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Published on: December 23, 2022
Low Rate of Spontaneous Closure in Premature Infants Discharged with a Patent Ductus Arteriosus: A Multicenter
Veeral N Tolia1, George C Powers2, Amy S Kelleher3
1Department of Neonatology, Baylor University Medical Center and Pediatrix Medical Group, Dallas, TX; The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL.
Insights
Spontaneous closure of patent ductus arteriosus (PDA) occurred in 58% of premature infants by 18 months. The study highlights the need for close surveillance due to high rates of assisted closure and adverse events in these infants.
Area of Science:
- Neonatal medicine
- Pediatric cardiology
- Perinatology
Background:
- Patent ductus arteriosus (PDA) is common in premature infants.
- The natural history and outcomes of PDA after hospital discharge are not fully understood.
- Assessing spontaneous closure rates and adverse events is crucial for guiding management.
Purpose of the Study:
- To determine the rate and timing of spontaneous closure of PDA in premature infants discharged home.
- To evaluate the incidence of assisted closure and serious adverse events.
- To identify factors predicting spontaneous PDA closure.
Main Methods:
- Prospective, multicenter study.
- 201 premature infants (23-32 weeks gestational age) with PDA at discharge.
- Follow-up at 6-month intervals through 18 months of age.
Main Results:
- Spontaneous closure occurred in 47% by 12 months and 58% by 18 months.
- Assisted closure was performed in 8.4% of infants.
- Three infants (1.5%) died; no predictive factors for spontaneous closure were identified.
Conclusions:
- Spontaneous PDA closure rates are lower than previously reported.
- A significant proportion of infants require assisted closure or experience adverse events.
- Close post-discharge surveillance is essential for premature infants with PDA.
Objectives:
To assess the rate of spontaneous closure and the incidence of adverse events in infants discharged home with a patent ductus arteriosus.
Study Design:
In a prospective multicenter study, we enrolled 201 premature infants (gestational age of 23-32 weeks at birth) discharged home with a persistently patent ductus arteriosus (PDA) and followed their PDA status at 6-month intervals through 18 months of age. The primary study outcome was the rate and timing of spontaneous ductal closure. Secondary outcomes included rate of assisted closure and the incidence of serious adverse events.
Results:
Spontaneous ductal closure occurred in 95 infants (47%) at 12 months and 117 infants (58%) by 18 months. Seventeen infants (8.4%) received assisted closure with surgical ligation or device assisted occlusion. Three infants died (1.5%). Although infants with spontaneous closure had a higher mean birth weight and gestational age compared with infants with a persistent PDA or assisted closure, we did not identify other factors predictive of spontaneous closure.
Conclusions:
Spontaneous closure of the PDA occurred in slightly less than one-half of premature infants discharged with a patent ductus by 1 year, lower than prior published reports. The high rate of assisted closure and/or adverse events in this population warrants close surveillance following discharge.
Trial Registration:
ClinicalTrials.gov: NCT02750228.
