Patent Ductus Arteriosus Persistence and Neurodevelopmental Outcomes: A Restrictive Treatment Approach Does Not Compromise Neurological Development.

AIM: Optimal treatment strategies for patent ductus arteriosus (PDA) and their impact on neurodevelopmental outcomes remain controversial. This study investigates the influence of PDA duration on neurodevelopment under a restrictive treatment approach.

METHODS

Retrospective single-center study of 171 preterm infants ≤ 32 weeks gestation with echocardiographically-identified PDA (treated hemodynamically significant PDA-hsPDA, untreated PDA-ntPDA) or no PDA. Assessments included cerebral MRI at term-equivalent age, General Movement Assessment at 8-16 weeks and Bayley Scales of Infant Development III at 22-26 months corrected age. Infants with severe IVH ≥ III° were excluded a priori to isolate PDA effects without major brain injury.

RESULTS

The hsPDA group represented infants with lower gestational age and birth weight, higher rates of bronchopulmonary dysplasia and longer hospitalization (all p < 0.001). Transcerebellar diameter differed significantly between groups (p = 0.004). PDA duration showed a statistical association with MRI-detected IVH ≤ II° in the hsPDA subgroup (OR 1.01 per day, p = 0.05). Multivariate analysis did not confirm any significant impact of PDA group or duration on neurodevelopmental outcomes after adjusting for confounders.

CONCLUSION

Gestational age and comorbidities, rather than longer PDA duration, determined neurodevelopmental outcomes in our cohort of very preterm infants without severe brain injury.