Patent ductus arteriosus (PDA) and response to late surfactant treatment in premature infants

Madeline S Beauchene; Alison M Cunningham; Amy H Stanford; Adrianne R Bischoff; John M Dagle; Danielle R Rios; Jonathan M Klein; Regan E Giesinger; Patrick J McNamara

doi:10.1038/s41372-023-01689-2

Patent ductus arteriosus (PDA) and response to late surfactant treatment in premature infants

J Perinatol. 2023 Oct;43(10):1245-1251. doi: 10.1038/s41372-023-01689-2. Epub 2023 May 9.

Authors

Madeline S Beauchene¹, Alison M Cunningham¹, Amy H Stanford¹, Adrianne R Bischoff¹, John M Dagle¹, Danielle R Rios¹, Jonathan M Klein¹, Regan E Giesinger¹, Patrick J McNamara^{2

3}

Affiliations

¹ Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA.
² Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA. patrick-mcnamara@uiowa.edu.
³ Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA. patrick-mcnamara@uiowa.edu.

PMID: 37160976
DOI: 10.1038/s41372-023-01689-2

Abstract

Objective: To determine the clinical/echocardiography (ECHO) phenotype of patients with hypoxic respiratory failure (HRF) and response to late surfactant, according to patent ductus arteriosus (PDA) status.

Study design: This retrospective study included infants ≤26⁺⁶ weeks gestation who received ≥1 surfactant dose after 6 postnatal days and where PDA status was available by ECHO. Response to surfactant was appraised based on change in respiratory severity score over 48 h. The relationship between PDA status and response to surfactant was evaluated via univariate analysis.

Result: We studied late surfactant (n = 71 doses) administration in 35 preterm infants born at a mean weight and GA at birth were 595 g (508, 696) and 23.3 (22.7, 25) weeks, respectively of whom 16 (46%) had a diagnosis of PDA. Positive response to late surfactant treatment was independently associated with absence of PDA [OR 26 (2, 334), p = 0.01] whereas presence of PDA was independently associated with negative response [OR 12 (1.1, 126), p = 0.04].

Conclusions: In neonates ≤26⁺⁶ weeks gestation, with HRF, response to surfactant after postnatal day 6 is influenced by PDA status. Future trials should consider PDA status which may enhance diagnostic precision and refine patient selection for late surfactant treatment.