Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort studyResearch in context

Aimin Qian; Siyuan Jiang; Xinyue Gu; Shujuan Li; Xiaoping Lei; Wei Shi; Jianguo Zhou; Liyuan Hu; Tiantian Xiao; Yanping Zhu; Yun Cao; Lizhong Du; Wenhao Zhou; Shoo K. Lee; Rui Cheng; Rong Yin

EClinicalMedicine (Jan 2024)

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort studyResearch in context

Aimin Qian,
Siyuan Jiang,
Xinyue Gu,
Shujuan Li,
Xiaoping Lei,
Wei Shi,
Jianguo Zhou,
Liyuan Hu,
Tiantian Xiao,
Yanping Zhu,
Yun Cao,
Lizhong Du,
Wenhao Zhou,
Shoo K. Lee,
Rui Cheng,
Rong Yin

Affiliations

Aimin Qian: Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
Siyuan Jiang: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
Xinyue Gu: NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
Shujuan Li: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
Xiaoping Lei: Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
Wei Shi: Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Center for Child Health, Hangzhou, China
Jianguo Zhou: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
Liyuan Hu: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
Tiantian Xiao: Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
Yanping Zhu: Department of Neonatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
Yun Cao: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
Lizhong Du: Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Center for Child Health, Hangzhou, China
Wenhao Zhou: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
Shoo K. Lee: Maternal-Infant Care Research Center and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
Rui Cheng: Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China; Corresponding author. Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, 210008, China.
Rong Yin: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Corresponding author. Department of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.

Journal volume & issue: Vol. 67
p. 102356

Abstract

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Summary: Background: The optimal treatment strategy for patent ductus arteriosus (PDA) in extremely preterm infants is currently highly controversial. This study aimed to evaluate the association between PDA treatment and short-term outcomes among extremely preterm infants. Methods: This cohort study included all extremely preterm infants (≤27 and 6/7 weeks) who were admitted to hospitals participating in the Chinese Neonatal Network from January 2019 to December 2021, and were diagnosed to have PDA by echocardiogram. PDA treatment was defined as medical treatment and/or surgical ligation of PDA during hospitalization. Short-term outcomes included death, bronchopulmonary dysplasia (BPD), death/BPD, retinopathy of prematurity, necrotizing enterocolitis, and severe brain injury. Multivariate logistic regression was used to evaluate the association between PDA treatment and outcomes. Subgroup analysis were performed among infants with different respiratory support on 3 and 7 days of life. Findings: A total of 2494 extremely preterm infants with the diagnosis of PDA were enrolled, of which 1299 (52.1%) received PDA treatment. PDA treatment was significantly associated with lower risk of death (adjusted odds ratio, 0.48; 95% confidence interval, 0.38–0.60). The decreased risk of death was accompanied by increased risk of BPD and death/BPD. In subgroup analysis according to respiratory support, PDA treatment was associated with lower risk of death among infants who required invasive ventilation. However, the beneficial effect on death was not significant among infants who did not require invasive ventilation. Interpretation: PDA treatment was associated with reduced mortality in extremely preterm infants, but this beneficial effect was mainly present among infants who required invasive ventilation. Funding: This study was funded by the Shanghai Science and Technology Commission's Scientific and Technological Innovation Action Plan (21Y21900800) and the Canadian Institutes of Health Research (CTP87518).

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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