Pediatrics and neonatology · 2025
In-hospital and neurodevelopmental outcomes of treatment strategies for patent ductus arteriosus in preterm infants: A retrospective cohort study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Shen Ping, Su Ying-Chi, Lin Ming-Chih, Chen Wei-Yu, Tsao Pei-Chen, Lee Yu-Sheng, Jeng Mei-Jy
Аннотация
BACKGROUND: The optimal management of patent ductus arteriosus (PDA) in premature infants remains controversial. This study compares in-hospital and neurodevelopmental outcomes of different PDA treatment strategies in preterm infants.
METHODS: This retrospective study included infants with PDA born between 2017 and 2021, with a gestational age of 22 0/7 to 29 6/7 weeks or a birth weight of 401-1500 g. They were categorized into conservative treatment, medical treatment, or invasive closure with/without medication.
RESULTS: Among the 130 infants analyzed, 76 had hemodynamically significant PDA (hsPDA), which was present in 96.0 % of the invasive closure group, 76.1 % of the medical treatment group, and 2.6 % of the conservative group. For infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of bronchopulmonary dysplasia (BPD) ≥ grade II, retinopathy of prematurity (ROP) ≥ stage 3 and cognitive impairment compared with medical treatment. Among infants with PDA, compared to the conservative treatment group, infants receiving medication had a higher risk of death or BPD ≥ grade II. Invasive closure was associated with a higher risk of BPD ≥ grade II. No significant difference in neurodevelopmental outcomes was found, except for better cognitive outcome at 2 years of corrected age in the medical treatment group.
CONCLUSION: For preterm infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of BPD ≥ grade II, ROP ≥ stage 3, and cognitive impairment compared to medical treatment. Among infants with PDA, despite a more turbulent postnatal course, neurodevelopmental outcomes for those receiving medication or invasive closure were comparable to those managed conservatively. Despite multiple statistical approaches, the limited sample size and potential reverse causality bias remain concerns. Further studies are needed to determine the optimal treatment strategy for PDA in preterm infants.
METHODS: This retrospective study included infants with PDA born between 2017 and 2021, with a gestational age of 22 0/7 to 29 6/7 weeks or a birth weight of 401-1500 g. They were categorized into conservative treatment, medical treatment, or invasive closure with/without medication.
RESULTS: Among the 130 infants analyzed, 76 had hemodynamically significant PDA (hsPDA), which was present in 96.0 % of the invasive closure group, 76.1 % of the medical treatment group, and 2.6 % of the conservative group. For infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of bronchopulmonary dysplasia (BPD) ≥ grade II, retinopathy of prematurity (ROP) ≥ stage 3 and cognitive impairment compared with medical treatment. Among infants with PDA, compared to the conservative treatment group, infants receiving medication had a higher risk of death or BPD ≥ grade II. Invasive closure was associated with a higher risk of BPD ≥ grade II. No significant difference in neurodevelopmental outcomes was found, except for better cognitive outcome at 2 years of corrected age in the medical treatment group.
CONCLUSION: For preterm infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of BPD ≥ grade II, ROP ≥ stage 3, and cognitive impairment compared to medical treatment. Among infants with PDA, despite a more turbulent postnatal course, neurodevelopmental outcomes for those receiving medication or invasive closure were comparable to those managed conservatively. Despite multiple statistical approaches, the limited sample size and potential reverse causality bias remain concerns. Further studies are needed to determine the optimal treatment strategy for PDA in preterm infants.