Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 674-681 (doi:10.1542/peds.2007-2781)
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ARTICLE

Patent Ductus Arteriosus Therapy: Impact on Neonatal and 18-Month Outcome

Juliette C. Madan, MD, MSa, Douglas Kendrick, MSb, James I. Hagadorn, MD, MSc, Ivan D. Frantz, III, MDa the National Institute of Child Health and Human Development Neonatal Research Network

a Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
b StatEpi Division, RTI International, Research Triangle Park, North Carolina
c Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut

OBJECTIVE. The purpose of this work was to evaluate therapy for patent ductus arteriosus as a risk factor for death or neurodevelopmental impairment at 18 to 22 months, bronchopulmonary dysplasia, or necrotizing enterocolitis in extremely low birth weight infants.

METHODS. We studied infants in the National Institute of Child Health and Human Development Neonatal Research Network Generic Data Base born between 2000 and 2004 at 23 to 28 weeks' gestation and at <1000-g birth weight with patent ductus arteriosus. Patent ductus arteriosus therapy was evaluated as a risk factor for outcomes in bivariable and multivariable analyses.

RESULTS. Treatment for subjects with patent ductus arteriosus (n = 2838) included 403 receiving supportive treatment only, 1525 treated with indomethacin only, 775 with indomethacin followed by secondary surgical closure, and 135 treated with primary surgery. Patients who received supportive therapy for patent ductus arteriosus did not differ from subjects treated with indomethacin only for any of the outcomes of interest. Compared with indomethacin treatment only, patients undergoing primary or secondary surgery were smaller and more premature. When compared with indomethacin alone, primary surgery was associated with increased adjusted odds for neurodevelopmental impairment and bronchopulmonary dysplasia in multivariable logistic regression. Secondary surgical closure was associated with increased odds for neurodevelopmental impairment and increased adjusted odds for bronchopulmonary dysplasia but decreased adjusted odds for death. Risk of necrotizing enterocolitis did not differ among treatments. Indomethacin prophylaxis did not significantly modify these results.

CONCLUSIONS. Our results suggest that infants treated with primary or secondary surgery for patent ductus arteriosus may be at increased risk for poor short- and long-term outcomes compared with those treated with indomethacin. Prophylaxis with indomethacin in the first 24 hours of life did not modify the subsequent outcomes of patent ductus arteriosus therapy.

Key Words: patent ductus arteriosus • bronchopulmonary dysplasia • necrotizing enterocolitis • neurodevelopmental impairment • therapy ductus arteriosus

Abbreviations: PDA—patent ductus arteriosus • ELBW—extremely low birth weight • NEC—necrotizing enterocolitis • BPD—bronchopulmonary dysplasia • IVH—intraventricular hemorrhage • NRN GDB—Neonatal Research Network Generic Data Base • NDI—neurodevelopmental impairment • OR—odds ratio • RDS—respiratory distress syndrome

Accepted Jun 3, 2008.


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