Journal Article

Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants

Graham, Brittany, Cunningham Jorden, Washington, Kristen, Stecchi Nathan, Sathanandam Shyam, Rush, Waller B, Apalodimas Leah, Chilakala Sandeep, Ranjit, Philip

2021

Overview

ObjectivesTo describe changes in hemodynamics, respiratory support, and growth associated with transcatheter PDA closure (TCPC) in ELBW infants, stratified by postnatal age at treatment.Study designThis is an observational study of ELBW infants who underwent TCPC at ≤4 weeks (Group-1; n = 34), 4–8 weeks (Group-2; n = 33), and >8 weeks of age (Group-3; n = 33). Hemodynamic assessment was performed during TCPC. Multivariate Cox-proportionate-hazard modeling was used to identify factors associated with respiratory severity score (RSS) > 2 for >30 days following TCPC.ResultsIn comparison with Group-1, Group-3 infants had higher pulmonary vascular resistance (PVRi = 3.3 vs. 1.6 WU*m2; P = 0.01), less weight gain between 4 and 8 weeks of age (16 vs. 25 g/day) and took longer to achieve RSS < 2 (median 81 vs. 20 days; P = 0.001). RSS > 2 for >30 days was associated with TCPC > 8 weeks (OR = 3.2, 95% CI: 1.75–5.8; p = 0.03) and PVRi ≥ 3 (OR = 4.5, 95% CI: 2.7–8.9; p < 0.01).ConclusionELBW infants may benefit from PDA closure within the first 4 weeks of life in order to prevent early onset pulmonary vascular disease, promote faster growth, and for quicker weaning of ventilator and oxygen support.

• Publisher: Nature Publishing Group
• Subject: Age / Birth weight / Cardiac catheterization / Clinical outcomes / Congenital diseases / Coronary vessels / Hemodynamics / Infants / Intubation / Low birth weight / Lung diseases / Nitric oxide / Pulmonary arteries / Vascular diseases / Veins & arteries / Ventilators / Weaning / Weight