231 - Impact of Early Screening Echocardiography and Targeted PDA Treatment on Neonatal Outcomes in 22-23 Week Infants

Poster Number: 231
Publication Number: 231.33

Amy A.. Hobson, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Adrianne R. Bischoff, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Patrick J. McNamara, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Regan Giesinger, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States

Background:
Extremely preterm infants born at 22⁺⁰-23⁺⁶ are surviving at higher rates but have the greatest risk of patent ductus arteriosus (PDA) attributable morbidity and mortality. Research is sparse; however, severe bronchopulmonary dysplasia (BPD) has recently been associated with a tolerant approach to PDA.


Objective: To evaluate the impact of early targeted PDA treatment based on targeted neonatal echocardiography (TnECHO) as compared to a historical “symptom-based” approach on the composite outcome of death < 36 weeks or severe BPD among patients born 22⁺⁰-23⁺⁶ gestational age (GA).

Design/Methods: A retrospective analysis was performed of a prospectively collected cohort of neonates < 27 weeks admitted at < 24hr postnatal age at the University of Iowa. Eligible infants born < 24 weeks with a diagnosis of hemodynamically significant PDA (hsPDA) or who died in the 1^st postnatal week were enrolled. Neonates were categorized in the control epoch (CE) [1/09-12/17] or hemodynamics screening epoch (HSE) [10/18-10/21] depending on month of birth. All neonates in the HSE underwent standardized TnECHO evaluation of heart function, pulmonary hemodynamics, and PDA within the first 24hr to enable physiology specific therapy. Infants with a hsPDA [PDA score ≥ 6,Table 1] received IV acetaminophen treatment. The primary outcome was a composite of death or severe (grade 3) BPD. Interrupted time series analysis was used to adjust for birth year in the context of HSE and variables with p< 0.05 on univariate analysis.

Results: A total of 189 (n=73 HSE, n=116 CE) patients born 22⁺⁰-23⁺⁶ weeks were included. The median GA was similar between epochs; however, HSE patients had slightly higher birth weight and less likely to be female. Perinatal optimization (magnesium sulfate, delayed cord clamping) was more frequent in HSE; however, adverse maternal risk factors were more prevalent.[Table 2] Although medical PDA treatment increased, duration of PDA exposure and rate of interventional PDA closure were lower in HSE.[Table 2] There was a 50% reduction in the primary composite outcome in the HSE.[Table 3] Additionally, use of dopamine in the first week and major adverse outcomes [severe intraventricular hemorrhage, necrotizing enterocolitis, illness severity] were lower in the HSE. After adjusting for confounders, the HSE predicted a higher likelihood of survival free from severe BPD (aOR 5.1; 95% CI 1.3- 20.4, p= 0.023).[Table 4]

Conclusion(s): Among neonates born 22⁺⁰-23⁺⁶ weeks GA, early hsPDA diagnosis and targeted acetaminophen is associated with a reduced risk of the composite primary outcome of death or severe BPD.