Neurodevelopmental Impairment at Two Years in Premature Infants with Prolonged Patency of Ductus Arteriosus after a Conservative Approach

Abstract

Objective The study aims to assess the impact on neurodevelopmental outcomes of a prolonged hemodynamically significant patent ductus arteriosus (PDA) after a conservative treatment. Study Design This involves the study of two cohorts of preterm infants 23 to 29 weeks gestation, before (n = 29) and after (n = 54) a conservative approach of PDA. We compared survival, major outcomes, and neurodevelopmental impairment (NDI) at 2 years and analyzed NDI in the conservative cohort according to the duration of the PDA. Results Conservative cohort received less medical (31.5%) and surgical treatment (7.4%) and had more days of PDA (59 days in 24–26 weeks and 22 days in 27–29 weeks; p < 0.001) in comparison with control cohort (19 days in 24–26 weeks and 11 days in 27–29 weeks; p = 0.688). Mortality, survival-without-morbidity at discharge, and NDI at 2 years were similar between the two groups (p = 0.732). In the multivariate analysis PDA >28 days was not related to worse outcomes at discharge (p = 0.296) or less survival-without-NDI at 2 years (p = 0.498). Conclusion Until randomized trials prove the benefit of attempting to close the PDA with ibuprofen in the first week of life, conservative management may be a reasonable option.

Conservative Treatment Without Any Intervention Compared With Other Therapeutic Strategies for Symptomatic Patent Ductus Arteriosus in Extremely Preterm Infants: A Nationwide Cohort Study in Korea

“…However, these interventions carry risks of short-and longterm adverse effects and complications (1-3). In addition, they might not reduce the risk of mortality and morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (4)(5)(6)(7)(8). Therefore, there have been growing calls for either abandoning routine interventions and/or more selective individualized interventions for PDA closure (9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

An Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosus

“…Treatment at or after 7 days was not associated with an increase in the risk of incidences of any morbidities. Long-term recent studies demonstrated that a conservative approach, even in the case of prolonged PDA, did not increase the risk of neurodevelopmental impairment ( 13 , 32 ).…”

“…Despite PDA's association with prematurity-related morbidities, no randomized controlled trial to date has demonstrated improvements in BPD, long-term neurodevelopmental outcomes or mortality after medical or surgical treatment of PDA (1,4,(9)(10)(11). Therefore, centers have been performing conservative follow-ups for PDA, especially since higher rates of spontaneous closure rates have been reported in the current era (12,13). A recent study that compared early routine treatment (ERT) of PDA with conservative management showed that ERT did not reduce either PDA ligations or the presence of a PDA at discharge, and did not improve secondary outcomes, However, ERT was associated with higher rates of late-onset sepsis (LOS) and death in infants born at >26 weeks of gestation (14).…”

Aminoglycosides were associated with higher rates of surgical patent ductus arteriosus closure in preterm infants

“…Overall, multicentre studies have reported a great variation in PDA-treatment rates among NICUs. 1,3 The effects of PDA treatment on long-term morbidity and mortality are being discussed controversially, 13,14,[17][18][19][20] which may partly explain the variation in treatment rates among NICUs worldwide.…”