Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?

Weisz, Dany E.; McNamara, Patrick J.

doi:10.4103/2249-4847.134670

Cited by 49 publications

(14 citation statements)

References 90 publications

(133 reference statements)

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“…The left to right shunt across a persistent PDA may lead to pulmonary over-circulation and left heart volume-overload (2). Delayed closure of a hemodynamically significant PDA has been reported to be associated with increased risk of bronchopulmonary dysplasia (BPD) / chronic respiratory disease (CLD), prolonged assisted ventilation, necrotizing enterocolitis (NEC), pulmonary hemorrhage, intraventricular hemorrhage (IVH), renal impairment and increased risk of mortality (2)(3)(4)(5)(6)(7)(8)(9)(10). This association led to numerous (more than 60) randomized controlled trials (RCTs) trying to prove that the treatment of PDA would be beneficial.…”

Section: Indications and Conventional Treatment Of A Hemodynamic Signmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

et al. 2020

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Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early-and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.

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Section: Indications and Conventional Treatment Of A Hemodynamic Signmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

et al. 2020

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“…Although a cause‐and‐effect relationship between PDAs and adverse outcomes has not been established,4 odds for death are sixfold higher in premature infants with a persistent PDA (failure of spontaneous or pharmacological closure) than with a closed ductus 5. Moreover, PDAs are considered precursors to respiratory morbidity, including prolonged ventilator dependency 2, 6…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Backes

Cheatham

Deyo

et al. 2016

JAHA

106

109

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BackgroundPercutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg.Methods and ResultsRetrospective analysis (January 2005–January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2–3.9 kg) underwent attempted PDA closure. Twenty‐five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01).ConclusionsAmong infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.

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“…The rates of SL are likely to fluctuate around a declining mean with increased adoption of conservative approaches, improved selection of SL patients, and alleviation of bias in SL outcome studies. 75,76 Improvements in catheter-based PDA closure techniques 77 may also reduce the need for SL in VLBW infants, as PDA treatments continue to be refined and scrutinized.…”

Section: Resultsmentioning

confidence: 99%

Changing patterns of patent ductus arteriosus surgical ligation in the United States

Reese

Scott

Patrick

2018

Seminars in Perinatology

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Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.

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Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?

Cited by 49 publications

References 90 publications

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Changing patterns of patent ductus arteriosus surgical ligation in the United States

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