Abstract
Objective : Patent ductus arteriosus (PDA) is a common
complication among premature infants, and it may be responsible for
prematurity-related complications, such as bronchopulmonary dysplasia
(BPD). It is unclear whether different interventional methods contribute
to the severity of BPD. To date, surgical ligation and the transcatheter
approach have shown equal success in premature infants with
hemodynamically significant PDA after medical treatment failure.
Immediate improvement in the respiratory condition after transcatheter
closure has been reported. However, the short-term pulmonary outcome has
not been clarified yet. Methods : This retrospective study
investigated infants born with a body weight less than 1000 g and
underwent either surgical ligation or transcatheter closure of PDA in a
single tertiary institution. The infants were divided into groups
according to the type of procedure (surgical ligation or transcatheter
occlusion). The primary outcome was the severity of BPD at discharge or
at post-menstrual age of 36 weeks. The outcome was analyzed with
logistic regression. Results : Forty-four patients met the
inclusion criteria, and of these, 14 underwent transcatheter occlusion
and 30 underwent surgical ligation. The overall birth body weight and
gestational age ranges were not different. The univariate model revealed
an association between the procedure type and BPD severity. The
multivariate model confirmed associations of BPD severity with procedure
type and severe respiratory distress syndrome requiring surfactant after
adjusting for confounders. Conclusion : Compared with the
transcatheter approach, surgery for PDA in extremely preterm infants is
associated with severe BPD at discharge. Further large-scale studies are
needed to determine the exact mechanism.
Introduction
Patent ductus arteriosus (PDA) is a common cardiovascular complication
among premature infants, and it may be responsible for
prematurity-related complications. The ductus arteriosus is a vessel
between the pulmonary circulation and systemic circulation in a fetus.1 In most term infants, the ductus arteriosus closes
spontaneously. However, in premature infants, the ductus often fails to
close spontaneously. The spontaneous closure rate has been shown to be
inversely related to the birth gestational age, and it ranges from 13%
to 98%. 2
In premature infants, a hemodynamically significant PDA has been
reported to be associated with complications, such as pulmonary
hemorrhage, 3; 4 bronchopulmonary dysplasia (BPD),5; 6 intraventricular hemorrhage, 7;
8 renal dysfunction, necrotizing enterocolitis, 9neurological impairments, 10 and mortality.11; 12 A hemodynamically significant PDA will usually
be treated with non-steroidal anti-inflammatory drugs, such as ibuprofen
and indomethacin. A PDA may fail to respond to medical treatment and may
require non-pharmaceutical interventions. Surgical ligation is a
well-established procedure for a PDA that has not responded to medical
treatment. However, surgical ligation has been shown to be associated
with the development of BPD. 2; 13
Recently, transcatheter interventions involving ductus arteriosus
closure have been used in premature infants. Wang et al. reported the
detailed process and experience of performing this technique in very low
birth weight infants. 14 Numerous studies have
compared complications and success rates between transcatheter
techniques and surgical ligation, and no statistically significant
differences were noted. Furthermore, a comparison of the short-term
effects after transcatheter techniques and those after PDA ligation
revealed that transcatheter techniques improved the pulmonary score
earlier. The authors reported the immediate benefits of respiratory
trajectory following the transcatheter closure of PDA.15 However, the short-term impacts on the severity of
BPD at discharge have not been reported, especially for extremely
premature infants. Therefore, this retrospective study was conducted in
a single institution to investigate the association between the
different procedure types of PDA interventions and the severity of BPD
among extremely premature infants requiring intervention for a
hemodynamically significant PDA.
Material and Methods