211 - Association Between Treatment of Patent Ductus Arteriosus and Outcomes Among Extremely Preterm Infants

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 211
Publication Number: 211.329

Aimin Qian, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (People's Republic); Youyan Zhao, Children's Hospital of Nanjing Medical University, nanjing, Jiangsu, China (People's Republic); Wenhao Zhou, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Lizhong Du, The Children's Hospital,Zhejiang University, Hangzhou, Zhejiang, China (People's Republic); Shoo K. Lee, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Rui Cheng, Children's hospital of Nanjing Medical univercity, Nanjing, Jiangsu, China (People's Republic); Rong Yin, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Presenting Author(s)

Aimin Qian, MD (he/him/his)

none
Children’s Hospital of Nanjing Medical University
Nanjing, Jiangsu, China (People's Republic)

Background: The optimal treatment strategy for patent ductus arteriosus (PDA) in preterm infants is controversial. Although several studies reported that PDA treatment did not improve outcomes, these studies included relatively small number of extremely preterm infants (EPIs, < 28 weeks’ gestation), homogenized infants with different severity of disease, focused mainly on composite outcomes, and authorized rescue therapy in the non-treatment group.

Objective: Our objective was to examine the association between PDA treatment and short-term outcomes among EPIs using a large cohort from the Chinese Neonatal Network (CHNN), and to determine whether there was a subgroup of infants who might benefit from PDA treatment.

Design/Methods: This cohort study included all EPIs who were admitted to hospitals participating in CHNN from January 2019 to December 2021, and were diagnosed to have PDA by echocardiogram. PDA treatment was defined as medical treatment and/or surgical ligation of PDA during hospitalization. Short-term outcomes included death before discharge, bronchopulmonary dysplasia (BPD, defined as requiring supplemental oxygen or positive pressure support at 36 weeks corrected gestational age), death and/or BPD, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and severe brain injury. Multivariate logistic regression and generalized estimating equation were used to evaluate the association between PDA treatment and outcomes with adjustment of confounders. Subgroup analysis were performed among infants with different respiratory support on day 7 of life.

Results: A total of 2494 EPIs with PDA were enrolled, of which 1299 (52.1%) received PDA treatment. PDA treatment was significantly associated with lower risk of death (adjusted OR 0.48; 95% CI 0.38-0.60). The decreased risk of death was accompanied by increased risk of BPD and death and/or BPD. PDA treatment was associated with lower risk of death among infants who remained on invasive ventilation 7 days after birth (adjusted OR 0.49; 95% CI 0.33-0.71). However, there was no beneficial effect on death among infants who did not require invasive ventilation on day 7 of life (adjusted OR 1.01; 95% CI 0.69-1.47).

Conclusion(s): PDA treatment was associated with reduced mortality in EPIs, but the beneficial effect was only present among infants who remained on invasive ventilation 7 days after birth. Future studies are needed to identify the subgroup of EPIs who may benefit from PDA treatment.