Comparing Death or Neurodevelopmental Outcomes of Haemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight Preterm Infants

Abstract BackgroundOptimal management of haemodynamically significant patent ductus arteriosus (HsPDA) remains controversial for premature infants. Treatment options include conservative treatment with fluid restriction and diuretics, medical treatment with cyclo-oxygenase (COX) inhibitors or surgical ligation. Our primary objective is to compare the death and/or adverse neurodevelopmental outcomes among very low birth weight (VLBW) infants with HsPDA who were managed with conservative, medical and/or surgical treatment. The secondary objectives are to examine antenatal factors predisposing to surgical treatment and the neonatal short-term morbidities between three groups.MethodsThis was a retrospective, gestational age-stratified study of VLBW infants born in National University Hospital (NUH) in Singapore and admitted to the intensive care unit from 2007–2016.. Perinatal variables, short-term neonatal outcomes and neurodevelopmental outcomes were studied. Statistical analysis were performed with chi square and t-test.. Results124 infants were included. 17 VLBW infants managed conservatively [C] were identified and compared with 83 VLBW infants managed medically [M] and 24 VLBW infants managed surgically [S]. The main group analysis compared outcomes between infants managed [C] and those who received either medical or surgical treatment [M+S]. The subgroup analysis compared outcomes between infants managed [C] vs [M] and [C] vs [S]. The main group analysis found group M+S infants had a higher incidence of chronic lung disease (CLD) (p=0.005) than group C. The odds ratio (OR) of group M+S developing CLD was significant (OR 6.83). They were significantly shorter (p=0.017) and had a smaller head circumference (p=0.039) at discharge. Group S infants were older at discharge, due to a longer NICU stay , and were lighter , shorter and had a smaller head circumference (p<0.05). No significant differences in death, composite outcome of death and global development delay and neurological outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. Conclusions: Comparing the management, infants requiring surgical treatment for hsPDA were more likely to have short-term complications such as CLD, longer hospitalization, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in these infants. Further randomized control studies will be useful to verify these findings.