EVOLUTION OF PATENT DUCTUS ARTERIOSUS IN EXTREMELY LOW GESTATIONAL AGE NEONATES: AN OBSERVATIONAL STUDY

Background Patent ductus arteriosus (PDA) has been associated with increased neonatal morbidity in preterm infants, although it is unknown if such an association is causative. Moreover, treatment of PDA induces adverse effects. Objective To assess the evolution of PDA in extremely low gestational age neonates (ELGAN) under an early, curative approach of asymptomatic, echocardiographically diagnosed PDA in a neonatal intensive care unit (NICU). Methods Observational study of PDA history and treatment in all newborns below 29 weeks hospitalised during an 18-month period in the NICU. Results 90 infants of mean gestational age 26.7 ± 1.2 weeks and mean birth weight 898 ± 224.8 g were included. Fifty-two had an echocardiographically significant PDA. In six, treatment was considered contraindicated. Treatment with ibuprofen allowed closure of the ductus arteriosus in 13 cases/46 only. There were no significant differences in mortality and morbidity between “success” and “failure” groups of infants who received ibuprofen, except for bronchopulmonary dysplasia, whose rate was higher in the “success” group. In the “failure” group, eight infants needed a surgical ligation and the ductus arteriosus closed spontaneously by a mean age of 3 months in 21 other infants. There were no significant differences in mortality and morbidity between these 21 infants and those in the “success” group. Two were still followed up at the end of the study and two died during hospitalisation. Conclusion In this study, PDA evolution and co-morbidity were little influenced by early attempts at closing the ductus arteriosus with ibuprofen. Randomised studies comparing pharmacological treatment of PDA with placebo are still needed.