364 - Neurodevelopmental Outcomes Following Transcatheter Occlusion of PDA versus Surgical Ligation

Poster Number: 364
Publication Number: 364.132

Tynisha Koenigsaecker, University of California Davis Children's Hospital, Sacramento, CA, United States; Christina Callas, University of California Davis Children's Hospital, Sacramento, CA, United States; Steven McElroy, UC Davis, Sacramento, CA, United States; Frank Ing, University of California Davis Children's Hospital, Sacarmento, CA, United States; Catherine A. Rottkamp, University of California Davis, Sacramento, CA, United States

Background: The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain. In recent years, several trials have demonstrated successful and safe transcatheter PDA closure in premature infants (including extremely low birthweight, < 1500 g), a less invasive closure method as compared to surgical intervention. Whether transcatheter PDA closure represents a shift in PDA management that will result in improved short, and long-term outcomes, especially neurodevelopmental outcomes, is unknown.

Objective:
In this study, we aim to evaluate if there is a significant difference between transcatheter occlusion (TCO) and surgical ligation (SL) on neurodevelopmental outcomes at 16-30 months of age.

Design/Methods: A retrospective chart review was conducted of patients admitted to the Neonatal Intensive Care Unit at UC Davis Children’s Hospital who received either surgical ligation or transcatheter closure between the years of 2013 to 2019. Exclusion criteria included birth weight greater than 1500 grams, gestational age greater than 31 weeks, additional congenital heart disease, or inadequate neurodevelopmental follow-up data. Neurodevelopmental outcomes were assessed using Bayley III, Bayley IV or Developmental Profile-4 (DP-4) scores. The DP-4 parental questionnaire was used during telemedicine visits during the Sars-Cov2 pandemic. Data was obtained from 12 patients with SL, and 13 patients with TCO at 16-30 months of age. Developmental outcomes were assessed in cognitive, language, and motor domains. Additionally, incidence of intraventricular hemorrhage (IVH) > 2 was assessed.  Outcomes were measured by Chi-square and Students T-test respectively.

Results:
There was no significant difference in cognitive, language, or motor outcomes at either one or two standard deviations below the average. P values fell between 0.666 in language (two standard deviations below average) to 0.63 in motor (one standard deviation below average).  There was likewise no significant difference in rates of IVH between the two groups.
Conclusion(s):
Transcatheter closure of the PDA in very low birth weight (VLBW) infants has equivalent neurodevelopmental outcomes at 16-30 months of age compared to infants undergoing surgical ligation. This novel data is among the first to describe neurodevelopmental equivalence between the two procedures. Larger studies with longer follow-up is warranted.

Neurodevelopmental outcomes in VLBW infants following transcatheter occlusion of PDA versus surgical ligationNeurodevelopmental outcomes at 16-30 months in VLBW infants who underwent PDA closure with either surgical ligation (SL), or transcatheter occlusion (TCO). Data from 25 infants total was included in the cognitive and language domains, 12 who received PDA closure with SL and 13 with TCO. The motor domain included data from 21 infants total, 8 who received SL and 13 TCO. A Chi-square test demonstrated no significant difference in outcomes at either one standard deviation (SD), or two standard deviations below the average (Ave).