Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1165-1174 (doi:10.1542/peds.2006-3124)
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ARTICLE

Patent Ductus Arteriosus and Its Treatment as Risk Factors for Neonatal and Neurodevelopmental Morbidity

Nancy Chorne, MDa, Carol Leonard, PhDa, Robert Piecuch, MDa and Ronald I. Clyman, MDa,b

a Department of Pediatrics
b Cardiovascular Research Institute, University of California, San Francisco, California

OBJECTIVES. The purpose of this work was to determine whether the reported association between neonatal morbidities and a patent ductus arteriosus is because of the left-to-right patent ductus arteriosus shunt itself, the therapies used to treat it, or the immaturity of the infants who are likely to develop a patent ductus arteriosus.

METHODS. A total of 446 infants (<28 weeks' gestation) were treated with the same patent ductus arteriosus care–oriented protocol, and logistic regression analysis was used to examine the effects of several patent ductus arteriosus–related variables (presence of a symptomatic patent ductus arteriosus, the number of indomethacin doses used, the ductus response to indomethacin, and the use of surgical ligation) on the incidence of retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment.

RESULTS. Most of the predictive effects that the presence of a patent ductus arteriosus and its treatment had on neonatal morbidity could be accounted for by the infants' immature gestation. Use of surgical ligation, however, was significantly associated with the development of chronic lung disease and was independent of immature gestation, other patent ductus arteriosus–related variables, or other perinatal and neonatal risk factors known to be associated with chronic lung disease.

CONCLUSIONS. These findings add to the growing uncertainty about the benefits and risks of surgical ligation during the neonatal period.

Key Words: patent ductus arteriosus • indomethacin • surgical ligation • chronic lung disease • necrotizing enterocolitis • retinopathy of prematurity • neurodevelopmental outcome • cognitive outcome • neurologic abnormality

Abbreviations: PDA—patent ductus arteriosus • NEC—necrotizing enterocolitis • CLD—chronic lung disease • ROP—retinopathy of prematurity • ICH—intracranial hemorrhage • MDI—Mental Development Index • FSIQ—full-scale IQ • OR—odds ratio

Accepted Jan 18, 2007.




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