The Effect on Extubation of Early vs. Late Definitive Closure of the Patent Ductus Arteriosus in Premature Infants: A...

Area of Science:

• Neonatalogy
• Pediatric Cardiology
• Critical Care Medicine

Background:

• Premature infants often require patent ductus arteriosus (PDA) closure when pharmacotherapy fails or is contraindicated.
• The optimal timing for definitive PDA closure (surgical or device) in this population remains unclear.
• Early identification of PDA closure need does not guarantee expedited intervention, impacting respiratory outcomes.

Purpose of the Study:

• To compare the impact of early versus late definitive PDA closure on early respiratory outcomes in premature infants.
• To emulate a target randomized trial using real-world registry data to assess extubation timing.
• To evaluate the effect of intervention timing on the need for mechanical ventilation.

Main Methods:

• Emulation of a hypothetical randomized trial using a single-institution registry.
• Inclusion criteria: premature infants (<30 weeks gestation or <1500g birth weight) undergoing definitive PDA closure.
• Comparison of early (0-4 days) vs. late (5-14 days) closure strategies based on referral date.

Main Results:

• 131 infants were included; 70 adhered to early closure, 38 to late closure.
• Higher cumulative incidence of extubation in the early closure group until day 40 (max risk difference: 22 percentage points at day 13).
• No significant difference in extubation rates or need for mechanical ventilation at 45-day follow-up between groups.

Conclusions:

• Infants undergoing early PDA closure were extubated sooner than those in the late closure group.
• The overall need for mechanical ventilation was similar between early and late PDA closure strategies at 45 days.
• Timing of definitive PDA closure may influence the rate of extubation but not the ultimate need for ventilation support.