Neurodevelopmental Outcome at 2 Years of Age according to Patent Ductus Arteriosus Management in Very Preterm Infants

Abstract

Background: Patent ductus arteriosus (PDA) is a condition frequently found in very preterm infants, and its treatment remains a subject of debate. Furthermore, there are only a few studies available that have examined the impact of these treatments on the neurological outcome of the patient. Objective: To evaluate the neurodevelopmental outcome of PDA treatment on preterm infants born between 24+0 and 28+6 weeks of gestation. Methods: We conducted an observational multicentric cohort study (LIFT Cohort). We compared three groups of patients according to their PDA treatment strategy: medical treatment with ibuprofen, surgical ligation, and no treatment. The neurodevelopmental outcome was assessed with a physical examination and cognitive function evaluation at 2 years of age. A propensity score was used to reduce bias in the analysis. Results: Between 2003 and 2011, 857 infants (91.3%) were evaluated at 2 years of corrected age and included in the analysis: 248 received ibuprofen treatment (29%), 104 had PDA surgical ligation (12%), and 505 did not receive any PDA treatment (59%). Surgical ligation of PDA was significantly associated with neurodevelopmental impairment at 2 years of age (adjusted odds ratio = 2.2; 95% confidence interval: 1.4-3.4). Conclusion: We found an association between PDA surgical ligation and a nonoptimal neurodevelopmental outcome at 2 years of age for preterm infants born before 29 weeks of gestation. These results suggest that if surgical ligation is unavoidable, particular attention should be given to the patient's neurodevelopmental follow-up.

Two-year neurodevelopmental outcomes of extremely preterm infants treated with early hydrocortisone: treatment effect according to gestational age at birth

“…Indeed, in the entire population enrolled in the PREMILOC trial, more infants without BPD had normal neurodevelopment outcome than those with BPD, a difference that was statistically significant in the hydrocortisone-treated group (113/143 (79%) vs 28/51 (55%), P=0.001), findings that are consistent with previous reports 18. PDA ligation has also been reported to be associated with a higher incidence of NDI in very preterm infants 19. Several reasons may explain the effect of hydrocortisone on PDA closure: (1) hydrocortisone treatment could decrease the sensitivity of the ductus arteriosus to the relaxing action of PGE2 as previously shown in vitro,20 21 (2) supplemental hydrocortisone could reduce the effect of low serum cortisol concentrations within the first week of life on the incidence of PDA, lung inflammation and chronic lung disease22 and (3) the beneficial effect of hydrocortisone on the rate of patients remaining extubated during the first 10 days and the mineralocorticoid effect of this treatment could play a role in the spontaneous closure of PDA.…”

Predictors of PDA Treatment in Preterm Neonates Who Had Received Prophylactic Indomethacin

“…We chose surgical ligation of PDA as our primary endpoint for two main reasons: it is a well-defined outcome with minimal bias due to misclassification and there is some evidence to suggest that PDA ligation could be associated with adverse neurodevelopmental outcomes in preterm neonates. [20][21][22] Our study has some important limitations, first being the drawbacks of a retrospective study design. In addition, several physicians during the study period treated PDA based on clinical signs alone without performing an echocardiogram and this might have resulted in overtreatment (medical) of some of the included babies.…”

Therapeutic potential to reduce brain injury in growth restricted newborns

“…no treatment (Bourgoin et al . ). In this retrospective study, ibuprofen treatment did not improve ‘non‐optimal outcome’ and there was no difference in mean developmental quotient.…”