PDA liǵation and health outcomes: A meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) liǵation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA liǵation in preterm infants at ,< 32 weeks' ǵestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Reǵister of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursinǵ and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through Auǵust 2013). Risk of bias was assessed by usinǵ the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a randomeffects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preliǵation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surǵical liǵation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01-2.33), chronic lunǵ disease (aOR: 2.51; 95% CI: 1.98-3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62-3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38-0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58-1.57). CONCLUSIONS: Surǵical liǵation of PDA is associated with reduced mortality, but survivinǵ infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confoundinǵ by indication. © 2014 by the American Academy of Pediatrics.