Patent Ductus Arteriosus Treatments and Neurodevelopment Outcome at 18 Months

Abstract

Introduction: Patent ductus arteriosus (PDA) is a common complication of prematurity associated with short and long term morbidities. The optimal treatment for PDA remains controversial, and recent data suggests that PDA ligation is associated with both increased neurosensory impairments and bronchopulmonary dysplasia. Objective: To determine whether PDA ligation is associated with increased neurosensory impairment in ELBW infants. Methods: Retrospective cohort study of all infants admitted to our Neonatal Intensive Care Unit (NICU) (British Columbia's Women's Hospital) between 1999 and 2004, born with weight less than 801 g. Infants that developed PDA were divided in 4 groups based on the treatment they received: supportive treatment, indomethacin only, indomethacin treatment followed by surgical ligation and primary surgical ligation. The data was extracted from the hospital database and chart reviews. Exposure to PDA ligation was the variable of interest. We excluded all infant with congenital anomalies and those who died in the first 48 hours. Sequential multidisciplinary assessments were performed at 18 months corrected age in the Neonatal Follow up Program. For the data analysis we used descriptive statistics to determine incidence of neurosensory impairment and univariate analyses. Results: We studied a total of 143 infants with less than 801 g. Median birth weight and gestational age was 670 +/- 94 g and 25 +/-1.8 weeks. Incidence of PDA was 64.1% (91/142). 12 infants had no treatment, 31 received indomethacin, 42 received indomethacin followed by ligation and 8 infants had primary surgical ligation. A total of 109 infants survived the neonatal period and 88 were assessed at 18 months in the follow up clinic. Twenty infants developed CP (22.7%), 21 infants had an MDI less than 70 (27.6%) and 16 had a PDI less than 70 (26%). Eight infants had sensoryneural deafness requiring aids (9.3%) and 7 infants became blind (8.1%). Infants that were exposed to ligation (n=50) showed a trend towards a higher incidence of CP (19% vs 5%) and an MDI less <70 (16% vs 8%) than infants that were not exposed to surgical ligation (n= 43) (p=0.07). Conclusion: We observed a high rate of PDA ligation in this population. There was a trend towards increased neurosensory impairment in infants exposed to ligation than those not. Further work is required to elucidate the role of PDA management.