The type and timing of patent ductus arteriosus treatment was associated with neurodevelopment when extremely preterm infants reached 6.5 years

Abstract

Aim This study investigated patent ductus arteriosus (PDA) treatment and neurodevelopmental outcomes when extremely preterm born children reached 6.5 years. Method Our cohort was 435 children with neonatal PDA treatment data and neurodevelopmental follow‐up data, born in 2004‐2007, who participated in the Extremely Preterm Infants in Sweden Study. Pharmacological or surgical PDA treatment and the age at PDA treatment, were investigated in relation to the risks of moderate to severe neurodevelopmental impairment (NDI) and full‐scale intelligence quotient (FSIQ) at 6.5 years. Results The children who received PDA drug treatment, including those who also had surgery, had the same risk of moderate to severe NDI or lower FSIQ as untreated children. However, children who had primary PDA surgery faced increased risks of NDI, with an adjusted incidence rate ratio of 1.62 (95% confidence interval [CI] 1.28‐2.06) and a lower adjusted mean difference FSIQ of −7.1 (95% CI −11 to −3.2). Surgery at less than 10 days of life was associated with a significantly increased risk of moderate to severe NDI and lower FSIQ than surgery after 20 days. Conclusion Drug treatment followed by deferred surgery appeared to be a safer option for extremely preterm infants severely affected by PDA.

An Update on Patent Ductus Arteriosus and What is Coming Next

“…In 2020, Gudmundsdottir et al 128 investigated PDA treatment with NSAIDs and neurodevelopmental outcomes when 435 extremely preterm infants reached age 6.5 years. PDA surgery at up to 10 days of life was associated with a significantly increased risk of moderate-to-severe NDI and lower full-scale intelligence quotient than surgery after 20 days.…”

“…125 The difficulty to define early hsPDA and the trend toward a less aggressive approach to treat PDA surgically during the last decade, have shown that postponing surgical treatment of late hsPDA in cases of failed medical treatment is both feasible and even safer in terms of reduced severe neurodevelopmental impairment. [126][127][128] Therefore, if there is a need of closing an hsPDA at a later stage, other less traumatic treatment options might might be preferred such as catheter-based PDA closure under fluoroscopic or echocardiographic guidance. 129,130…”

“…In the preterm lung, there is a delicate balance between increased fluid infiltration induced by PDA and lung lymphatic fluid reabsorption. Any increase in pulmonary microvascular pressure can cause a sudden increase in interstitial and Turk Arch Pediatr 2022; 57(2): [118][119][120][121][122][123][124][125][126][127][128][129][130][131] Erdeve et al alveolar lung fluid because the premature newborn has low oncotic pressure and high capillary permeability. 72 This inadequate structural development and function of the pulmonary vessels is an important feature of BPD.…”

Early closure mechanisms of the ductus arteriosus in immature infants

“…Patent ductus arteriosus ligation is associated with excess deaths, IVH, BPD and poor neurodevelopment 36,37 . Intravascular devices inserted by percutaneous catheterisation are associated with bleeding, misplacement and reopening 38,39 .…”

Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA

“…(3) One study done in Sweden found that primary surgical ligation of a PDA was associated with increased risk for NDI at 6.5 years of age. (17) Another study in Canada found that surgical ligation of the PDA was associated with decreased mortality but increased NDI in early childhood. (3) ELBW infants are the most vulnerable to the morbidities of surgical ligation.…”