The Natural History of Patent Ductus Arteriosus and the Effects of late Patent Ductus Arteriosus Closure in Preterm Infants with severe Bronchopulmonary Dysplasia

Ansems, S. (Sophie) (2017) The Natural History of Patent Ductus Arteriosus and the Effects of late Patent Ductus Arteriosus Closure in Preterm Infants with severe Bronchopulmonary Dysplasia. thesis, Medicine.

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Abstract

Introduction: Patent ductus arteriosus (PDA) is a strong risk factor for development of bronchopulmonary dysplasia (BPD), the most common chronic complication of prematurity. However, treatment of PDA has not been clearly shown to reduce BPD risk. Given the increasing survival of extremely preterm infants and ongoing controversy regarding PDA treatment, optimal management of a PDA among infants with established severe BPD remains unknown. Objectives: To describe the incidence, echocardiography findings and PDA closure rates among preterm infants with severe BPD. To assess the association between late surgical PDA closure and the risk for the composite outcome of tracheostomy, treatment with a systemic pulmonary vasodilator at discharge, or death prior to discharge from neonatal intensive care unit (NICU). Finally, we assessed the relationship between PDA size and shunting direction on postoperative clinical deterioration. Methods: We retrospectively identified all infants born <32 weeks with severe BPD admitted to our tertiary referral center between 10/2010 and 7/2016 with echocardiographic evidence of a PDA at ≥ 36 weeks postmenstrual age (PMA). Infants with severe congenital anomalies were excluded. Echocardiograms (ECHO) recorderd at three time points (≥ 36 weeks PMA, discharge and 1 year of age) were independently re-reviewed for this study. Multivariate logistic regression assessed the influence of surgical PDA closure, PDA size and shunting pattern on the study outcomes. Results: Among a total of 329 infants admitted during the study period, 59 (18%) infants had a PDA at ≥ 36 weeks PMA. Demographic characteristics were similar between infants with and without a PDA at ≥ 36 weeks PMA. The majority of the 59 PDA infants had a small (56%) and left-to-right shunting (90%) PDA. Twenty-three (39%) infants underwent surgical PDA closure after 36 weeks PMA. Among the 12 infants with an open ductus at discharge and an ECHO available for review, half (n=6) demonstrated spontaneous closure within 9 months after discharge. After adjustment for potential confounders, surgical PDA closure after 36 weeks PMA was not associated with increased or decreased risk for the primary outcome (OR 1.84, 95% CI [1.01-3.35]). We found an increased risk for discharge on pulmonary vasodilator therapy among PDA surgery infants. However, after adjustment for pulmonary vasodilator treatment prior to surgery, this finding was no longer statistically significant. We did not detect a relationship between PDA size (OR 2.97, 95% CI 0.30-29.52) or shunting direction (OR 0.63, 95% CI 0.05-8.25) and postoperative clinical deterioration. Conclusions: This is the first study to describe the natural history of PDA after 36 weeks PMA in infants with severe BPD. We found a higher incidence of PDA after 36 weeks PMA than reported in other cohorts consisting of preterm infants without BPD. Half of the infants with a PDA at hospital discharge demonstrated spontaneous closure within 9 months post-discharge. Surgical PDA closure was not associated with increased odds for death, tracheostomy, or prolonged vasodilator therapy. PDA size and shunting direction were not associated with postoperative clinical deterioration.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Kooi, Dr. E.M. Universitair Medisch Centrum Groningen
Supervisor name:	Second supervisors: and Jensen, Dr. E. and and and Kirpalani, Dr. H. and Children’s Hospital of Philadelphia and Location: Children’s Hospital of Philadelphia, Department of
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:50
Last Modified:	25 Jun 2020 10:50
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1134

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