12 - Outcomes in extremely preterm infants according to Patent Ductus Arteriosus attitude to treatment in a large multicenter cohort from South American NEOCOSUR network.

Poster Number: 12
Publication Number: 12.337

Maria G. Deu, Hospital Universitario Austral, buenos aires, Buenos Aires, Argentina; Milagros Risso, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Cecilia Cocucci, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Jose L L. TAPIA, Pontificia Universidad Católica de Chile, SANTIAGO, Region Metropolitana, Chile; Alvaro J. Gonzalez, Pontificia Universidad Catolica de Chile, Santiago, Region Metropolitana, Chile; Gabriel Musante, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina

Background: The diagnosis of Patent Ductus Arteriosus (PDA) is common in very low birth weight (VLBW) infants. Mortality and several co-morbidities are associated with the presence of PDA. To date, there is no consensus on its treatment and management varies widely among neonatal intensive care units (NICUs), regions and countries. However, there is a trend which supports a decrease on cyclooxygenase inhibitor therapy and surgical ligation. Nevertheless, evidence on how PDA treatment levels account for different outcomes is controversial.

Objective: To compare results in mortality and major morbidities by centers’ attitude to treatment in extremely preterm  infants with diagnosis of a PDA.

Design/Methods: We analyzed a cohort of VLBWs with Gestational Age (GA) 23-28 weeks born at NEOCOSUR centers between 2010 and 2020 with clinical or echocardiography diagnosis of PDA. Infants with major congenital malformations were excluded. Treatment attitude was defined as the percentage of infants diagnosed with a PDA that received treatment. Percentages were categorized into 3 groups: Conservative treatment (no treatment to 71% of treatment), Moderate treatment (% of treatment 71-80%) and Aggressive treatment (% of treatment >80%). Attitude to treatment was the main exposure variable. Main outcome was Death at the NICU. Secondary outcomes were Intracranial Hemorrhage Grades III-IV (IVH), Bronchopulmonary Dysplasia (BPD), Perforated NEC and combined outcomes of BPD/Death and IVH/Death. A step forward logistic regression model was fit with GA < 26wk, gender, Birthweight (BW) < 1000g, Apgar Score < 3 within the 1st minute of life, Intrauterine Growth restriction, prenatal steroids and NEOCOSUR observed/expected mortality index which reflects centers' performance as adjusting variables. GA and BW interactions were also explored.

Results: We analyzed 4035 infants from 32 centers (Table 1). Both conservative and aggressive attitude to treatment were significantly associated with poorer outcomes in death, Perforated NEC, IVH and IVH/Death than a moderate treatment attitude. There was a significant interaction between BW and treatment attitude. Tables 2&3 show crude and adjusted OR for main and secondary outcomes for BW strata (< or ≥1000grs).Conclusion(s): Our findings suggest that undertreatment and agressive treatment of PDA may be harmful and a moderate approach associates with better outcomes in extreme preterm infants. Moreover, BW and GA can be important factors to consider in the decision of treating a PDA.
Table 1. Demographic data*One Way ANOVA test for continuous variables. Chi Square test for categorical variables.

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