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Patent Ductus Arteriosus Persistence and Neurodevelopmental Outcomes: A Restrictive Treatment Approach Does Not
Moses Kallenberger1, Alina Bartling1, Britta Hüning1,2
1Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology and Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Insights
Patent ductus arteriosus (PDA) duration did not significantly impact neurodevelopment in very preterm infants. Gestational age and comorbidities were the primary determinants of outcomes in this cohort.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Cardiology
Background:
- Patent ductus arteriosus (PDA) management in preterm infants is debated.
- The impact of PDA duration on neurodevelopmental outcomes requires further investigation.
Purpose of the Study:
- To investigate the influence of PDA duration on neurodevelopmental outcomes in preterm infants treated restrictively.
- To determine if PDA duration affects neurodevelopment independently of gestational age and comorbidities.
Main Methods:
- Retrospective study of 171 preterm infants (≤32 weeks gestation) with or without PDA.
- Neurodevelopmental assessments included cerebral MRI, General Movement Assessment, and Bayley Scales of Infant Development III.
- Infants with severe IVH (≥III°) were excluded.
Main Results:
- Infants with hemodynamically significant PDA (hsPDA) had lower gestational age, birth weight, and higher rates of bronchopulmonary dysplasia.
- PDA duration showed a weak association with mild IVH (≤II°) in the hsPDA subgroup.
- Multivariate analysis revealed no significant impact of PDA group or duration on neurodevelopmental outcomes after adjusting for confounders.
Conclusions:
- Gestational age and comorbidities, not PDA duration, were the key factors influencing neurodevelopmental outcomes.
- Restrictive PDA treatment approaches may mitigate the direct impact of PDA duration on neurodevelopment in preterm infants without severe brain injury.
Aim:
Optimal treatment strategies for patent ductus arteriosus (PDA) and their impact on neurodevelopmental outcomes remain controversial. This study investigates the influence of PDA duration on neurodevelopment under a restrictive treatment approach.
Methods:
Retrospective single-center study of 171 preterm infants ≤ 32 weeks gestation with echocardiographically-identified PDA (treated hemodynamically significant PDA-hsPDA, untreated PDA-ntPDA) or no PDA. Assessments included cerebral MRI at term-equivalent age, General Movement Assessment at 8-16 weeks and Bayley Scales of Infant Development III at 22-26 months corrected age. Infants with severe IVH ≥ III° were excluded a priori to isolate PDA effects without major brain injury.
Results:
The hsPDA group represented infants with lower gestational age and birth weight, higher rates of bronchopulmonary dysplasia and longer hospitalization (all p < 0.001). Transcerebellar diameter differed significantly between groups (p = 0.004). PDA duration showed a statistical association with MRI-detected IVH ≤ II° in the hsPDA subgroup (OR 1.01 per day, p = 0.05). Multivariate analysis did not confirm any significant impact of PDA group or duration on neurodevelopmental outcomes after adjusting for confounders.
Conclusion:
Gestational age and comorbidities, rather than longer PDA duration, determined neurodevelopmental outcomes in our cohort of very preterm infants without severe brain injury.
