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

TLDR

The study aimed to determine whether the link between patent ductus arteriosus and neonatal morbidities is due to the shunt itself, its treatments, or the infants’ immaturity. A cohort of 446 infants born before 28 weeks gestation received a standardized PDA care protocol, and logistic regression assessed how PDA presence, indomethacin dosing, ductal response, and surgical ligation influenced retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment. Results showed that most PDA‑related morbidity was explained by gestational immaturity, while surgical ligation independently increased chronic lung disease risk, underscoring uncertainty about its neonatal benefits and harms.

Abstract

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.