Outcome of conservative and pharmacological treatment of hemodynamically significant patent ductus arteriosus in preterm infants less than 34 weeks

Abstract

Background: Preterm infants frequently have hemodynamically significant patent ductus arteriosus (PDA). Persistent ductal shunting may result in pulmonary hyper circulation, increasing the risk of mortality and morbidity. The effectiveness of active management, as well as the timing and modality of PDA treatment, is still debatable. Aim: The purpose of this study was to determine whether there was a difference in mortality and morbidity between conservative and pharmacological treatment of clinically significant PDA in preterm infants at <34 weeks. Design: Retrospective study. Setting: Comprised of two neonatal intensive care units (NICUs). Materials and Methods: NICUs medical records from 2017 to 2020. Statistical Analysis: Logistic regression analysis. Results: A total of 1059 medical records were screened for the study, with 106 preterm (PT) infants included. The mean gestational age was 29.2 ± 3.2 weeks, the mean birth weight (BW) was 1267 ± 485 g, and the mean length of stay in the hospital was 30 ± 20 days. Twenty patients (18.8%) received paracetamol, six patients (5.6%) received ibuprofen, one patient (0.9%) received surgical ligation, and one patient (0.9%) received indomethacin. Five patients (4.7%) received multiple courses of PDA medication. Nineteen patients (17.9%) received diuretics. [Table 1] also contains additional data characteristics. After adjusting the confounding variables, intraventricular hemorrhage (IVH) (odds ratio [OR]: 5 P: 0.04) and BW were found to increase mortality (OR: 0.87 P: 0.034). Conservative treatment (OR: 1.4, P = 0.38), paracetamol (OR: 0.87, P = 0.22), and ibuprofen (OR 1.2, P = 0.12) had no effect on mortality. None of the treatment modalities (conservative, paracetamol, or ibuprofen) has a significant effect on morbidities (IVH, bronchopulmonary dysplasia, retinopathy of prematurity, late onset sepsis, pulmonary hemorrhage, or necrotizing enterocolitis). Conclusion: In PT 34 weeks, there was no difference in mortality or morbidity between conservative and pharmacological treatment of hemodynamically significant PDA.