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

Journal of Perinatology volume 41, pages 100–108 (2021)Cite this article

Subjects

Abstract

Objectives

To describe changes in hemodynamics, respiratory support, and growth associated with transcatheter PDA closure (TCPC) in ELBW infants, stratified by postnatal age at treatment.

Study design

This 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.

Results

In 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).

Conclusion

ELBW 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.

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Fig. 1: Echo and angiograms pre- and post-transcatheter PDA closure.
Fig. 2
Fig. 3: Hemodynamic assessment of 40 infants with pulmonary hypertension (PHT), which is defined as pulmonary vascular resistance >3 WU*m2 under three differing conditions—at baseline, with 100% oxygen (FiO2) and 20 ppm iNO and with test occlusion of the PDA.

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Authors and Affiliations

  1. University of Tennessee Health Science Center, Memphis, TN, USA

    Ranjit Philip, B. Rush Waller, Sandeep Chilakala, Brittany Graham, Leah Apalodimas, Jorden Cunningham & Shyam Sathanandam

  2. LeBonheur Children’s Hospital, Memphis, TN, USA

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

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Philip, R., Waller, B.R., Chilakala, S. et al. Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 41, 100–108 (2021). https://doi.org/10.1038/s41372-020-00772-2

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