterns for the management of patent ductus arteriosus (PDA) in premature infants are changing with advances in medical management. We sought to determine the increased mortality for premature infants who had a PDA ligation with a co-existing diagnosis of intraventricular hemorrhage (IVH).
Methods:
Premature neonates (<1 y old with known gestational week ≤36 wk) with a diagnosis of IVH were identified within the Kids' Inpatient Database (KID) for the years 2006, 2009, and 2012. Diagnoses and procedures were analyzed by ICD-9 codes and stratified by a diagnosis of PDA and procedure of ligation. Case weighting was used to make national estimations. Multivariable logistic regression was performed to adjust for confounders.
Results:
We identified 7567 hospitalizations for premature neonates undergoing PDA ligation. The population was predominately male (51.6%), non-Hispanic white (41.1%), were from the lowest income quartile (33.1%), had a gestational week of 25-26 wk (34.0%), and a birthweight between 500 and 749 g (37.3%). There was an increased mortality (10.7% versus 6.3%, P < 0.01) and an increased length of stay (88.2 d versus 74.4 d, P < 0.01) in those with any diagnosis of IVH compared with those without. Adjusted multivariable logistic regression demonstrated that high-grade IVH (III or IV) was associated with a significantly increased risk of mortality in those undergoing PDA ligation (aOR 2.59, P < 0.01). Specifically, grade III and IV were associated with an increased odds of in-hospital mortality (aOR 1.99 and 3.16, respectively, P < 0.01).
Conclusions:
Attitudes regarding the need for surgical intervention for PDA have shifted in recent years. This study highlights that premature neonates with grade III or IV IVH are at significantly increased risk of mortality if undergoing PDA ligation during the same hospitalization.
Level Of Evidence:
III.
