Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Sung, Se In; Chang, Yun Sil; Ahn, So Yoon; Jo, Heui Seung; Yang, Misun; Park, Won Soon

doi:10.3389/fped.2020.605134

Cited by 12 publications

(6 citation statements)

References 75 publications

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“…Compared to the rate of surgery in cohorts in previous studies, this reflects a conservative approach in line with the general trend during the last decade, where increased survival has been observed with this strategy but also with a trend toward increased BPD, periventricular leukomalacia and ROP (7,23). In a recent mini-review of conservative treatment for PDA, the authors stated that there do exist evidence for this approach even in the most severe forms of hsPDA and in extremely pre-term infants without a concomitant increase in either mortality or morbidity (24,25). In addition, more than half of the infants in the Ligated groups in our study had been primarily pharmacologically treated for PDA and did not show any response to this treatment, reflecting the poor effectiveness of pharmacological treatment in extremely pre-term infants, as previously described by our group and others (26)(27)(28)(29)(30).…”

Section: Discussionsupporting

confidence: 54%

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

et al. 2021

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Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010–2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/−1 week) and time of birth (+/−1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24+5 ± 1+3 weeks and 668 ± 170 g) and the Control group (24+5 ± 1+3 weeks and 704 ± 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.

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Section: Discussionsupporting

confidence: 54%

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

et al. 2021

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“…Considering that studies on PDA treatment in the preterm population were not able to demonstrate meaningful short or long-term bene ts of neonatal outcomes (35), many institutions have opted to progressively adopt a more conservative approach (9,39,47). However, most studies have underrepresented the most immature population of preterm infants, which are those born at < 26 weeks and even those born at < 24 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Controversy exists regarding the optimal approach for PDA management in the extremely preterm infants (7)(8)(9). Indeed, medications like non-steroidal anti-in ammatory medications (NSAIDs) accelerate ductal closure without clear improvements in neonatal outcomes outlined by trials, and these medications have side effects that can impact neurodevelopmental outcomes, such as survival without CP (3,6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants

Cervera,

Saeed,

Luu

et al. 2024

J Perinatol

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Assess if unit-level PDA management correlates with neurodevelopmental impairment (NDI) at 18-24 months corrected gestational age (cGA) in extremely preterm infants. Study design:Retrospective analysis of infants born at < 29 weeks (2014-2017) across two units having distinct PDA strategies. Site 1 utilized an echocardiography-based treatment strategy aiming accelerated closure (control). Site 2 followed a conservative approach. Primary endpoint: NDI, characterized by cerebral palsy, any Bayley-III composite score < 85, sensorineural/mixed hearing loss, or at least unilateral visual impairment. Results377 infants were evaluated. PDA treatment rates remained unchanged in Site 1 but eventually reached 0% in Site 2. Comparable rates of any/signi cant NDI were seen across both sites (any NDI: 38% vs 36%; signi cant NDI: 13% vs 10% for Site 1 and 2, respectively). After adjustments, NDI rates remained similar. ConclusionPDA management strategies in extremely preterm newborns showed no signi cant impact on neurodevelopment outcomes at 18-24 months cGA. **Adjusted for bronchopulmonary dysplasia, chorioamnionitis, gestational age at birth and signi cant intraventricular hemorrhage (grade 3 or 4, or presence of periventricular leukomalacia).Abbreviations: Gross Motor Function Classi cation System (GMFCS).

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“…However, surgical treatment after the combined use of COX inhibitors delays the treatment timing by about 1 to 2 months, and it is also reported that the repeated administration of COX inhibitors may inhibit intimal thickening in the ductus arteriosus and thereby delay closure [34], likely resulting in an increase in the PDA exposure time [22,24,35]. Thus, the optimal timing of ductus arteriosus closure remains controversial, and there is even the view that patent ductus arteriosus is not a treatment target in preterm infants who does not present respiratory problems or other abnormalities [36]. However, the results of this study do not agree with this view.…”

Section: Discussionmentioning

confidence: 99%

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Kikuchi,

Goto,

Katsumata

et al. 2024

JCDD

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In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011–2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson’s correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the “posture/motor” sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.

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Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Cited by 12 publications

References 75 publications

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants

Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

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