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Am J Perinatol 2024; 41(S 01): e1759-e1768
DOI: 10.1055/s-0043-1768962
Original Article

Patent Ductus Arteriosus Response to Treatment by Course and Associations with Perinatal and Clinical Factors

Austin D. Rutledge 
1   Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
,
Amy E. Wahlquist
2   Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
3   Department of Biostatistics and Epidemiology, Center for Rural Health Research, East Tennessee State University, Johnson City, Tennessee
,
Ekta U. Patel
4   Department of Pediatrics (Neonatology), Children's Mercy Hospital, Kansas City, Missouri
,
Anthony M. Hlavacek
1   Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
,
Rita M. Ryan
1   Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
5   Department of Pediatrics (Neonatology), Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio
,
Heidi J. Steflik
1   Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
› Institutsangaben Funding None
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Abstract

Objective The objective of this study is to examine patent ductus arteriosus (PDA) response by treatment course and investigate associations with postmenstrual age (PMA), chronological age (CA), gestational age (GA), antenatal steroid exposure (ANS), birthweight (BW), weight at treatment initiation (WT), and PDA/left pulmonary artery (LPA) ratio.

Study Design This is a single-center retrospective cohort study of preterm infants less than 37 weeks' GA born January 1, 2016 to December 31, 2018 who received acetaminophen and/or indomethacin for PDA treatment. Cox proportional hazards regression models were used to determine whether factors of interest were associated with PDA response to medical treatment.

Results In total, 289 treatment courses were administered to 132 infants. Thirty-one (23%) infants experienced treatment-associated PDA closure. Ninety-four (71%) infants had evidence of PDA constriction following any treatment course. Ultimately, 84 (64%) infants experienced definitive PDA closure. For each 7-day increase in CA at the time of treatment initiation, the PDA was 59% less likely to close (p = 0.04) and 42% less likely to respond (i.e., constrict or close) to treatment (p < 0.01). PDA/LPA ratio was associated with treatment-associated PDA closure (p = 0.01). For every 0.1 increase in the PDA/LPA ratio, the PDA was 19% less likely to close in response to treatment.

Conclusion In this cohort, PDA closure is independent of PMA, GA, ANS, BW, and WT; however, CA at treatment initiation predicted both treatment-associated PDA closure and PDA response (i.e., constriction or closure), and PDA/LPA ratio was associated with treatment-associated closure. Most infants experienced PDA constriction rather than closure, despite receiving up to four treatment courses.

Key Points

  • Detailed PDA responses for up to four treatment courses provide a novel perspective.

  • Chronological age at the start of treatment predicted treatment-associated PDA closure and response.

  • For each 7-day increase in chronological age, the PDA was 59% less likely to close.

Keywords

neonate - PDA - age - treatment - factors

Authors' Contributions

A.D.R., H.J.S., A.E.W., and R.M.R. were responsible for the study concept and design. A.D.R. and E.U.P. were responsible for acquisition of the data. A.E.W. was responsible for the statistical analysis. A.D.R. and H.J.S. were responsible for drafting of the manuscript. A.E.W., E.U.P., A.M.H., R.M.R., and H.J.S. were responsible for the interpretation of data and critical revision of the manuscript. All authors have reviewed and approved the final manuscript.




Publikationsverlauf

Eingereicht: 14. November 2022

Angenommen: 06. April 2023

Artikel online veröffentlicht:
18. Mai 2023

© 2023. Thieme. All rights reserved.

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