Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

Abstract

Objective: Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants p28 weeks or 1250 g.Study Design: This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl À1 and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and w 2 . Significance was set at P<0.05.Result: PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA. Conclusion:A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.

Management of Patent Ductus Arteriosus in Premature Infants

“…The rationale behind the current approach are 1) in infants >1000 g, up to 67 % of PDA close spontaneously by 7 d and >94 % close before discharge [6], even in infants <1.0 kg 40 % of PDA close spontaneously [7], 2) early aggressive medical therapy is associated with side effects like oliguria, GI bleed, NEC and bowel perforation, 3) early therapy has not changed the morbidities like BPD, NEC and neurodevelopmental outcome. However a recent small prospective case controlled study (n=28) reported that prolonged persistent PDA (PP-PDA) in ELBW infants (<28 wk) was associated with significantly higher BPD, NEC and ROP compared to infants with closed PDA [29]. Thus there is no consensus regarding whom to treat, when to treat, and how to treat.…”

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

“…8,9 It has been postulated that persistent leftto-right shunt results in low systemic blood flow and retinal ischaemia, and thus is associated with higher risk of ROP development. 8,29 In addition, use of indomethacin to close PDA might reduce retinal blood flow and contribute to ROP development. 8,30 Dilated fundal examination in ROP screening is a stressful event for premature infants.…”

Necrotizing enterocolitis: current perspectives

“…In a more recent study, Saldeno et al compared babies with a persistent PDA for .3 weeks with babies with a persistent PDA for ,3 weeks. 56 Twenty-nine percent of babies with PDA for .3 weeks developed NEC compared with only 5% of babies with a PDA that persisted for ,3 weeks. Despite this, various trials that have targeted treatment of PDA have consistently failed to show any difference in the incidence of NEC.…”