Related Experiment Video
Updated: Jul 30, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Patent Ductus Arteriosus Response to Treatment by Course and Associations with Perinatal and Clinical Factors
Austin D Rutledge1, Amy E Wahlquist2,3, Ekta U Patel4
1Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Insights
Chronological age at treatment initiation, not other factors, predicted patent ductus arteriosus (PDA) closure in preterm infants. Older infants were less likely to achieve PDA closure or response to medical treatment.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants.
- Medical management with acetaminophen and indomethacin is frequently used for PDA treatment.
- Understanding factors influencing PDA response is crucial for optimizing treatment strategies.
Purpose of the Study:
- To examine patent ductus arteriosus (PDA) response to medical treatment across multiple courses.
- To investigate associations between PDA response and various infant factors, including postmenstrual age (PMA), chronological age (CA), gestational age (GA), antenatal steroid exposure (ANS), birthweight (BW), weight at treatment initiation (WT), and PDA/left pulmonary artery (LPA) ratio.
Main Methods:
- A single-center retrospective cohort study included preterm infants (<37 weeks GA) treated for PDA between 2016 and 2018.
- Cox proportional hazards regression models were employed to analyze the association between infant factors and PDA response.
- Data on 289 treatment courses in 132 infants were analyzed.
Main Results:
- Overall, 64% of infants achieved definitive PDA closure, and 71% showed PDA constriction after treatment.
- Chronological age (CA) at treatment initiation was a significant predictor: each 7-day increase in CA reduced the likelihood of PDA closure by 59% (p=0.04) and response by 42% (p<0.01).
- PDA/LPA ratio was associated with treatment-associated PDA closure (p=0.01), with a 0.1 increase reducing closure likelihood by 19%.
Conclusions:
- PDA closure in this cohort was independent of PMA, GA, ANS, BW, and WT.
- CA at treatment initiation emerged as a key predictor for both treatment-associated PDA closure and overall PDA response.
- Most infants experienced PDA constriction rather than complete closure, even after multiple treatment courses.
Objective:
The objective of this study is to examine patent ductus arteriosus (PDA) response by treatment course and investigate associations with postmenstrual age (PMA), chronological age (CA), gestational age (GA), antenatal steroid exposure (ANS), birthweight (BW), weight at treatment initiation (WT), and PDA/left pulmonary artery (LPA) ratio.
Study Design:
This is a single-center retrospective cohort study of preterm infants less than 37 weeks' GA born January 1, 2016 to December 31, 2018 who received acetaminophen and/or indomethacin for PDA treatment. Cox proportional hazards regression models were used to determine whether factors of interest were associated with PDA response to medical treatment.
Results:
In total, 289 treatment courses were administered to 132 infants. Thirty-one (23%) infants experienced treatment-associated PDA closure. Ninety-four (71%) infants had evidence of PDA constriction following any treatment course. Ultimately, 84 (64%) infants experienced definitive PDA closure. For each 7-day increase in CA at the time of treatment initiation, the PDA was 59% less likely to close (p = 0.04) and 42% less likely to respond (i.e., constrict or close) to treatment (p < 0.01). PDA/LPA ratio was associated with treatment-associated PDA closure (p = 0.01). For every 0.1 increase in the PDA/LPA ratio, the PDA was 19% less likely to close in response to treatment.
Conclusion:
In this cohort, PDA closure is independent of PMA, GA, ANS, BW, and WT; however, CA at treatment initiation predicted both treatment-associated PDA closure and PDA response (i.e., constriction or closure), and PDA/LPA ratio was associated with treatment-associated closure. Most infants experienced PDA constriction rather than closure, despite receiving up to four treatment courses.
Key Points:
· Detailed PDA responses for up to four treatment courses provide a novel perspective.. · Chronological age at the start of treatment predicted treatment-associated PDA closure and response.. · For each 7-day increase in chronological age, the PDA was 59% less likely to close..
More Related Videos
06:04Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model
Published on: June 9, 2023
09:40Induction of Right Ventricular Failure by Pulmonary Artery Constriction and Evaluation of Right Ventricular Function in Mice
Published on: May 13, 2019
Related Concept Videos
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
01:22Mitral Stenosis I: Introduction
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...