Low Rate of Spontaneous Closure in Premature Infants Discharged with a Patent Ductus Arteriosus: A Multicenter Prospective Study

Tolia, Veeral N.; Powers, George; Kelleher, Amy S.; Walker, M W; Herrman, Kristy K.; Ahmad, Kaashif A.; Buchh, Basharat; Egalka, Matthew C.; Hinkes, Michael T.; Ma, Meiyun; Richards, Moira; Rudine, Anthony C.; Sato, Ray; Clark, Reese H.

doi:10.1016/j.jpeds.2021.07.035

Cited by 11 publications

(25 citation statements)

References 18 publications

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“…It has been shown that cases with a larger PDA size are more prone to require assisted closure, either pharmacological or surgical, whereas minor PDAs are more likely to close spontaneously 22 . Despite differences in both PDA sizes and follow‐up period, our cohort of infants was in agreement with other studies that report similar median GA and birth weight, hence making our findings comparable 7,16–18 …”

Section: Discussionsupporting

confidence: 89%

“…Conservative PDA treatment has become more widespread, and as a consequence, more infants are discharged from the hospital with a PDA 7,8,15,16 . Among these infants, multiple studies have reported high rates of spontaneous PDA closure, up to 92% 7,16–18 . The present study confirmed a high rate of spontaneous PDA closure, which continued increasing until five years of follow‐up to 80%, emphasising the possibility of spontaneous ductal closure years after hospital discharge.…”

Section: Discussionsupporting

confidence: 79%

“…The recommendations imply ductal closure in cases with a moderate or large PDA with a left‐to‐right shunt, resulting in congestive heart failure, failure to thrive, pulmonary over circulation, or an enlarged left atrium or ventricle 29 . The proportion of infants requiring assisted closure in our study corresponds to previous findings 7,16–18 . The catheter‐based procedure is the most frequent surgical treatment in infants with a median GA of 27 weeks 17 .…”

Section: Discussionsupporting

confidence: 77%

“…Up to 22% of infants are discharged from the hospital with a PDA 7,16 which makes it crucial to comprehend the long‐term outcomes in these patients. In selected cohorts, the spontaneous closure rate after hospital discharge has been evaluated, with an incidence of up to 92% 7,16–18 . Only one study performed follow‐up until the closure of the PDA was obtained 16 .…”

Section: Introductionmentioning

confidence: 99%

“…In selected cohorts, the spontaneous closure rate after hospital discharge has been evaluated, with an incidence of up to 92%. 7 , 16 , 17 , 18 Only one study performed follow‐up until the closure of the PDA was obtained. 16 No other studies exist with a minimum follow‐up above 36 months.…”

Section: Introductionmentioning

confidence: 99%

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The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

et al. 2022

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Aim: The primary aim was to estimate premature infants' spontaneous patent ductus arteriosus closure rate. Secondly, to identify criteria associated with the chance of spontaneous closure. Methods:We performed a retrospective cohort study of 167 infants born before 32 weeks of gestation and diagnosed with a patent ductus arteriosus between 1 January 2008 and 31 December 2017. The spontaneous patent ductus arteriosus closure event rate was evaluated using the Kaplan-Meier estimator. Results:The spontaneous closure rate within the first year of life was 66% (95% CI 58%-73%), increasing to 80% (95% CI 72%-86%) five years after birth. When including both spontaneous closure and closure following treatment, 96% (95% CI 86%-100%) closed within 5 years after birth. The chance of spontaneous closure was reduced in the case of a large patent ductus arteriosus: OR 0.16 (95% CI 0.05-0.52), left atrial enlargement: OR 0.16 (95% CI 0.05-0.51), and pulmonary hypertension: OR 0.23 (95% CI 0.07-0.74). Conclusion:The chance of spontaneous closure in premature infants born between 23 and 32 weeks of gestation was high, and the incidence continued increasing until 5 years of follow-up.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

et al. 2022

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Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Villamor,

van Westering-Kroon,

Gonzalez-Luis

et al. 2023

JAMA Netw Open

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ImportanceBronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.ObjectiveTo explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.Data SourcesPubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.Study SelectionStudies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.Main Outcomes and MeasuresThe primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).ResultsA total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.Conclusions and RelevanceIn this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

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Going Home with a Patent Ductus Arteriosus: Is it Benign?

Bischoff

Moronta

McNamara

2022

The Journal of Pediatrics

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Low Rate of Spontaneous Closure in Premature Infants Discharged with a Patent Ductus Arteriosus: A Multicenter Prospective Study

Cited by 11 publications

References 18 publications

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow‐up

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Going Home with a Patent Ductus Arteriosus: Is it Benign?

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