48 - Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 48
Publication Number: 48.446

Maria Cristina Fernandez, Westchester Medical Center, Kearny, NJ, United States; Amy Reichlin, Maria Fareri Children's Hospital at Westchester Medical Center, Brooklyn, NY, United States; Jordan Kase, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Joseph Giamelli, Maria Fareri Children's Hospital at Westchester Medical Center, Pleasantville, NY, United States

Presenting Author(s)

Maria Cristina Fernandez Ramos, MD (she/her/hers)

Fellow
Westchester Medical Center
Kearny, New Jersey, United States

Background: PDA ligation has been associated with increased risk of morbidities and neurodevelopmental impairment (NDI). Percutaneous transcatheter closure (PTC) represents a potential paradigm shift in PDA management that may result in improved short- and long-term outcomes.

Objective: Review a cohort of preterm infants < 29 weeks of gestation at birth and compare morbidities and neurodevelopmental (ND) outcomes based on type of PDA closure.

Design/Methods: Retrospective-prospective cohort study of preterm infants born at 23-29 weeks gestation admitted to the Neonatal ICU at Maria Fareri Children’s Hospital (MFCH) at Westchester Medical Center between the years 2015-2020 who underwent surgical ligation or PTC of the PDA. Subjects were seen at The Regional Neonatal Follow Up Program affiliated with MFCH and had ND testing using the Bayley Scales of Infant Development 3^rd ed (BSID 3^rd). Subjects were compared by type of PDA closure using T-test for continuous variables, and Chi-Square for categorical variables. P< 0.05 is statistically significant.

Results: 34 infants were evaluated, 18 in the surgical ligation group (53%) and 16 in the PTC group (47%). Infants in the surgical group were more likely to be born to mothers with a diagnosis of chorioamnionitis. There was a statistically significant difference in day of transfer of outborn infants between groups, which could explain the difference in day of life (27.6±18 v 53.94±34, p=0.008) and corrected gestational age (CGA) (28.74±2.9 v 32.94±5.2, p=0.006) at procedure. Creatinine levels before and after procedure were higher in the surgical group, but no difference was seen in change of creatinine level between groups (-0.17±0.1 v 0.01±0.7). Infants in the surgical group were more likely to require high frequency ventilation after procedure (66.7% v 31.3%, p=0.039), and were on room air post-procedure later (day 80±24 v 46±27, p=0.004). Infants in the surgical group started enteral feeds post-procedure later (day 4.35±4.9 v 1.38±1, p=0.024), but this did not result in sooner achievement of full oral feeds. Vocal cord paralysis was highly associated with surgical ligation (44.4% v 6.7%, p=0.015). There was no significant difference in the BSID 3^rd composite cognitive (91±14.9 v 89±12.9, p=0.79), motor (86.6±16 v 87.6±15.9, p=0.905) or language (87.3±19.9 v 83±11.8, p=0.65) scores at 2 years CGA between groups.

Conclusion(s): Our findings suggest that PTC of the PDA may be associated with reduced short-term complications among very preterm infants compared to surgical ligation without increasing the risk of NDI. Data collection is ongoing to this date.