240 - Non-interventional approach to PDA in preterm infants: time to look at the chronic pulmonary hypertension outcome

Poster Number: 240
Publication Number: 240.222

Audrey Hebert, Universite Laval, Quebec city, PQ, Canada; Gabriela De Carvalho Nunes, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Camille Maltais-Bilodeau, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada; Marie-Ève Leclerc, Faculty of Medicine Université Laval, Lévis, PQ, Canada; Punnanee Wutthigate, Mahidol University, Thailand, Montreal, PQ, Canada; Jessica simoneau, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; christine Drolet, Faculty of Medicine Université Laval, Quebec, PQ, Canada; Patrick J. McNamara, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Gabriel Altit, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Background: Controversy exists regarding management of the patent ductus arteriosus (PDA) in the extreme premature infant and its impact to neonatal outcomes. A non-interventional policy has been adopted by some centers, but its impact on the immature pulmonary vasculature has not been evaluated, especially in the context of bronchopulmonary dysplasia (BPD).

Objective: To evaluate the association between center-driven PDA management policy (interventional vs non-interventional) and rate of chronic pulmonary hypertension (cPH) in extreme premature newborns with BPD.

Design/Methods: Retrospective comparative evaluation of newborns < 29 weeks gestational age (GA), admitted within 24 hours of birth to two distinct centers (2017-2020), with a clinical diagnosis of BPD. Enrolled infants survived to the time of screening echocardiography (ECHO) at approximately 36 weeks post-menstrual age (PMA). Center A has a non-interventional PDA policy (no medical or surgical attempt to accelerate PDA closure). Center B has a targeted interventional policy based on ECHO significance. The primary outcome of cPH was defined by echocardiography evidence of systolic pulmonary pressure ≥40 mmHg or eccentricity index ≥1.3. Wilcoxon Mann Whitney and Chi-squared / Fischer exact tests were used for continuous and categorical variables. The outcome of cPH was analyzed by multi-logistic regression.

Results: Of 338 patients screened, 84 infants at Center A and 67 at Center B satisfied eligibility criteria. Figure 1. Infants at Center A had lower GA and weight at birth (Table 1), and a higher exposure to post-natal steroids (70% vs 42%, p=0.0008). In total, 73% of patients with PDA diagnosis at Center B were exposed to “PDA treatment”. A diagnosis of cPH occurred more frequently at Center A (36% vs 16%, p=0.009), Table 2. Tricuspid annular plane systolic excursion (TAPSE), a measure of right ventricular systolic performance, was also lower in the center A population (p < 0.0001). Exposure to the non-intervention PDA policy was associated with an increased odds of cPH after adjustment for gestational age and sex (OR: 2.92, 95%CI[1.28-7.14], p=0.01). The association remained in the subgroup with a closed ductus at the 36 weeks ECHO (OR: 4.38, 95%CI[1.41-16.87], p=0.02).Conclusion(s): In surviving preterm infants < 29 weeks GA with BPD, a non-intervention PDA treatment policy was associated with an increased occurrence of cPH. Future studies should characterize the relationship of PDA shunt burden of exposure to pulmonary vascular maldevelopment, and the impact of individualized management.
Figure 1: Flow diagram for patient inclusion
Table 1. Neonatal demographics & outcomes