Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus

Jania Jia-Ying Wu; Krishnamoorthy Niduvaje; Le Ye Lee; Zubair Amin

doi:10.1186/s12887-021-02920-9

Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus

BMC Pediatr. 2021 Oct 19;21(1):457. doi: 10.1186/s12887-021-02920-9.

Authors

Jania Jia-Ying Wu¹, Krishnamoorthy Niduvaje^{1

2}, Le Ye Lee^{3

4}, Zubair Amin^{1

2}

Affiliations

¹ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Healthcare System, Singapore, Singapore.
³ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. le_ye_LEE@nuhs.edu.sg.
⁴ Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Healthcare System, Singapore, Singapore. le_ye_LEE@nuhs.edu.sg.

Abstract

Background: Optimal management of haemodynamically significant patent ductus arteriosus (HsPDA) in premature babies remains controversial. Our aim is to compare death and/or adverse neurodevelopmental outcomes in extremely low birth weight (ELBW) infants with HsPDA who were managed with conservative [C], medical [M] and/or surgical [S] treatment, with secondary aim to examine short-term morbidities among [S] and [C] groups. The study also compared outcomes in very low birth weight (VLBW) infants with HsPDA and non-HsPDA.

Methods: A retrospective study of VLBW preterm infants born before 29 weeks in Singapore from 2007 to 2016 was conducted.

Results: A total of 474 VLBW infants were admitted in NUH from 2007 to 2016. Infants aged between 24 + 0 and 28 + 6 weeks of gestation, weighing ≤1500 g and diagnosed with patent ductus arteriosus (PDA) were included in the study, of which 172 infants (124 HsPDA and 48 non-HsPDA) were analyzed. Among infants with HsPDA, 17 infants were managed with [C], 83 with [M] and 24 with [S]. Mortality was not increased regardless of the presence of HsPDA or treatment received. Infants with non-HsPDA were less likely to have isolated speech delay (p < 0.05), but not global developmental delay (GDD). No significant differences in neurodevelopmental outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. [M + S] infants were at a higher risk of developing chronic lung disease (CLD) (OR 6.83, p < 0.05) and short-term growth failure compared to [C] infants. They were significantly shorter and had a smaller head circumference at discharge (p < 0.05). [M + S] infants also had elevated creatinine compared to those in group [C] (81.1 ± 24.1 vs 48.3 ± 11.8 umol/L, p < 0.000).

Conclusions: Compared to conservative management, infants requiring [M + S] treatment for HsPDA were more likely to have short-term complications such as CLD, elevated creatinine, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in infants managed with [M + S].

Keywords: Chronic lung disease; Conservative treatment; Death; Extremely preterm infants; Neurodevelopmental delay.

MeSH terms

Ductus Arteriosus, Patent* / therapy
Humans
Ibuprofen
Infant
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Retrospective Studies

Substances

Ibuprofen