Relationship between Duration of Infant Exposure to a Moderate-to-Large Patent Ductus Arteriosus Shunt and the Risk of Developing Bronchopulmonary Dysplasia or Death Before 36 Weeks

Ronald I. Clyman; Nancy K. Hills; Melissa Liebowitz; Sandy Johng

doi:10.1055/s-0039-1697672

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(02): 216-223
DOI: 10.1055/s-0039-1697672

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship between Duration of Infant Exposure to a Moderate-to-Large Patent Ductus Arteriosus Shunt and the Risk of Developing Bronchopulmonary Dysplasia or Death Before 36 Weeks

Ronald I. Clyman

¹Department of Pediatrics, University of California San Francisco, San Francisco, California

²Cardiovascular Research Institute, University of California San Francisco, San Francisco, California

,

Nancy K. Hills

³Department of Neurology, University of California San Francisco, San Francisco, California

,

Melissa Liebowitz

¹Department of Pediatrics, University of California San Francisco, San Francisco, California

,

Sandy Johng

¹Department of Pediatrics, University of California San Francisco, San Francisco, California

› Author Affiliations

Abstract

Objective This study was aimed to examine the relationship between duration of infant exposure to a moderate-to-large patent ductus arteriosus (PDA) shunt and the risk of developing bronchopulmonary dysplasia (BPD) or death before 36 weeks (BPD/death).

Study Design Infants <28 weeks' gestation who survived ≥7 days (n = 423) had echocardiograms performed on day 7 and at planned intervals.

Results In multivariable regression models, BPD/death did not appear to be increased until infants had been exposed to a moderate-to-large PDA for at least 7–13 days: OR (95%CI) (referent = closed or small PDA): moderate-to-large PDA exposure for <7 days: 0.38 (range, 0.10–1.46); for 7 to 13 days = 2.12 (range, 1.04–4.32); for ≥14 days = 3.86 (range, 2.15–6.96). Once the threshold of 7 to 13 days had been reached, additional exposure (≥14 days) did not significantly add to the increased incidence of BPD/death: (referent exposure = 7–13 days) exposure for 14 to 27 days = 1.34 (range, 0.52–3.45); for 28 to 48 days = 2.34 (range, 0.88–6.19); for ≥49 days = 1.80 (range. 0.59–5.47). A similar relationship was found for the outcome of BPD-alone.

Conclusion Infants < 28 weeks' gestation required at least 7 to 13 days of exposure to a moderate-to-large PDA before a significant increase in the incidence of BPD/death was apparent. Once this threshold was reached additional exposure to a moderate-to-large PDA did not significantly add to the increased incidence of BPD/death.

Keywords

ductus arteriosus - bronchopulmonary dysplasia - death - extremely low gestational age infants

Full Text

References

References
1 Sung SI, Chang YS, Chun JY. , et al. Mandatory closure versus nonintervention for patent ductus arteriosus in very preterm infants. J Pediatr 2016; 177: 66-71
2 Schena F, Francescato G, Cappelleri A. , et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr 2015; 166 (06) 1488-1492
3 Sellmer A, Bjerre JV, Schmidt MR. , et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed 2013; 98 (06) F505-F510
4 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010; 7 (07) CD000174
5 Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2003; 2 (02) CD003745
6 Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev 2015; 2 (02) CD003481
7 Ohlsson A, Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2011; 7 (07) CD004213
8 Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?. J Perinatol 2010; 30 (04) 241-252
9 Clyman RI, Liebowitz M, Kaempf J. , et al. PDA-TOLERATE trial: an exploratory randomized controlled trial of treatment of moderate-to-large patent ductus arteriosus at 1 week of age. J Pediatr 2019; 205: 41-48
10 Jhaveri N, Moon-Grady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr 2010; 157 (03) 381-387
11 El Hajjar M, Vaksmann G, Rakza T, Kongolo G, Storme L. Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed 2005; 90 (05) F419-F422
12 Liebowitz M, Clyman RI. Prophylactic indomethacin compared with delayed conservative management of the patent ductus arteriosus in extremely preterm infants: effects on neonatal outcomes. J Pediatr 2017; 187: 119-126
13 Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117 (04) 1113-1121
14 Walsh MC, Yao Q, Gettner P. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics 2004; 114 (05) 1305-1311
15 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
16 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
17 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7