Surgical ligation, not transcatheter closure, associated with a higher severity of bronchopulmonary dysplasia in extremely preterm infant intervened for patent ductus arteriosus

Abstract

Objective Patent ductus arteriosus (PDA) is a common complication among premature infants, which may be responsible for prematurity‐related complications such as bronchopulmonary dysplasia (BPD). It is unclear whether different interventional methods contribute to the severity of BPD, given the original National Institute of Child Health and Human Development (NICHD) 2001 definition. To date, surgical ligation and the transcatheter approach have been equally successful in premature infants with hemodynamically significant PDA after medical treatment failure. Immediate improvement in the respiratory condition has been reported after transcatheter closure. However, the short‐term pulmonary outcome has not been clarified yet. Methods This retrospective study investigated infants born with a body weight <1000 g and who underwent either surgical ligation or transcatheter closure of PDA in a single tertiary institution. The infants were divided into groups according to the type of procedure (surgical ligation or transcatheter occlusion). The primary outcome was the severity of BPD at discharge or at a postmenstrual age of 36 weeks. The outcome was analyzed with logistic regression. Results Forty‐four patients met the inclusion criteria, of whom 14 underwent transcatheter occlusion and 30 underwent surgical ligation. The overall birth body weights and gestational age ranges were not different. The univariate model revealed an association between the procedure type and BPD severity. After adjusting for confounders, the multivariate model confirmed associations between BPD severity and procedure type and severe respiratory distress syndrome requiring surfactant. Conclusion Compared with the transcatheter approach, surgery for PDA in extremely preterm infants is associated with severe BPD at discharge. Further large‐scale studies are needed to determine the exact mechanism.

Renal function after ductus arteriosus transcatheter closure with or without angiography in very preterm infants

“…With the development of new implantation techniques, new miniaturised devices and delivery systems, TCPDA is now being performed in patients ≥700 g 5,6 . Overall, clinical reports of TCPDA closure in VLBW infants show favourable clinical outcomes 7–10 …”

“…3,4 With the development of new implantation techniques, new miniaturised devices and delivery systems, TCPDA is now being performed in patients ≥700 g. 5,6 Overall, clinical reports of TCPDA closure in VLBW infants show favourable clinical outcomes. [7][8][9][10] Preterm infants are particularly susceptible to iatrogenic injury during TPCDA. 11,12 The procedure is now relatively standardised, but there are still some technical differences in TCPDA between centres.…”