204 - Comparing outcomes of medical and surgical treatments to conservative management of infants with a patent ductus arteriosus in two tertiary neonatal intensive care units (NICUs)

Poster Number: 204
Publication Number: 204.220

Mark Baker, Loma Linda University Children's Hospital, San Bernadino, CA, United States; Agatha M. Formoso, Phoenix Children's Hospital, Phoenix, AZ, United States; Becky Micetic, Mednax/Arizona Neonatology, Phoenix, AZ, United States; Christine Wade, Arizona Neonatology, Phoenix, AZ, United States; Keith S. Meredith, MEDNAX, Carefree, AZ, United States; Suganya Kathiravan, Banner University Medical Center-Phoenix/Arizona Neonatology-Mednax, Phoenix, AZ, United States

Background: Patent ductus arteriosus (PDA) is a common comorbidity with increasing frequency in lower birth weight and younger gestational age NICU patients. Depending on the size, a prolonged PDA can lead to severe complications such as pulmonary overcirculation, endocarditis, and eventual heart failure. Treatment options include conservative management, medical treatment with indomethacin, ibuprofen, and/or acetaminophen, and surgical closure. Large-scale studies have failed to demonstrate consistent long-term benefits for specific treatments.

Objective: To determine whether medical/surgical treatment of a PDA in extremely low birth weight (ELBW) infants leads to improved morbidity, mortality, and length of stay.

Design/Methods: A retrospective review was conducted on infants born from December 2017 to June 2021 weighing less than or equal to 1000 grams at birth with a confirmed PDA by echocardiogram. Demographics, type of treatment, median growth rate, length of stay, ventilator days, need for home oxygen, major comorbidities, and mortality were collected. Patients were divided into two cohorts, those that received only conservative management (Cohort 1), and those who received medical and/or surgical treatment with intent of closing the ductus (Cohort 2). Chi-square and Mann-Whitney U Tests were used for statistical purposes to determine significance between the two cohorts.

Results: There were 225 patients that met inclusion criteria with 79 (35%) in Cohort 1 and 146 (65%) in Cohort 2. Interestingly, male patients (P = 0.0246) and infants delivered via Cesarean section (P = 0.0162) were more likely to receive conservative treatment. The cohorts were similar in race, ethnicity, gestational age, and birth weight (Table 1). There were no significant differences in length of stay, weight gain, or number of ventilator days, nor were there differences in the need for home oxygen, rates of necrotizing enterocolitis, bronchopulmonary dysplasia, or mortality (P >0.05) (Table 2).Conclusion(s): The management of ELBW infants with a documented PDA was varied, although more than half received a medical and/or surgical intervention. In the treatment cohort, this study failed to demonstrate a significant improvement in several important outcomes or common comorbidities. This suggests that while treating a PDA may improve the day-to-day clinical course, it has little if any benefit to long term outcomes. Further research across multiple centers is needed to increase statistical power and to obtain generalizable results.
Comparing outcomes of medical and surgical treatments with conservative management of neonates with a patent ductus arteriosus in two community tertiary care neonatal intensive care unitsCV PAS 2022.pdf
Table 2Comparison of Outcomes