Safety of Conservative Approach for Persistent Patent Ductus Arteriosus in Preterm Infants: Neurodevelopmental Outcomes at 5 Years of Age

Abstract

Patent ductus arteriosus (PDA) is a common problem among preterm infants. The standard of care for PDA has been to attempt to close the PDA by pharmacological treatment or surgical ligation. Recently, conservative approach for PDA (i.e., infants receive no treatment for PDA unless it is necessary for rescue) is gaining interest. However, when PDA is persisted under the conservative approach, there is a concern about the neurodevelopmental problems caused by decreased cerebral oxygenation. Our objective was to examine the risk of neurodevelopmental impairment in preterm infants, when PDA remained persistently open under conservative approach for PDA. We retrospectively analyzed data from the medical charts in 72 included infants (gestational age < 29 weeks, birth weight < 1,250 g). Under our conservative approach for PDA, we divided infants by their ductal patency: a closed ductus group (ductus closure within 14 days after birth, n = 52) and a persistent patent ductus arteriosus group (ductus closure after 14 days, n = 20). We compared the clinical parameters and neurodevelopmental outcomes assessed with the Kaufman Assessment Battery for Children (K-ABC) at 5 years of corrected age in two groups. Among the children who completed the K-ABC test, there were no significant differences in neurodevelopmental scores between a closed ductus group (n = 44) and a persistent patent ductus arteriosus group (n = 17). A conservative approach for PDA, even in the case of prolonged PDA, does not increase the risk of neurodevelopmental impairment at 5 years of corrected age in preterm infants.

Ductus Arteriosus of Extremely Preterm Twins is More Resistant to Cyclooxygenase Inhibitors Than Those of Singletons

“…There are no cardiovascular surgeons in our hospital, resulting in more indomethacin doses and delayed surgical ligation; therefore, our results may have been biased. Nevertheless, it is notable that there were no significant differences regarding neurodevelopmental outcomes between premature infants whose DA closed within 14 days and those whose DA remained open for a long time in our previous study [ 26 ]. In addition, although infants treated with indomethacin developed oliguria, all of them recovered without any sequelae.…”

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

“…In another retrospective Japanese cohort study, preterm infants born at < 29 weeks and exposed to a conservative policy regarding the PDA were evaluated at 5 years cGA, using the Kaufman Assessment Battery for Children. No increased risk of neurodevelopmental disorders was found at 5 years of corrected age (39). Those with a closed ductus within the rst 14 days of life were found to have similar neurodevelopmental scores when compared to those who achieved ductal closure after 14 days, indicating that early ductal patency duration did not signi cantly impact their outcomes.…”

Ciências Da Saúde: Conhecimentos Interdisciplinares Para O Fortalecimento Da Prática

“…Nesse contexto, ao aplicar a Bateria de Avaliação Kaufman para Crianças, um estudo mostrou que o tratamento conservador para PCA, mesmo se exposto a PCA mais prolongado, não afetou os resultados do neurodesenvolvimento da idade corrigida (IC) de 5 anos em prematuros. Não foram encontradas diferenças significativas nos escores aos 5 anos de IC entre o grupo de canal fechado em até 14 dias após o nascimento e o grupo de persistência do canal arterial por mais de 14 dias após o nascimento (KAGA et al, 2019).…”

“…Ainda nesse interim, diante de um cenário onde pacientes receberam alta hospitalar com PCA, outro estudo levantou a questão de como a manutenção de um shunt prolongado da esquerda para a direita pode afetar a perfusão cerebral e o status de crescimento. Contudo, sugere-se a realização de novas pesquisas, com uma amostra maior durante um maior de tempo de acompanhamento para avaliar de forma mais fidedigna os desfechos em longo prazo do desenvolvimento neurológico desses bebês (KAGA et al;BENITZ, 2019).…”